Phobias can complicate medical procedures and can result in the refusal of necessary medical intervention or tests. Patients with cancer who have a history of obsessive- compulsive disorder may engage in compulsive behaviors such as hand washing, checking, or counting to such an extent that they cannot comply with treatment. For such patients, normal worry about the cancer diagnosis and prognosis can develop into full obsessive-compulsive symptoms and be severely disabling. This disorder is rare in cancer patients who do not have a premorbid history. Cancer patients who have post-traumatic stress disorder can become very anxious before surgery, chemotherapy, painful medical procedures, or dressing changes.
Anxiolytic medications given in preparation for treatment can foster adjustment and reduce distress.
Generalized anxiety disorder Generalized anxiety disorder is characterized by ongoing, unrealistic, and excessive anxiety and worry about two or more life circumstances. Some examples are patients' fears that no one will care for them even though they have adequate and willing social support and the fear of exhausting their finances even though adequate insurance and financial coverage is available. Frequently a generalized anxiety disorder is preceded by a major depressive episode. Poorly controlled pain Insufficient or as-needed pain medications. Abnormal metabolic states Hypoxia, pulmonary embolus, sepsis, delirium, hypoglycemia, bleeding coronary occlusion, or heart failure.