Anxiety is a condition which is characterised by psychological response to an unpleasant or threatening situation. Mild to moderate levels of anxiety does not affect the performance of the patient as it ensure appropriate action is taken. However, excessive or prolonged symptoms of anxiety can be disabling, lead to high stress and cause much impairment to social functioning. However, as the anxiety level increases beyond acceptable or tolerated levels, the performance declines.
The Common Anxiety Disorders
Symptoms Common to all Anxiety Disorders:
Fear or worry, sleep disturbances, concentration problems, dry mouth, sweating, palpitations, GI discomfort, restlessness, shortness of breath, avoidance behavior
Generalized anxiety disorder (GAD):
Persistent (free floating), excessive and inappropriate anxiety on most days for at least 6 months. The anxiety is not restricted to a specific situation
Panic disorder (with or without agoraphobia):
Recurrent, unexplained surges of severe anxiety (panic attack). Most patients develop a fear of repeat attacks or the implications of an attack. Often seen in agoraphobia (fear in places or situations from which escape might be difficult)
Social phobia (or social anxiety disorder):
A marked, persistent and unreasonable fear of being observed, embarrassed or humiliated in a social or performance situation
In this type, there is persistent fear that is excessive or unrealistic, precipitated by the presence (or anticipation) of a specific object or situation (e.g. flying, spiders). Sufferers avoid the feared object/subject or endure it with intense anxiety
Post-traumatic stress disorder (PTSD):
Can occur after an exposure to a traumatic event which involved actual or threatened death, or serious injury or threats to the physical integrity of self or others. The person responds with intense fear, helplessness or horror. Sufferers can re-experience symptoms (flashbacks) and avoid situations associated with the trauma. Usually, occurs within 6 months of the traumatic event
Obsessive-compulsive disorder (OCD):
Persistent thoughts, impulses or images (obsessions) that are intrusive and cause distress. The person attempts to get rid of these obsessions by completing repetitive time-consuming purposeful behaviors or actions (compulsions). Common obsessions include contamination while the compulsion may be repetitive washing or cleaning
Causes Of Anxiety Disorders
Anxiety is commonly precipitated by stress but vulnerability to stress appears to be linked to genetic factors such as trait anxiety. Many patients presenting for the first time with anxiety symptoms have a long history of high anxiety levels going back to childhood. Anxiety may also be induced by central stimulant drugs (caffeine, amphetamines), withdrawal from chronic use of central nervous system depressant drugs (alcohol, hypnotics, anxiolytics) and metabolic disturbances (hyperventilation, hypoglycemia, thyrotoxicosis). It may form part of a depressive disorder and may occur in temporal lobe lesions and in rare hormone-secreting tumors such as phaeochromocytoma or
Apart from the psychological symptoms of apprehension and fear, somatic symptoms may be prominent in anxiety and include palpitations, chest pain, shortness of breath, dizziness, dysphagia, gastrointestinal disturbances, loss of libido, headaches, and tremor. Panic attacks are experienced as storms of increased autonomic activity combined with a fear of imminent death or loss of control.
Diagnosis Of Anxiety Disorders
In patients presenting with symptoms and clinical signs of anxiety, it is important to exclude organic causes such as thyrotoxicosis, excessive use of stimulant drugs such as caffeine and the possibility of alcoholism or withdrawal effects from benzodiazepines. However, unnecessary investigations should generally be avoided if possible. Extensive gastroenterological, cardiological and neurological tests may increase anxiety by reinforcing the patient’s fear of a serious underlying physical disease.
Treatment for Anxiety Disorders
Treatment for anxiety disorders often requires multiple approaches. The patient may need short-term treatment with an anxiolytic, such as a benzodiazepine, to help reduce the immediate symptoms combined with psychological therapies and an antidepressant for longer term treatment and prevention of symptoms returning.