- What are the Symptoms?
- How Long?
- Any precipitating cause or factor
- Family history
- Is it aggravating?
- Is it primary or secondary?
- If secondary, what is the present medical disease?
- Anxiety is defined as a subjective sense of unease, dread or foreboding, and may be a
primary psychiatric condition or component or reaction to any medical disease.
Different forms of Anxiety are Panic disorders with intense fear with many physical symptoms. (Palpitations, sweating,
trembling, shortness of breath, chest pain, dizziness, fear of death.)
- May be self-limiting up to 1 hour. Frequency & severity may vary.
- Its diagnosis is done after ruling out medical conditions related to cardiovascular,
respiratory, endocrine & neurological disorders by selective investigations related to
symptoms like blood tests Xray chest ECG,
Endoscopy..etc.(Thyrotoxicosis,Pheochromocytoma,Hypoglycemia..e tc)
- 75% of panic disorders are found to suffer from depression at some point of their illness
- Cause is unknown but genetic predisposition and autonomic responsibility may play a part.
They are found to have heightened sensitivity to somatic symptoms which triggers the
arousal.
- This forms the base of Cognitive Behavioral Therapy which teaches patients to alter the
cognitive interpretations of anxiety producing experiences.
- It is a hypothesis that these individuals have a neuronal circuit which gets stimulated by
certain stimuli involving nor adrenergic & serotonergic neurons. The cornerstone of drug
therapy aims at
- correction of depression
- immediate relief of panic symptoms.
First group of medicines take 2 to 6 weeks to become effective, hence should
be taken regularly for 3 to 6 months. Second group of medicines give rise to dependence,
hence should be used for short duration.
- In addition to CBT, described above, breathing techniques are found to be helpful
Generalized anxiety Disorder (GAD) is the presence of persistent, excessive, unrealistic
worry, causing muscle tension, impaired concentration, insomnia , restlessness or autonomic
arousal.
- History of childhood fear or inhibition may be present
- 80% of GAD suffer from depression.
Phobic disorders- are manifested as marked & persistent fear of objects or situations which
lead to immediate anxiety reactions. Patients avoid the phobic stimulus which impairs their
occupational or social functioning. Common examples are fear of closed spaces
(claustrophobia), fear of flying (aerophobia)and fear of blood.
- CBT forms a cornerstone to correct distorted perception & interpretations of fear producing
stimuli.
- Individual & group therapy, desensitization therapy (gradual exposure to feared situations
to face & alter the responses.) are found to be useful.
Stress disorders are often observed after exposure to extreme traumatic conditions like
injury, threat to self or others or death of loved one. The person’s response is fear,
helplessness, horror. They may arise as acute or delayed. This may manifest as distressing
recollection of events, dreams of events, actually living the event again & again, avoiding
stimuli associated with trauma,etc. The stress disorders are usually self-limited & need
short duration anxiolytics & supportive- expressive psychotherapy