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Anxiety Disorders

Anxiety Disorders is also known as mental health problem. It is inseparable part of human response to any stress situation. It is a subjective feeling of heightened tension and diffused uneasiness. It is to be distinguished from fear in that it lacks a specific object.

The main features of anxiety disorders are persistent irrational worries which are accompanied by physical symptoms. There are subjective feelings of worry and apprehension where a person anticipates danger, misfortune and calamity.

There are behavior disturbances such as restlessness, irritability and insomnia. Somatic complaints such as sweating shortness of breath, chest pain, paresthesia, headache and diarrhea may be present.

There is often some degree of depression and the person may have mood changes (ranging from uneasiness to panic), troubled thinking, sleep disturbances and even delusions.

Anxiety Disorders

It may be manifestation of some physical problems, psychiatric problem, drugs and alcohol abuse.

Classification of anxiety disorders

These are classified as follows:

1. Anxiety states – Panic, Generalized anxiety disorder, OCD and Post traumatic stress.

2. Phobic disorders – Agoraphobia (with or without panic attack), Social phobia and Simple phobia

Aetiology

1. Genetic – There is higher incidence of illness in the relatives of the patients compared to general population. A greater concordance of disease in monozygotic twins as compared to dyzygotic twins has been demonstrated.

2. Neuro chemical abnormalities – Neurotransmitters are associated with neither anxiety disorders nor epinephrine, serotonin and gamma amino butyric acid (GABA). Abnormal functioning of GABA receptors has been implicated in anxiety disorders.

3. Environmental factors – These play important role in anxiety disorders. It develops as a defense mechanism against pressure from outside and within.

Aspects of anxiety disorders

These range from psycho pathological symptoms (inner unrest and tension) psycho-motor symptoms to autonomic symptoms (facial pallor, sweating, and tachycardia, dryness of mouth anorexia, insomnia, hyperglycemia and hypertension).

Clinically the response to anxiety and fear is almost identical. The bodily changes that accompany these changes are designed to prepare the body for emergency action. Under the influence of epinephrine, the heart beats more rapidly, respiration deepens and the arterial pressure rises. Glycogenolysis is accelerated and the blood glucose levels rise.

Patient looses appetite and is unable to concentrate. Hands are clammy and sweating. Frequency of urination increases. The bowel activity is disturbed. Skin may reflect changes such as vaso- constriction, vaso dilatation, and increased pilomotor activity (Blushing, sweating, pruritis and urticaria).

In sum total anxiety involves almost all the major organs in the body producing a varied picture of stress. The Hamilton Anxiety rating scale (HARS) lists important aspects of anxiety while COW anxiety rating scale is helpful in making a diagnosis.

It is an important factor in directing an individual’s attention to a particular part of the body and to perceive sensations that earlier on were below the level of consciousness. For most anxious patients the bodily focus may be on cardiovascular system.

These patients have chest pain, substernal discomfort, pounding of heart and palpitations while symptoms of hyperventilation mimic those of other clinical conditions, organic or functional.

Symptoms of hyperkinetic heart

1. Fatigue

2. Pericardial pain

3. Palpitations

4. Giddiness

5. Dizziness

6. Cold hands and feet / sweating

7. Sighing

8. Anorexia / weight loss

9. Tremors

10, Poor concentration and retention

Symptoms of Hyperventilation

1. Fatigue / weakness / exhaustion

2. Shortness of breath / chest pain / dryness of the mouth

3. Dizziness I Numbness I Tingling

4. Palpitations I Pericardial pain

5. Aerophagia / epigastric pain

6. Tremors / Muscle pains and cramps

7. Tension / Insomnia I Night mare

HAMILTON ANXIETY RATING SCALE

1. Anxious Mood: Worries, anticipation of the worst, fearful anticipation, irritability.

2. Tension Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feeling of restlessness, inability to relax.

3. Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.

4. Insomnia: Difficulty in falling asleep, broken sleep, unsatisfying sleep, and fatigue on waking, dreams, nightmares, night terrors.

5. Intellectual: Difficulty in concentration, poor memory.

6. Depressed Mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, and diurnal swing.

7. Somatic (Muscular): Pains and aches, twitching, stiffness, cyclonic jerks, grinding teeth, unsteady voice, increased muscular tone.

8. Somatic (Sensory): Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.

9. Cardiovascular symptoms: Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, sighing, dyspnea.

10. Respiratory symptoms Pressure or constriction in chest, choking feelings, sighing, dyspnea.

11. Gastrointestinal symptoms: Difficulty in swallowing, wind, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, looseness of bowels, loss of weight, constipation.

12. Genitourinary symptoms: Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.

13. Autonomic symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, rising of hair.

14. Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing etc.

COVI ANXIETY RATING SCALE

0 = Not at all; 1 = somewhat; 2 = moderately; 3 = considerably; 4 = very much

Verbal import: Feels nervous, shaky, jittery, jumpy, suddenly scared for no reason; fearful, apprehensive, tense, or keyed up; has to avoid certain things, places, or activities because of getting frightened; finds it hard to keep mind on task.

Behavior: Appears frightened, shaking, restless, apprehensive, jumpy, and jittery.

Somatic symptoms of anxiety disorders: Unjustified sweating, trembling; heart pounding or racing; trouble getting breath; hot or cold spells; restless sleep; going unjustifiably more frequently to bathroom; discomfort at pit of stomach; lump in throat.

• Total score is obtained by the addition of scores for each item.

• Mean score in anxious patients is between 6 and 8.

• Mean score in anxious depressed patients is between 4 and 6

Treatment

A case of anxiety disorders should be reassured and a treatment plan established. Counseling of the patient is essential and to a patient with somatic complaints, assurance about the condition be given after thorough investigations and excluding any organic ailment.

Of the drugs, Benzodiazepines are the drug of choice because of their efficacy, less sedation and adverse effects. Alprazolam in the dose of 0.25 mg twice a day is given. This drug is effective with somatic complaints. Tricyclics such as Imipramine and clomipramine are also useful.

Check out the video below on anxiety disorders

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