Anxiety Disorder

Definition and Causes:

DEFINITION:

Anxiety is a normal human response, occurring occasional and short-lived, and typically does not cause problems with a person’s ability to lead a normal life. It may be due to psychologic stress such as work-related issues, examinations or test, making important decisions, or in response to a threat which may trigger a fight-or-flight response. However, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

  • Occur at inappropriate times
  • Occur frequently
  • Out of proportion for the situation or age
  • So intense and persistent that it interferes your ability to function normally

Several types of anxiety disorders exist:

  • Agoraphobia (ag-uh-ruh-FOE-be-uh): A fear of being in situations or places where person think that escape may be difficult or embarrassing or help might not be available if intense anxiety develops
  • Generalized anxiety disorder:  Excessive anxiety and worry about many common everyday events and activities
  • Panic disorder: Repeat episodes of sudden intense feelings of anxiety and fear or discomfort that reach a peak within minutes. Symptoms may include shortness of breath/ choking, chest pain, sweating, heart racing, fear of dying, chills or hot flashes
  • Post-traumatic stress disorder (PTSD):  Can develop after an unpleasant experience such as witnessing a traumatic and/or terrifying event, for example, sexual or physical assault, or the unexpected death of a loved one, or a natural disaster. With PTSD symptoms may not appear until several months or even years later
  • Separation anxiety disorder:  Excessive fear or worry about separation from family members or other close people. The feeling is beyond what is appropriate for the person’s age and causes problems with normal functioning
  • Selective mutism: Predominantly a childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in certain situations, such as school, but speaks comfortably in other situations, such as at home with close family members
  • Social anxiety disorder (social phobia):  Overwhelming fear or anxiety about being humiliated or rejected or looked down in social situations, which causes significant distress or impairment in daily functioning and lasts at least six months
  • Specific phobias: are characterized by an intense fear when exposed to a specific object or situation, such as animals (zoophobia), fear of heights (acrophobia), and fear of thunderstorms (astraphobia or brontophobia)
  • Other specified anxiety disorder and unspecified anxiety disorder:  Terms for anxiety or phobias that don’t meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive

CAUSES:
The exact cause of anxiety disorders is not known. It can be triggered by several factors, such as

  • Genetic factors (including a family history of an anxiety disorder)
  • Environment (such as experiencing a traumatic life event or stress)
  • Psychologic makeup
  • Medical problems (such as thyroid problems, heart disease, asthma)
  • Childhood development issues
  • Alcohol or illegal substances
  • Medications (such as amphetamines, corticosteroids)

Symptoms:

Anxiety signs and symptoms vary depending on the type of anxiety disorder, but common anxiety signs and symptoms include:

  • Feelings of being nervous, fear and uneasiness
  • Feeling weak or tired
  • Nightmares
  • Trouble with sleeping
  • Sweating
  • Breathing rapidly
  • Increased heart rate
  • Palpitations
  • Trembling (tremor)
  • Gastrointestinal (GI) problems
  • Difficulty remaining still and/or calm
  • Difficulty controlling worrisome thoughts

Anxiety can arise suddenly, as in panic, or gradually over minutes, hours, or days.

 

Investigations and Treatment:

INVESTIGATION:

Diagnosis is based upon medical and personal history, clinical evaluation, physical examination and exclusion of any organic cause for the symptoms. Although there is no specific lab test for the diagnosis of anxiety, a healthcare provider can order blood work and other tests to check for other medical conditions, such as

  • Complete blood count (CBC) to rule out such as anemia, infection
  • Thyroid-stimulating hormone (TSH) to rule out thyroid dysfunction
  • Electrolytes to rule out metabolic derangements

 
TREATMENT:

The treatments for anxiety disorders are psychotherapy, medications and managing the underlying other medical condition which is triggering the anxiety.
 
Psychotherapy also known as talk therapy: Cognitive behavioral therapy (CBT) is an effective form of psychotherapy.
 
