Monday, October 29, 2012

Anxiety Disorders

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.
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.
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).

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).
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 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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