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What are they?
The following are six types; psychiatric
disorders in which anxiety is one of the most important symptoms. Anxiety is a
normal emotion in humans (and other animals) that fulfills an adaptive function,
ie good for something, prepares for fight or flight when it perceives a threat.
However, because the human being is more complex than animals, may experience
anxiety about many more situations than they, and what at first were adaptive
mechanisms, can lead to a serious obstacle to perform the activities of daily
living . The six types are discussed below (Generalized Anxiety Disorder, Panic
Disorder or Panic Attack, Social Phobia, Specific Phobias, Obsessive Compulsive
Disorder and Post Traumatic Stress Disorder) are the best known and studied but
many patients with panic disorder itself can not be included in these
categories and which, however, are subsidiaries of medical help.
Generalized anxiety disorder (GAD).
What is it?
The person with generalized anxiety
is almost uneasy all day, and for much of his life (though it takes at least
six months with symptoms to make the diagnosis). The patient with a TAG also
has a tendency to worry excessively about almost anything or, following any
minor detail, for example, after seeing a story on an accident or illness load
worried, all day for the possibility that a colleague has an accident, or
having a disease on which read something. Another hallmark of GAD is difficulty
sleeping because the bed is circling the concerns that have hovered in the head
all day. Other anxiety symptoms are muscle aches and headache (due to muscle
tension), sensation of breathing difficulty (dyspnea), nausea, dizziness and
sweating, (for vegetative nervous system hyperactivity or self, which is in
charge of preparing the individual for fight or flight to danger through
various reactions in different organs of the body), irritability, nervousness
and difficulty concentrating and paying attention to what is being done.
Treatment
In the pharmacological treatment of
GAD are often used benzodiazepines, some well known and consumed drugs
worldwide. They are anti-anxiety drugs that relieve anxiety shortly (minutes) to
take them, but its effect remains continuously only while enough of the drug
circulating in the blood. As long as they remain active in the body (which is
measured by the so-called half-life of the drug) is spoken; benzodiazepine, short
half-life, medium and long, and based on this and other features decides the
benzodiazepine most appropriate for each patient. Benzodiazepines are drugs
useful and quite safe but also have side effects and disadvantages, the main
disadvantage is that it can lead to dependence which forces, to close
supervision and care, especially when interrupt (after a period of several
weeks consumer can never be suddenly).
There are other alternatives to
treatment with benzodiazepines. Buspirone is an effective drug for the
treatment of some cases of anxiety that is not habit forming, cause sleepiness
or benzodiazepines, but takes a few days to start working (this phenomenon is
called latency of drug action ), and people who already have taken
benzodiazepines for anxiety on occasion may not appreciate a sufficient effect.
Also when there depressive symptoms (which, in fact, very often associated with
anxiety symptoms) may be associated with some antidepressant therapy, mainly
from the group of selective inhibitors of serotonin reuptake (SSRI) or
serotonin and of noradrenaline (ISRNS).
Other possibilities of treatment of
GAD are different psychotherapies, alone or in combination with medications, depending
on the severity. As with depression, the main types of therapy are dynamically
oriented and cognitive-behavioral. From a psychodynamic point of view, there
have been different approaches to understanding the phenomenon of anxiety.; Basically,
anxiety is understood as a product of the conflicts taking place in the
unconscious of the individual therapy by analyzing these conflicts to make them
aware, psychologically and resolve, thus stop producing anxiety. The cognitive-behavioral
approach aims to retrain the individual eager to learn how to control anxiety, to
recognize how to build and modify the ways of thinking that lead to their appearance.
Uses for it as relaxation techniques, stress management and feedback or "biofeedback"
(a technique in which through various instruments that measure physical changes
such as muscle tension etc., The patient learns to recognize the onset of
anxiety and control , watching normalize measured changes) and cognitive
therapy.
Crisis of anxiety or panic attacks
What is it?
In this type of anxiety disorder is
episodic (ie, is not constant as in the TAG), and the person who has suffered
anxious moments short (typically less than one hour) very intense and no
apparent trigger. The experience is the same as you have before a sudden and
serious threat, such as an assault face fierce etc. As in the rest of disorders
which have been exposed, panic reaction is, in principle, an adaptive response
in the animals, ie through one learns, for example, not to be one when a tiger
face has suffered panic at the sight. The problem in the case of the man who
suffers, panic disorder is that crises occur seemingly nothing to threaten
directly the subject. Experiencing a panic isolated on a sudden stressful
situation does not involve intense, panic disorder, and it is relatively normal.
