Anxiety

ANXIETY – definition

Anxiety is a chronic state of apprehension, a feeling that has the character of unpleasant anticipation, foreboding and uncertainty. Anxiety syndrome began to be recognized as an individual disease relatively late, at the end of the 19th century. The first scientific research reports contain more descriptions of physical/somato-vegetative symptoms than psychological ones, and these somatic signs could not be explained by physical illness but by the effects of an overstimulated nervous system, stress and fatigue. We all feel discomfort, fear, anxiety and tension at a certain period of our lives, which is desirable and useful in certain situations, because it allows an individual to overcome life’s challenges and leads to personality development. On the other hand, anxiety, which, due to its intensity or duration, disables and significantly reduces the quality of life, is a subject of interest in modern society.

CAUSES – etiology

The interaction of biological, psychological and socio-social factors in the development of anxiety disorders varies, both for infectious disorders and for each individual. Genetic predisposition, or heredity, confirms the role in the etiology of anxiety disorders. Biochemical factors, a decrease in 5-HT and GABA neurotransmission, as well as an increase in NA and DA transmission, are one of the chemical correlates of these diseases. Then, long-term exposure to stressful situations and long-term accumulation of stress often precede the development of panic attacks and phobic disorders. Also crucial are environmental factors in childhood, or parenting. Negative childhood experiences that have been imprinted on our personality limit us, hinder the development of our relationships and connections. On the other hand, children who were overprotected by their parents also have a predisposition to the later development of anxiety.

SYMPTOMS

Anxiety syndrome is manifested by numerous psychological symptoms, such as: constant worry about everyday activities, constant anticipation and expectation of unfavorable events, loss of energy and reduced concentration for performing usual activities, withdrawal, self-isolation, distancing from close people. On the other hand, numerous physical symptoms are also present, for example: palpitations and rapid heartbeat, sweating, muscle tension, shortness of breath, a feeling of tightness in the chest and suffocation.

RISK FACTORS

TRAUMA

Children and adults who have experienced a stressful event (rape, abuse, child neglect by parents, death of a close person, illness, traffic accident) have a higher risk of developing an anxiety disorder;

GENETIC FACTORS

hereditary predisposition increases the risk of developing anxiety;

LACK OF EMOTIONAL INTELLIGENCE

emotions are signs, so it is important to be able to “read” what they are saying, if we sabotage and stifle them or on the other hand analyze them too much and get into doubt, they can also lead to discomfort and unrest;

DRUGS AND ALCOHOL

massive use and abuse can cause and worsen anxiety;

OTHER MENTAL DISORDERS

anxiety occurs as a symptom of other illnesses, such as during depression;

‍

ANXIETY DISORDERS

GENERALIZED ANXIETY DISORDER (F41)

Generalized anxiety disorder is characterized by persistent anxiety and worry, which is not related to external circumstances, but is exclusively a “floating” fear. The patient is unable to control emotions, due to excessive fear and worry, which lasts for weeks or even months, and significantly affects the quality of life and daily functioning.

GAP is the most common among anxiety disorders, its etiology is usually unknown and the cause is difficult to detect. About 2/3 of patients are women. It is most commonly found in divorced and widowed people, housewives and unemployed people, and in urban areas, where the pace of life is significantly faster.

The intensity of symptoms varies during the day, although in the evening hours before bedtime they can be severe and cause insomnia, which further affects the quality of life and the performance of daily activities the next day.

If the disorder is not treated, it can become chronic. About 25% of people with GAP develop panic disorder.

OBSESSIVE-COMPULSIVE DISORDER (F42)

Obsessive-compulsive disorder (OCD) is a type of neurosis, belonging to the anxiety disorders, and the main characteristics are repetitive compulsive thoughts and compulsive actions, which are unpleasant, occur against their will and the person experiences them as their own. What distinguishes OCD from other anxiety disorders is the fact that fears are associated with repetitive, unwanted and intrusive unpleasant thoughts – obsessions and compulsive actions.

