diease

Anxiety


OVERVIEW OF Anxiety :

It is  characterized by the unpleasant state,worrisome thoughts,avoidance and panic and nervous behaviour.


EPIDEMIOLOGY :

It account for 20-30 % of the cases foe stress


CAUSES :

Exposure to negative situations

Exposure to stressful environments

Genetics

Cultivating the habit of shyness and hesitations from childhood

Some systemic problems related to cardio vascular system,thyroid problems,arrythmias

Negative life events

Low self esteem.

Certain medications :

caffeine,steroids,amphetamine,salmetrol,theophylline,ergotamine,phenytoin.


PATHOPHYSIOLOGY :

Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol.

In the Central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the automic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.

The amygdala is central to the processing of fear and anxiety, and its function may be disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been implicated with expansion of dendritic arborization of the amygdaloid neurons. Potassium channels create inhibitory effects on action potential.

Increased anxiety levels leads to the higher amount of secreation of glutamate which in turn interferes with the brain function.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Generalized anxiety disorder:

Generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

Symptoms include:

Feeling restlessness

Easily fatigued

Staying away from the crowd

Irritation

Difficulty in concentration

Muscle tightness

Excessive worrying

Having sleep problems.

Panic Disorder:

      They tend to have recurrent panic  attacks.Panic attacks are sudden fear that comes into an act and reaches the peak within a minutes.These attacks can occur unexpextedly and also by triggering objects or subjects.

Symptoms:

Heart palpitations

Trembeling

Shortness of breathe

Trembling

Feeling of out of controls

Tremor

Chills

Peoples suffering from panic attacks usually tend to have the fear regarding the next attack.The fear might be regarding any places,persons,situations.This in long run can lead to agyrophobia.

Phobia related disorders:

it is an aversion to specific objects or place or situation.

Symptoms:

These people tend to worry /worry to encounter the next situations (phobic situations)

Take the necessary step to avoid the episodes of phobia

experience immediate anxiety / fear on encountering the objects which panics them.

Simple phobias:

Peoples tends to have fear regarding specific objects or specific situations.

Eg:flying, heights, fear to animals ,birds,  receiving injections and blood.

Social anxiety disorder: this is previously termed as social phobia. People with social phobia tend to have fear regarding the groups,social gatherings or social situations.they fear that their act would leads to the negatively evaluated by others and they fell so embrassed .they are mainly seen with social and school environments.

Agoraphobia:

the peoples tends to have fear with one or two of the following

Using public transport

Being in closed spaces

Being in enclosed areas

Standing in crows

Being outside of the home alone

Fear of strangers.

Separation anxiety disorder:this is more common among children but adults are also victim to it.

The person get fear of being separated from their attached ones.

 They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated

Selective mutism:

It is the rare form of anxious disorder.Inspite of having normal language skills peoples tends to get anxiety/fear in social situations.It occurs before 5 years of age and it is associated with shyness,embrassement,compulsive traits,hesitations and temper tantrums.


DIAGNOSTIC :

Psychological evaluation:

During this evaluation the specialist might ask you regarding the familial background of anxiety and some other questionnaire to rule out the etiology of anxiety.By this the specialist comes to know that if anyother associated mental health problems such as depression or substance misuse is present.

Comparing the symptoms with the DSM-5:

Many specialist uses the diagnostic and statistic manual  of mental disorders(DSM-5) to rule out the anxiety disorder.

Complete physical examination:certain illness, any medications,caffeine consumption and hormonal changes should be ruled out.

Zung self rating anxiety state:

It is an questionnaire that asks you to rate your anxiety from a little of the time to most of the time with topics such as nervousness,anxiety,shaling,rapid heart beat,fainting, frequent urination,nightmares.

Hamilton anxiety scale:

It involve s14 questionnaire that includes your mood sings,mental ,physical,behavioural traits.

Generalized anxiety disorder (GAD)scale:seven question test screening tool for GAD.It maily focuses on the duration of the illness.

Socio phobia inventory(SPIN):

It consists of 17 questions.the rate varies from zero to four.Zero indicates no anxiety and four indicates extreme anxiety.

 


TREATMENT AND PROGNOSIS :

Treatment:

Psychotherapy:

  This is other wise called as talk therapy.the patient is asked about the situations or objects which triggers them.

Cognitive behavioural therapy:

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy which aids the patient to reveal their anxiety and shows good results when compared to other therapies.. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects .

and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.It is conducted  as a group or as an individual and often home assignments are given.

Medications:

The medications does not provide any relief but they to relieve the symptoms in an individual suffering from anxiety.The medicines used to relieve the symptoms include anti anxiety drugs,antidepressant drugs and beta blockers.

Anti anxiety medications:

Symptoms such as worrying,panic attacks and extreme happiness are cured.

The medicines include benzodiazepines.they reduce the anxiety and main problem with this group of drug is tolerance is created.hence psychiatrist usually prescripe the drug for a shorter period of time.Withdrawal symptoms might also occur.Benzodiazepines are the best choice in reducing the anxiety when comparing to the other drugs.

Anti depressants:

These medications reduces the depression. On intake of these medicine they secrete some chemicals which leads to the difference in the mood status of an individual.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).Drugs such as Escitalopram,Fluoxetine,Sertraline are some of the examples of selective serotonin reuptake inhibitors.Duloxetine and venlafaxine are some of the examples of  serotonin norepinephrine reuptake inhibitors.

Beta blockers:

 Beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing.

Antiseizure medications:

Gabapentin,pregabalin and lamotrigine can be used to cease the seizure attacks.

Yoga:It calm down the mind and impart healthy lifestyle.


PREVENTION :

Avoid stressful situation

Limit the use of caffeine

Live a healthy lifestyle and have healthy diet practices

Practice yoga and medications and keep the mind calm.


Recovery Period :

The recovery period varies from individuals mental health.approximatelt it ll take 16-18 weeks for recovery and follow up of the treatment is must.

 


Medicines used in the Treatment :

Benzodiazepines,Gabapentin,pregabalin and lamotrigine can be used to cease the seizure attacks,

Drugs such as Escitalopram,Fluoxetine,Sertraline are some of the examples of selective serotonin reuptake inhibitors.

Duloxetine and venlafaxine are some of the examples of  serotonin norepinephrine reuptake inhibitors.

 


REFERENCE :

References: https://www.nimh.nih.gov/health/topics/anxiety-disorders/#pub2

http://cdc.govt.in

Davidson Principle of generak medicine 22nd edition

http://www.anxiety treatment.org