Medications:

Several types of medications are helpful to relieve symptoms, depending on the type of anxiety disorder. Seek advice from your doctor about which treatments work best for you and about benefits, risks and possible side effects of medications.

Some of the medicines that are used to treat anxiety disorder are:

  • Selective serotonin reuptake inhibitors (SSRIs): Such as buspirone (Buspar), escitalopram (Lexapro), fluoxetine (Prozac) and sertraline (Zoloft)
  • Benzodiazepines: Such as alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan)
  • Beta-blockers: Such as propranolol (Inderal), atenolol (Tenormin) are used for heart conditions, can be helpful in the treatment of the physical symptoms of anxiety

 
Tips for self-management anxiety:

  • Identify and give detailed thought to what is causing you stress
  • Think clearly of ways to help overcome this stress; discuss with trusted family member and friends. Sharing your stress-burden would help to lighten the load of carrying this alone
  • Develop a good daily routine, including good sleeping habits
  • Eat healthy, well-balanced meals
  • Avoid excess use of stimulants such as caffeine as this can disrupt sleep
  • Avoid excess use of alcohol and other types of drugs
  • Join a gym (if possible) or engage in daily exercise including stretching and deep breathing
  • Mindfulness meditation might help reduce stress
  • Consider seeking help through with a psychologist or psychotherapist
  • If already being treated with anxiety medications, discuss with Family doctor psychiatrist if medication adjustment is required

 
Covid-19: Coping with stress, anxiety or distress

  • Remind yourself that COVID-19 is a serious but temporary illness, and that in time, life will return to normal
  • Make time to consider how to take advantage of unexpected flexibility in your daily routine
  • Create a schedule for yourself and your children for each day
  • Social isolation means physical distancing, stay connected with your friends and family and others by e.g. telephone, text, FaceTime, or video chatting
  • Try to engage in other activities you enjoy
  • Take breaks, hearing about the pandemic repeatedly can be upsetting
  • Avoid rumors and fake news
  • Stay connected to your official health news and recommendations for accurate information

Children and adolescents:

  • Try not to pass your anxiety on to your kids
  • Reassure your children that they are safe with the measures being undertaken to control the pandemic
  • Parents take time to talk to children about what’s happening, listen to their concerns and answer their questions realistically
  • Maintain regular routines and schedules as much as possible, or help create new ones in a new environment, including school/learning as well as time for safely playing and relaxing
  • Encourage children to draw, write, or journal so they can express their feelings
  • Parents teach good hand-washing practices and let children know that all the adults in their lives are working hard to keep them safe
  • Give them extra love and attention

 

Risk Factors and Prevention:

RISK FACTORS:

  • Family history of anxiety disorders
  • Environmental factors
  • Childhood trauma
  • History of accident
  • Alcohol abuse
  • Excess caffeine intake
  • Witnessing a death
  • Exposure to natural disaster (hurricanes, earthquakes)
  • War
  • Medical conditions, such as
    • Anemia
    • Thyroid dysfunction
    • Heart disease
  • Psychological causes
    • An imbalance between id and ego
    • Impulsivity (impulse control)
    • Personality problem
    • Perception of normal environment as dangerous situation

 
PREVENTION:
Anxiety disorder can negatively affect educational and work performance as well as personal relationships.
The following may help to control or decrease anxiety symptoms:

  • Get help early specially after a traumatic or disturbing experience
  • Exercise and stay active
  • Relaxation exercises (deep breathing)
  • Adequate rest and sleep
  • Well-balance meals / diet
  • Avoid alcohol or drug use
  • Reduce or quit caffeine consumption (coffee, tea, cola and chocolate)
  • Identify and avoid potential triggers

 

Outcome:

Although each anxiety disorder has unique characteristics, early recognition, diagnosis and treatment can help reduce and control symptoms of anxiety and improve the outlook.