But when crises recurring in nature are usually relatively normal. But when
crises recurring in nature often pathological.
An anxiety attack can be experienced
in many ways, but more often it is noted that hardly breathe, you feel chest
pain, tingling in the hands and feet, feeling of numbness around the mouth (parentheses),
muscle cramps and even and dizziness. All these symptoms "physical" are
accompanied by intense anxiety and the feeling that one is going to die or go
crazy soon. As these symptoms are very similar to those experienced when having
a heart attack, many people who have to go first emergency room of a hospital or
cardiologist, and is usually a doctor not a psychiatrist who explains that they
have suffered a panic attacks (usually usually indicate some additional
examinations before - electrocardiogram analysis often-negative result)., The
patient may worry about whether this "going crazy", which contribute
to other symptoms of this crisis like the feeling that one is not oneself (depersonalization)
or the reality that surrounds him is strange or changing (serialization). The
first thing to do in these cases is to reassure the patient, for although
crises are experienced as very threatening, actually no vital danger, and
indeed once triggered anxiety is compounded by the experience of those who , and
creates a vicious circle (the higher the more anxiety symptoms, and the more
anxious symptoms becomes the subject). Very often, that the anxious patient
hyperventilate (ie breathing faster than normal), and that this will cause
alterations in blood gases that produce symptoms.
A common problem of who has panic
attacks is that progressively avoiding the circumstances that led to believe
that, with what has just developed a phobia or agoraphobia places (this symptom
is explained below in section, of phobias) that can end up completely or partially
confine the subject in his home with an irrational fear of leaving the
protection provided by your home. At the end of a poor outcome may eventually
triggered also at home. However, there are effective treatments against panic
attacks and should never reached these extremes.
Treatment
Drug treatment is the benzodiazepines
mentioned above, which have the advantage of cutting the crisis shortly. Some
are taken or placed under the tongue and act very quickly, so that the person
suffering the panic attack can always carry in your pocket in case presents a
sometime. However, the most effective treatment, although in the longer term
are different antidepressants, as inhibitors of the reuptake of serotonin by a
mechanism of action independent of their antidepressant effect, able to control
seizures in a variable period of time some weeks. Typically, until it begins to
make the antidepressant effect is maintained after treatments with
benzodiazepines are withdrawn gradually to keep the antidepressant about six
months after the last crisis. Many people balk at the prospect of such a long
treatment, but clearly compensates be free of crisis. Also useful
psychotherapies (related to medication) that help individuals to feel control
over the situation by mechanisms that vary by type of therapy.
Phobias (agoraphobia, social phobia, simple
phobia)
What is it?
Agoraphobia is an irrational fear and
end of open spaces and crowded places such as department stores, public
transportation, in crowds, etc.; Like all phobias are a fear that the patient
considers excessive and irrational despite what they can not help feeling, and
when exposed to what they fear (the phobic stimulus) triggers a panic attack. The
problem of agoraphobia, as already said, is progressively prevents the subject
places, public transport, etc.. To the extent that, for example usual places
can go into a long path through which avoids large avenues, or go to the
workplace becomes an hour walk can not take the subway, in the end the severe
agoraphobic patient can stay confined to home, only to leave it in the company
of someone you trust.
The person with social phobia
experience symptoms of anxiety when exposed to situations where it is watched
by a crowd or a small group of people, so, for example, to the fact lecture, attend
a party or any other event social, the subject suffers from tachycardia, sweating,
tremor, anxiety and other symptoms described above. This leads the individual
to avoid such social situations and for that reason appears to others as
someone extremely shy, almost no speech or out. Treatment is similar to those
described for other phobias, although in these cases may be of use beta-blockers
(drugs used in cardiology generally) acting through inhibition of the
sympathetic nervous system response (one of those responsible for the symptoms
anxious) and thus help to control the individual's anxious response to these
social events.
In specific phobias phobic stimulus
is unique, for example, a person may have a phobia of dogs, another aircraft, another
of heights, etc., And can deal appropriately with daily life, if not exposed
their specific phobic stimulus. In many cases these people never consult their
disorder and is not a major constraint for them, until there is a change in
life (for example, a promotion that requires multiple air travel make a person
with phobia flying).
