Wednesday, January 30, 2013

Anxiety Disorder

What is anxiety?
Anxiety is an unpleasant state of fear that manifests externally through various symptoms and signs, and can be a normal or exaggerated response to certain stressful world we live in, but can also be a pathological response and produced by abnormal variety of medical and / or psychiatric.
Although usually speaks of anxiety and distress as equivalent terms, are not really the same, so that the first is related more to the psychological inner feeling of discomfort and distress with bodily outward manifestations that accompany anxiety.

How does it manifest anxiety and what causes it?
Anxiety can occur chronically, as a personality trait present for most of the individual's life ("GAD") or as cut-intensive episodes. These episodes that cause feelings of impending doom ("thanatophobia"), or fear of going crazy ("manifobia") are the "panic attacks", "panic" or "panic attacks" and are the "panic disorder or panic. "
The difference, therefore, between the "generalized anxiety disorder" and "anxiety or panic" is based on that in the first patient continually unwell, whereas panic disorder, the subject is perfectly fine between crises. In addition, many people who suffer panic attacks often develop a fear or dread a repetition progressive, appearing then called "anticipatory anxiety".
As for the causes, we speak of primary and secondary anxiety.
In primary anxiety found no cause that justifies the table, while the secondary is always due to another disorder (drug and alcohol, amphetamines and cocaine, hyperthyroidism, etc.

What are the characteristics of "generalized anxiety disorder?
These patients are characterized by a constant state of hypervigilance and hyperactivity of the nervous system as well as a state of constant motor voltage.
The picture is more frequent in women than in men.
It is related to chronic stress situations.
According to WHO, to say that a patient has a "generalized anxiety disorder", you must have the following symptoms most of the day for 2-3 consecutive weeks:
Muscle tension manifested by headache, inability to relax, restlessness and difficulty sleeping.
Autonomic nervous system hyperactivity manifested by sweating, palpitations, upset stomach, shortness of breath and dry mouth.
Apprehension, worry, and difficulty with attention and concentration.

What are the characteristics of "panic disorder?
Introduction of one or more panic attacks have been unexpected, namely that have not been displayed immediately before or during exposure to a situation that almost always causes anxiety, and have not been triggered by situations in which the individual has been the focus of attention of others.
At least the presence of four crises over a four week period, or one or more attacks followed by persistent fear of another attack present for at least a month.
At least four of the following symptoms for any of the crisis:
Shortness of breath or choking sensation.
Dizziness, unsteadiness or loss of consciousness.
Palpitations or increased heart rate.
Trembling or shaking.
Nausea or abdominal discomfort.
Feeling of not recognizing our own body or "derealization".
Numbness of hands.
Chest pain.
Fear of dying.
Fear of going crazy or losing control.
In some of these crises, at least four of the above symptoms have emerged rapidly and increased in intensity during the 10 minutes of the onset of the first symptom.
Unable to establish the existence of other pathology or organic factor explaining the picture.
Panic attacks usually last between 5 and 30 minutes, rarely more.
The disorder is more common in women and usually begins between 20 and 30 years.
Some patients develop secondary dependencies to alcohol or anxiolytic drugs.
It is often associated with agoraphobia (fear of being in places or situations where escape is difficult and many people concentrate.
It is currently one of the most frequent reasons for consultation in emergency departments, and frequent cause of admission.

What other processes can confuse anxiety attack?
With medical disorders that sometimes occur with sympathetic nervous system hyperactivity: myocardial infarction, stroke, epilepsy, pain, hypoglycemia, toxic tables, etc..
Anxiety or fear as a psychological reaction to physical discomfort or significant life circumstances in the person's life (as possible from an incurable disease).
Abuse of drugs and toxic substances (caffeine, cocaine, cannabis) or pictures of them abstinence (primarily alcohol and opiates like heroin).
Crisis of anxiety as a symptom of a major psychiatric illness: psychotic disorders or mood disorders in subjects who have been abused.

What to do when a "generalized anxiety disorder?
First go to the general practitioner to rule out physical problems that are causing this disorder. This will scan the patient and carried out blood tests and an electrocardiogram. It may also be useful the determination of thyroid hormones and glucose levels.
In cases where there are no other causes, patient calm concerns explaining the picture and saying "There's nothing wrong."
It is necessary to keep a healthy lifestyle while avoiding alcohol and coffee.
Use techniques or relaxation and yoga courses can be very useful, especially in patients with high voltage motor.
In case of persistent box must control the symptoms with medication: anxiolytic substances such as benzodiazepines, low dose, with regular and temporary suspensions depending on the patient's improvement.

What to do about a "crisis of anxiety or distress?
In the emergency room should be provided with the patient lying down relaxing on the couch, inviting you to close your eyes, breathe deeply and slowly, and trying not to think about anything.
While blood tests will be done to rule out other possible causes.
If we are witnessing a crisis with hyperventilation (the subject breathes a very fast), it may be helpful to place a plastic bag or glove over your nose and mouth to breathe in an atmosphere rich in CO2. This operation will occur all over the head uncovered and provided with plastic bag to observe and see the patient's face (may vomit or acquire a bluish hue that can indicate a more serious).
Anxiolytic medication is useful for cutting the crisis. Benzodiazepines are commonly used orally at low doses, Diazepam or Clorazepam type.
The patient was informed that suffers a panic attack and that his life is not in danger.
Once the emergency situation, patients will be referred to control your GP to decide, according to evolution, to refer to a psychiatrist. If repeated crises will require a background treatment with antidepressants.

What are phobias and what are its characteristics?
They are a group of disorders in which anxiety appears only in certain well-defined situations, for example take the lift, public speaking, traveling by subway, etc. In young children are very common as a derivation of his childhood fears, rarely needing treatment. The defining characteristics of irrational fear that occurs in phobias are:
Is disproportionate to the situation that creates it.
It can not be explained rationally. The patient himself is no explanation for their behavior.
The subject tends to avoid the phobic situation.
This situation have approximately 0.5 to 2% of the population, and 65% female. Predisposing factors are the existence of separation anxiety during childhood and the sudden loss of a loved one. Most phobias appear in childhood resolve spontaneously. However, occur or persist into adulthood typically require for submission antidepressants and behavioral therapy.

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