Three clinical forms are possible:

1. Presence of only compulsive thoughts;

2. Presence of only compulsive actions;

3. Presence of both compulsive thoughts and actions – found in 80% of patients

In order to fully understand OCD, we need to distinguish it from ordinary fear and worry. For example, someone may think that they did not turn off the stove or iron or left the apartment unlocked, although somewhere in themselves that person knows that they did it, but in order to calm their thoughts, they have to go back and check if the action was done. Very often, this certain number of repetitions is repeated more and more, and behind this is the unrealistic idea of the patient that in this way they will “prevent” the disaster. In practice, the most common obsessions are related to: infections and cleanliness, details and symmetry, death, loss of control, sexual and aggressive content

Diagnosis and differential diagnosis:

The diagnosis is made based on the presence of obsessive thoughts and/or compulsive actions, which are a source of suffering and the patient’s inability to perform everyday activities.

OCD should be differentiated from mental disorders such as:

· Schizophrenia

· Depressive disorder

· Tourette’s syndrome

PANIC DISORDER (F41)

Panic disorder is characterized by frequent panic attacks, associated with constant worry about whether and when the attack will occur again, and avoidance of activities that may trigger an attack.

The incidence of panic disorder is 2 to 4% in the general population at some point in life. It is twice as common in females. It occurs in late adolescence and early adulthood.

Panic disorder is manifested by:

· Recurrent, unpredictable panic attacks, which are a specific type of anxiety, accompanied by various physical symptoms, such as rapid heartbeat or palpitations, tremors, shaking, shortness of breath, sweating, dry mouth, chest pain or discomfort;

· Patients feel a strong and very intense fear or discomfort between panic attacks;

· almost always accompanied by a secondary fear of death, loss of control and reason;

· half of patients develop agoraphobic behavior – they avoid places and situations that they think are a potential cause of the attack, fearing the outcome of the situation and whether the environment will understand them and accept their current state;

A person who has panic attacks is not mentally ill, nor mentally ill, but has a certain problem, with which he or she currently does not know or cannot cope.

A panic attack occurs suddenly and abruptly, usually lasts 10 to 30 minutes, with the peak reaching in the first 5 to 10 minutes. Patients usually see a doctor immediately, because the physical symptoms are very pronounced and most often think that the illness in question is a physical illness, such as a heart attack, stroke, or it all depends on which physical symptom is the most pronounced. The doctor’s duty is to take a precise history, perform a physical examination, do an ECG and check thyroid hormones. If there is no pathological element, or disease, it is important to diagnose panic attacks and give a referral to a psychologist and/or psychiatrist. But the most important thing is to provide the patient with adequate help and to promptly return to their daily routine step by step.

Panic disorder should be distinguished from physical diseases such as endocrine (hormonal), cardiac, pulmonary or neurological.

POST TRAUMATIC STRESS DISORDER(F43)

Post-traumatic stress disorder is an anxiety disorder and occurs as a delayed or prolonged reaction to a stressful event, such as natural disasters, exposure to torture, rape, war events, terrorism, and includes intense fear, fright and helplessness. A person does not necessarily have to survive a dangerous event to get sick. Also, the sudden unexpected death of a loved one can cause upheaval.

The risk of contracting PTSD after a stressful event is about 8% for men and about 20% for women.

The clinical picture and symptoms are possible immediately after the stressful event, several weeks later or even several years.

Symptoms of re-experiencing a stressful event (flashbacks)

a) The patient feels or behaves as if the event is currently happening (through the feeling of re-experiencing the trauma, illusions, hallucinations), in a particularly vivid and disturbing way;

b) Present daydreams, dreams and nightmares;

c) Intense discomfort when exposed to internal or external stimuli

Symptoms of avoidance of events or circumstances related to the trauma

a) Efforts to avoid thoughts, feelings or conversations related to the trauma

b) Emotional apathy, feeling of numbness, disconnectedness with emotions

c) Feeling of alienation

Symptoms of overexcitement (hypersensitivity):

a) Difficulties with sleeping

b) Irritability

c) Difficulties with concentration

A detailed assessment and analysis by a psychiatrist together with a psychotherapist decides on the type of therapy, whether psychotherapy alone is possible or whether drug therapy is also included.

PHOBIAS (F40)

A state of irrational fear of a specific object or situation. The fear and apprehension interfere with daily activities, work or relationships, causing mental distress. People suffering from phobias avoid situations or objects that cause discomfort and anxiety. The prevalence of agoraphobia is 2.7-5.8%, social phobia 1.2-2.2%, and specific phobias 4.5-11.8%.

