Doctors somatic specialties ...

Physicians somatic specialties, patients with somatic symptoms of anxiety usually receive therapy aimed at correcting the physiological function and symptoms (Fig. 2), often in the form of polypharmacy. For example, in the U.S. in 1999 for treatment of anxiety disorders was spent 42.3 billion dollars, more than half of the cost falls on drugs that do not belong to the category of psychotropic [32]. However, since the psychopathology, usually remains undetected, this therapy is not effective enough. Simultaneously, these patients are understandably rarely seek psychiatric help. Thus, patients with GAD and subsyndromal anxiety swell the ranks of patients who, on the one hand, rightfully unhappy with the results of treatment, and the other somatic professions are considered by doctors as "problematic." For example, among patients, physicians believed that "difficult" for the diagnosis and treatment, 13% had GAD, and this diagnosis was only 9% of them [23]. Kane [42,43] revealed GAD in 26-63% of several hundred patients complained of typical angina, which, with the full survey (including coronary angiography) was proved by the absence of coronary artery disease, 25% were taking nitrates without effect and neither received therapy for GAD. Detection and Identification of comorbidity of GAD doctors nepsihiatrami leaves much to be desired, even in countries where this diagnosis is very firmly entrenched in everyday life. In Germany, general practitioners diagnosed only 34% of patients with GAD, although the depression reveals two times more efficiently [39]. Reasons for unsatisfactory diagnosis of GAD are numerous. These include lack of awareness of physicians about the GAD, the lack of time at the doctor, the frequent presence of other psychiatric disorders, undulating course of GAD, as well as the fact that the patients attributed their symptoms solely to the physical health and domestic reasons (for example, persistent difficulties in falling asleep patient GAD usually explains the chronic congestion on the job, etc.). "Household" explain their complaints prefer to give about half of patients with anxiety and this circumstance greatly affects the detection of anxiety disorders by physicians general medical practice [51]. In our country, the primary reason for the low detectability can be called a lack of familiarity of physicians with specialties somatic anxiety disorders. Many local psychiatrists traditionally considered GAD (especially with a predominance of somatic symptoms) in the "somatized depression or mixed anxiety-depressive disorders. In contrast, skepticism about foreign psychiatrists for independent nosological significance of GAD overcome [3.12]. Even the most general practitioners consider GAD and depression, as a variety of diseases [87]. The most frequent comorbid, ie occurring with GAD, mental disorders - a depression, social phobia and panic and posttraumatic stress disorder [41].