Treatment
The pharmacological treatment with
these benzodiazepines phobias usually done at the time of exposure to the
phobic stimulus accompanied by some form of specific psychotherapy. Behavioral
techniques are helpful and quick in its effect. The so-called systematic
desensitization involves presenting the patient to progressively more phobic
stimuli as being overcome fear (eg, in the first dog phobia could show a
picture of a dog, then a tape of a dog barking, then get closer distance to a
dog leash, etc.., ... to be able to touch and pet a dog loose). The technique
of flooding (which, for obvious reasons, is accepted by a smaller number of
patients than before) is suddenly present the phobic stimulus until the subject
as alive as the stimulus is not actually dangerous (for termination of his
anxiety response). There are other techniques. Also used psychoanalytic
psychotherapy type, although the effects of this are usually longer term, and
is more aimed at the subject understands why his phobia to eliminate within a
short period of time. Of course you can combine several types of therapy
according to each case.
Obsessive Compulsive Disorder (OCD)
What is it?
In OCD life of an individual may be
impoverished and trapped in endless repetitive behaviors and rituals. Rituals
and superstitions are widespread in humanity, and its purpose seems to be to
provide security and sense of control over life conditions that are
unpredictable. There are very superstitious person, they develop ritualistic
behaviors associated with random events, many of these people, if asked, they
will not know exactly why they do it, but still do not want to stop. Obsessive-compulsive
disorder is somehow an exaggeration to the limit of these behaviors. The main
symptoms of this disorder are obsessions and compulsions, terms that do not
mean exactly the same language in the colloquial psychiatric. In psychiatry, obsessions
are defined as thoughts that are intrusive and parasites, because who's got the
live as strangers, not intended and can not voluntarily give them up despite
considering them extremely unpleasant. However Compulsions are acts that makes
the person to get rid of anxiety produced by obsessions, and that although it
could avoid if he wanted, and in fact may be able to do, this will increase
both anxiety that ultimately ends up repeating compulsion again, despite
knowing that it makes no sense or rationality. For example, a patient may think
of his father as if he had died, this thought pops into your head repeatedly, even
though he knows that his father is alive and healthy, and not consciously want
any harm to him (obsession) , to avoid the thought comes into your head the
patient may, for example, begin to keep off the rays of the pavers, so he feels
that if his father die treads (compulsion). If asked about what he thinks and
does say it's all nonsense, who knows that her father will die if he stepped on
the stripes, but can not stop because, if he tries, the anxiety is so, that
ultimately ends up succumbing to the compulsion. Of course, within this
disorder's degrees (in the above example, from having to step on the lines from
time to time to go out, stay locked up in a room for fear of stepping on any
line, and its shadow brush one any wall stripe). They are very common
compulsions associated wash cleaning obsessions or compulsions of evidence (eg,
see if the gas has been closed or the door to leave the house countless times
to the point, take hours to terminate the verification task).
Treatment
Pharmacological treatment of OCD, is
usually done with specific antidepressants have proven effective in these
disorders (one tricyclic structure and practically all inhibitors of serotonin
reuptake), to which is sometimes added a particular type of benzodiazepines and
sometimes, if not the desired effect, other drugs such as neuroleptics or mood
stabilizers. For mild to moderate cases are useful psychotherapies cognitive
behavioral type also help to alleviate the most serious cases associated with
the above drugs.
Posttraumatic stress disorder (PTSD)
What is it?
As the name suggests this disorder
occurs after suffering an extremely traumatic event such as a major catastrophe,
an assault or an attack. Of course, any human being, having undergone intensive
stress presents an adaptive time, where they can be symptoms of anxiety and
depression that disappear gradually and although never forget what happened, you
learn to overcome it.; It is not easy to define where normalcy ends and begins
PTSD, (although surely this is not the most important, and the main task of the
psychiatrist, but the best way to help patients suffering from symptoms of PTSD
after major trauma and tragedies).
The symptoms of PTSD is primarily
anxious type, but also produce depressive symptoms such as sadness, feelings of
guilt for having survived, or for failing to prevent what happened, etc.. Are
characteristic sleep disturbances, insomnia and nightmares related to the
stressful event. There are also difficulties in concentrating, tendency to
relive the event in the form of vivid imagery (flashbacks or "flashbacks")
and recall the event after any stimulus that is associated (eg slam revives an
explosion, etc.). The likelihood of these symptoms depends on characteristics
of the person and what happened, and is less likely to occur if the victim can
do something after the disaster and help other victims, participate in the
salvage, after an earthquake, etc. PTSD occurs most likely after aggression and
acts of human cruelty, that after natural or accidental traumatic events.
Treatment
Treatment requires crisis
intervention (to avoid) and supportive psychotherapy and other. The
pharmacological treatment of anxiety symptoms usually done with benzodiazepines
and antidepressants if needed. For treatment of flashbacks or "flashbacks"
are used mood stabilizers.
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anxiety disorders
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