Manifestations

a) Agoraphobia (Greek: Agora-trg)

It is a fear of open spaces and crowds, closed spaces with many people, travel or any other situation where self-isolation, or escape from one’s own home, is not possible. It manifests itself in a classic panic attack, or the inability to self-control one’s emotions. The main characteristic is the avoidance of places or situations that cause them anxiety and fear, which significantly affects the quality of life. People who suffer from agoraphobia often carry medication, amulets and insist on being accompanied by a person who gives them security.

c) Specific (isolated) phobias

They are limited to narrowly specific situations.

They are:

1. Animal phobias

2. Phobias of natural phenomena (heights, weather, water)

3. Phobias of blood/injections/injury

4. Phobias of situations (transport, elevators, bridges, clowns)

The most favorable prognosis is for social phobia, then for agoraphobia with panic disorder, and then for specific phobias.

DIAGNOSTICS

In order to rule out the occurrence of a physical illness, the general practitioner should first recommend laboratory tests and analyses. If the physical examination is negative, the diagnosis is made by a psychiatrist and psychologist.

Long-term conversations and sessions with a psychologist/psychiatrist, psychological tests and questionnaires, insight into negative feelings and thoughts, as well as symptoms in order to establish an accurate diagnosis of the disorder.

TREATMENT

PSYCHOTHERAPY

the method of choice for the prevention and reduction of any type of anxiety disorder. Choosing a psychotherapist is not an easy task and it is quite okay if someone does not suit you at first and you change it and look for an adequate person for you, the most important thing is not to give up and be persistent in your goal, because it is a process, like everything else in life. Psychotherapy is a process in which we discover personal, painful and intimate things, therefore we strive to feel safe, understood and accepted. The psychotherapist should provide support and help the patient to become psychologically resistant to stress and to be more effective in everyday life and in relationships with others. Also, in order to learn more about ourselves, our emotions and the way we express them, and with the help of certain tools to establish control over emotions.

PHARMACOTHERAPY (DRUGS)

Drugs can be used to regulate and neutralize symptoms and feelings of tension and anxiety. The most common and most effective treatment for anxiety disorders is a combination of drugs and psychotherapy methods. Research and practice have shown that antidepressants from the SSRI group (selective serotonin reuptake inhibitors), or tricyclic antidepressants, have the best effect, which are prescribed for a period of six months to a year.

Side effects of antidepressants are:

o Dizziness;

o Nausea;

o Dry mouth;

o Sleep problems;

Various anxiolytics are also included (benzodiazepines are drugs that have a depressant effect on the central nervous system and eliminate feelings of tension, anxiety and fear, which leads to calmness, another name – psychosedatives).

Side effects of anxiolytics are:

o Drowsiness;

o Uncertainty in walking (ataxia);

o They affect the reduction of alertness and coordination of movements (called setrignoses);

o Benzodiazepines, although relatively safe, are advised to be treated for as short a period as possible;

CHANGE LIFESTYLE HABITS

A large number of people have a mild form of anxiety and by changing their lifestyle habits, it is possible to reduce the level of stress and worry, and bring everything under control.

1. Eat healthy

Foods rich in tryptophan (milk, bananas, soy, nuts, sesame seeds, chicken), vitamin B (green vegetables, rice, eggs,) omega-3 fatty acids (salmon, chia seeds, nuts, avocado) can have a beneficial effect on the body and be an appropriate stimulant for improving mood.

2. Sleep is crucial

Sleep is a physiological process that is necessary for life in order to cope with everyday stress, prevent fatigue, preserve energy, and restore the mind and body.

3. Be physically active

In addition to being important for physical health, it is also important for mental health. It increases mood levels by stimulating the secretion of dopamine.

4. Avoid alcohol and drug consumption

Alcohol and drug abuse lead to damage to both physical and mental health.

Although they reduce anxiety symptoms at the time of use, in the long term, they only reinforce and intensify symptoms.

5. Reduce caffeine intake and cigarette consumption

6. Educate yourself and implement relaxation techniques and training

Breathing techniques, meditation, yoga and reading books can help relieve symptoms.

7. Surround yourself with people who are important to you

Support and understanding from family, friends and other close people can be the most important thing in treating mental disorders.

8. Ashwagandha Supplementation

Ashwagandha is an herbal supplement that has been used in naturopathic medicine for centuries. It is obtained from the root of the Indian plant Withania somnifera and has the ability to reduce stress and anxiety, affect glucose, testosterone and strength.

9. LUCHA T8 Device

Lucha T8 is a device that reduces stress levels in the body and synchronizes our brain waves with nature and the natural frequencies of the earth’s vibrations, strengthens the immune system and eliminates pain.