ANXIETY

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What is Anxiety?

It is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.

How it develops?
It develops through the activation of the sympathetic nervous system preparing the human beings (and all animals) to “fight or flight”.


The activation of the sympathetic nervous system will cause over activity of several systems in the body which will manifest in several symptoms E.g.:
Increased heart rate, increase respiration, increase muscle tension, sweating, decrease in skin blood flow, hyper arousal, hyper vigilance, constipation and delay emptying of the urinary bladder. Anxiety

Is anxiety abnormal?
NO
Anxiety is considered to be a normal reaction to stress. It may help a person to deal with a difficult situation, for example at work or at school, by prompting one to cope with it.

Would anxiety be abnormal?
Yes

  • when anxiety becomes more than it should be,
  • lasting longer than it should be,
  • And without a reason.
  • When it interferes with function.

So we have two types of anxiety one which helps us to survive and one that makes as suffer.

When we know we are suffering from generalized anxiety disorder (GAD)?
We are suffering from pathological anxiety when we experience the followings:

  • Difficulty in concentrating
  • Fatigability
  • Sleep disturbance
  • Restless feeling
  • Irritability
  • Muscle tension
  • Significant impairment in social, occupational, or other areas of functioning

The above symptoms are:

  • For at least 6 months (chronic) about a number of events and activities (e.g. money, job security, marriage, health)
  • Difficult to control the worry
  • Three or more of the following six symptoms (only one for children):
  • Not due to a General Medical Condition or substance use.

Anxiety can be accompanied by physical effects such as heart palpitations, fatigue, nausea, chest pain, shortness of breath, stomach aches, or headaches. Blood pressure and heart rate are increased, sweating is increased, blood flow to the major muscle groups is increased, and immune and digestive system functions are inhibited (the fight or flight response). External signs of anxiety may include pale skin, sweating, trembling, and pupillary dilation.

There are many emotional manifestations like apprehension or dread, trouble concentrating (leading to memory impairment), feeling tense or jumpy, anticipating the worst, irritability, restlessness and expecting the worst.

One of the worst felling in anxiety is depersonalization (I am not my self) and derealization (the surroundings are not the same).

What Causes Generalized Anxiety Disorder?
The exact cause of GAD is not known, but a number of factors may play a roll like:

  • Genetics: the incidence of GAD is higher in some families, but that may be not due to the genetic factors alone, but to the family dynamics.
  • Neurotransmitters: like nor epinephrine and serotonin.
  • Stresses: chronic stress and stressful life events will predispose to GAD.
  • The use of and withdrawal from addictive substances, including alcohol, caffeine and nicotine.

How common is GAD?
It is very common as a mater of fact it is the commonest psychiatric disorder accruing in about 17% of the population.
Women are affected twice as common as men.
And it does happen in children.

Would GAD be confused with other disorders?
Yes

Because people with GAD experience a lot of physical symptoms lots of times they are thought to have an organic illness; and most commonly they think they have either:

  • Cardiovascular problems like angina, MI, hypertension.
  • CNS problems like TSI, migraine, lumbosacral problems
  • Metabolic problems like hyperthyroidism, DM
  • substance abuse and withdrawal
  • GIT problems like ulcers.
  • Respiratory problems like asthma.
  • Urinary problems.

So we should think of anxiety when we don’t have organic explanations to the symptoms.

How do we manage GAD?

  1. Exclude organic causes: like hyperthyroidism and other hormonal disorders, heart problems, metabolic disorders like diabetes and substance abuse.
  2. Cognitive-behavioral therapy: in which you learn to recognize and change thought patterns and behaviors that lead to troublesome feelings. In addition, relaxation techniques, such as deep breathing and biofeedback, may help to control the muscle tension that often accompanies GAD.
  3. Medication: several group of drugs are used like:
    • Tricycles antidepressants.
    • Monoamine oxidase.
    • Specific serotonin reuptake inhibitors (SSRIs).
    • Noradrenalin serotonin reuptake inhibitors (NSRIs).
    • Benzodiazepines. They are used for short time and they are addictive drug and should be avoided in the long treatment of GDA
  4. there are some measures that may help like:
    • Stop or reduce your consumption coffee, tea, cola and chocolate.
    • Exercise daily and eat a healthy, balanced diet.
    • Seek counseling and support after a traumatic or disturbing experience.
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