Hello. My name is Dr. Jonathan Shaywitz. I'm currently the Medical Director at Montare Behavioral Health. I have previously been the medical director of Cedar Sinai Anxiety Disorder unit, as well as the Medical Director of Glendale Hospital for Behavioral Health, as well as the Medical Director for Mission Hospital, as well as Mission VA Home in Laguna beach. I'm going to talk about anxiety and dyslexia and how they're related, and the medications that are used to help treat anxiety and other cognitive behavioral therapies as well. To start with, virtually everyone who is diagnosed as dyslexic, whether it's a Yale student an Uber driver, a physician, a middle-school boy or girl, a mom, or a retired senior citizen, comes with a full load of anxiety. In fact, it is rare to see a dyslexic who doesn't have any anxiety or for that matter, ADHD. It is important to be aware of the very common co-morbid conditions for they too must be recognized, diagnosed, explained, and treated if the dyslexic individual is to have an optimal outcome. Anxiety and ADHD so commonly occur along with dyslexia that it is critical that once someone is diagnosed as dyslexic, anxiety, and ADHD must be asked about. This is so important. Both anxiety and ADHD are well-described, well-delineated, and each can be treated effectively. In the following sections, we're going to review each of these conditions that commonly occur along with dyslexia. Let's start with anxiety and let's think about how we define it and also some of the symptoms. I'm going to talk about an individual. His name is Sam, and he is a second-year medical student, who was attending a prestigious school. He was diagnosed with dyslexia in middle school but struggled particularly with standardized tests in oral examinations. Sam was able to persevere due to his own resilience, but also because of the incredible support he had from his family, including his mother, father, two brothers. Sam remembers his long and sometimes arduous journey to get where he was. What makes a person who is dyslexic anxious? Basically, its uncertainty. For Sam, it made him so anxious not to know when he would be called on to read aloud or when he would have to go off to a special room to take his exams. He remembers the stares of the other children in middle school and high school while he took his examinations, all in a separate room with extra time. He remembers hearing his fellow classmates complain to the teachers. That's not fair, they would say, why does Sam get extra time and we don't? Sam couldn't comprehend this since he wished more than anything that he didn't need to take the extra time and could be like everyone else. He also remembers being told by one of his admissions counselors and this was unbelievable that he would never get into medical school. There were other good professions, the admissions counselor said to him, and he remembers one of his medical school teachers patronizingly imploring the rest of the class. Would someone please tell Sam what is going on? Sam, though, used all these comments for motivation. Sam was diagnosed with anxiety. Growing up, he was a shy child but had friends, wonderful childhood and at college, he was particularly in stressful situations. He experienced panic attacks and then doing these panic attacks, which lasted 15 minutes, often folks don't realize that panic attacks are fairly short in nature. He had a choking sensation. His heart was beating rapidly, which we call palpitations and he had a feeling of impending doom. He felt he was having a heart attack and was going to die. As you can imagine, what this felt like for him. But more than actually those symptoms, it was the anticipation of having these attacks made him even more anxious. Performance situations such as written or oral examinations would often trigger the panic attacks as we meeting individuals in social situations. Group, study projects, or oral exams or public speaking meet him so anxious that at times you would try to avoid these situations altogether, and when he couldn't avoid them, his anxiety would become so great that his hands would begin to tremble, he would sweat, and he would lose his focus and concentration. Then when his anxiety became so debilitating, Sam sought professional help from a psychiatrist, and through assist these discussions with the psychiatrist, and through reading, Sam learned that anxiety is a normal reaction to the stress and can actually be beneficial. In some situations, however, anxiety can be excessive, and while the person is suffering, may realize anxieties excessive, he may have difficulty controlling it, and it may affect negatively affect his day to day living. Sam was very interested in learning about what these disorders, and he learned that there's a spectrum of anxiety disorders, and that the spectrum of anxiety it includes social anxiety disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, and obsessive compulsive disorder. Sam was told that given his symptoms, he most likely had both social anxiety disorder and panic disorder. Particularly with social anxiety disorder he learned that it's the third most prevalent psychiatric disorder in the United States. This was something that he was quite surprised about. This social anxiety was third behind major depression, and alcoholism. In the diagnostic and statistical manual of mental disorders, we call it the DSM. It is characterized by one marked fear, anxiety, or avoidance of social interactions, and situations that involve being scrutinized or being the focus of attention as being observed while speaking, eating, or performing in front of others, and is also involved a fear of negative judgment from others. In particular, a fear of being embarrassed, humiliated, or rejected, or offending others. Terms of when it appears social anxiety, it often first appears in adolescents, and around 15 or 16 years of age. A great number of people are so affected by social anxiety disorder that they can not work, start, or maintain professional relationships, and there's also a high co-morbidity of social anxiety with major depression. Panic disorder is also common with a prevalence perhaps as high as two percent of the population like many anxiety disorders, it involves a combination of biological and environmental factors. The onset, unlike social anxiety, is often a little later in early adulthood or later adolescence, and panic disorder occurs more often in women than men. The core symptoms of panic disorder involves short, discrete periods of intense fear that's accompanied by somatic symptoms such as they're racing, heart, sweating, shortness of breath, and specifically, it is defined in the DSM as recurrent unexpected panic attacks, which involve an abrupt surge, a surge of intense fear, or discomfort that reach a peak within minutes and include four or more symptoms. These symptoms include palpitations, sweating, trembling, shortness of breath, feeling of choking, chest discomfort, nausea, lightheadedness, and a fear of losing control, numbness and chills. This is again one of the real like social anxiety where it's an intense scrutiny and fear of anticipation of going into these events, panic disorder. Often individuals not only as Sam did, not only fear the actual panic attack, but fear the anticipation of the attack occurring again.