During my childhood days, I have seen my grandmother being very tense and anxious whenever any of the family members got delayed any day. She would keep thinking, why the person is late? Did he or she face any problem? She would neither take food nor would she sleep. She would keep worrying till the person reaches home. If we asked her, she would say that she was not feeling well, having headache, dry mouth, sweating and palpitations. She would frequently go to the toilet.
Today, when I think of it, I am able to realize that she was suffering from anxiety disorder. Similarly, I have seen my brother having anxiety attacks during exams. He would read whole night without being able to remember anything. He wouldn’t eat properly and have repeated vomiting. He would not listen to anybody’s advice and keep praying to all gods and goddesses. Sometimes he even used to have panic attacks i.e., he would be excessively fearful. He would say that he has a feeling as if he would die.
Anxiety disorders are mainly hereditary. Traumatic life events and stress can cause anxiety too. Everybody experiences anxiety. It is characterized most commonly as a diffuse unpleasant, vague sense of apprehension, often accompanied by headache, palpitation, tightness of chest, sweating, mild stomach discomfort and restlessness. It’s indicated by inability to stand or sit for long. However Psychiatrist consultation becomes necessary, when a person is unable to perform his daily routine activities or there is social/occupational impairment due to his anxiety.
Previously, people were not aware of this problem. Even now, many children have the same problem. They are afraid when they go to appear an exam or deliver a speech on dais, etc. even though they are capable of doing so. Such fear can be controlled by medicines and counseling and they can be helped to perform better.
Now days, many medicines are available to treat such anxiety attacks. They can be properly counseled and given medicines to control their anxiety. The therapist helps in reality testing and may offer advice regarding behavior. With treatment a person become aware of his maladaptive behavior that is secondary to distortions in how people perceive themselves and in how others perceive them.
1.What is generalized anxiety disorder?
Anxiety and worry are commonly experienced responses to the stress of day-to-day life. We all worry at times about various aspects of our lives—particularly the unknown or novel. This is absolutely normal. However, when worry and anxiety are the predominate approach to life, it is not normal. People with generalized anxiety disorder (GAD) experience excessive levels of anxiety and worry most of the time and have great difficulty controlling their worry. The excessive level of anxiety they experience causes significant distress and often impairs their ability to function in various areas of their life (such as socially or occupationally). Many people with GAD become preoccupied with the physical symptoms associated with anxiety (such as gastrointestinal distress and fatigue) and worry about their health. This worry may lead them to repeatedly seek out medical evaluations and reassurance.
2.What are the physical symptoms of generalized anxiety disorder ?
- Physical restlessness (feeling “on edge”)
- Muscle tension
- Difficulty concentrating or mind going blank
- Sleep disruption
3.What is the prevalence of GAD?
Estimates from epidemiologic surveys estimate that the lifetime prevalence of GAD in the general population is 5.1%, with a higher prevalence in women (6.6% versus 3.6% in men). It is a chronic condition that may demonstrate periodic episodes of acute worsening throughout its course. GAD often begins in childhood and persists throughout life. For some individuals it may consist of chronic, yet mild symptoms; for others it may cause significant levels of impairment in social settings, interpersonal relationships, and occupational functioning. Chronic medical conditions such as irritable bowel syndrome and headaches often occur along with GAD.
4.What other psychiatric illnesses are likely to occur with GAD?
It has been estimated that 50–90% of people with GAD also have at least one other psychiatric condition. Major depression and dysthymia frequently are seen in individuals with GAD. Some believe that this cluster of symptoms reflects a mixed anxiety–depressive state. Other anxiety disorders such as panic disorder, simple phobias, social phobia, and obsessive-compulsive disorder also can occur in an individual with GAD. Substance abuse is likely—just as it is with all other anxiety disorders. Personality disorders also may be seen in these individuals.
5.Which psychiatric conditions mimic with GAD?
- post-traumatic stress disorder
- somatization disorder
- substance use disorders
- 6.What are the medical conditions that can cause anxiety?
- Hyperthyroidism or hypothyroidism
- Hypoglycemia, Diabetes mellitus, Pheochromocytoma
- Seizure disorders
- Strokes, Traumatic brain injuries, CNS tumors
- Chronic obstructive pulmonary disease, Asthma, Pulmonary emboli
- Cardiac arrhythmias, Mitral valve prolapse
- Substance intoxication and/or withdrawal
- Can certain types of medications cause anxiety symptoms?
Yes. Many classes of drugs used for medical as well as psychiatric conditions can cause symptoms of anxiety. Anxiety is a common side effect of some drugs (such as bronchodilators, psychostimulants,
and corticosteroids); with other drugs (e.g., meperidine, antihistamines, and benzodiazepines), anxiety may represent an idiosyncratic response to the medication. Rapid discontinuation may precipitate anxiety in a patient as well (reported with corticosteroids, benzodiazepines, some SSRIs, and venlafaxine). Toxicity may result in symptoms of anxiety (seen with theophylline). Almost all classes of antidepressants cause anxiety in some patients, particularly during the initiation of treatment.
Antipsychotics commonly cause akathisia—a markedly distressing level of internal agitation.
8.What are the pharmacologic treatments used in GAD?
Benzodiazepines, which decrease the severity of anxiety symptoms, have long been the mainstay of treatment for GAD. Although benzodiazepines offer the benefit of rapid symptom relief, their chronic use can lead to tolerance. Other drugs that are being used are Buspirone, Tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRIs)
9.What other treatments are used to treat GAD?
Management of anxiety symptoms through relaxation training, exercise programs, and stress reduction are all important aspects of treatment. These interventions help people to feel more in control of the degree of their anxiety and worry. Cognitive behavioral therapy has been shown to decrease the physiologic aspects of GAD and alter the cognitive distortions that fuel the anxiety.
10.What are the common symptoms that constitute a panic attack ?
A panic attack is defined as a discrete episode of intense discomfort or fear during which there is a sudden onset of the following symptoms:
- palpitations, sweating, nausea or abdominal distress
- dizziness or lightheadedness
- chills or flushing
- a sense of smothering or shortness of breath
- feelings of unreality or being detached from oneself
- chest pain, sensation of choking
- fear of dying, fear of losing control or of going crazy
The development of these symptoms must reach a peak within 10 minutes.
11.What differentiates a panic attack from panic disorder?
A panic attack is not considered to be a psychiatric disorder in and of itself. Panic attacks may occur infrequently in some people without being part of any clinical syndrome—as much as 15% of the population report having had at least one panic attack in their lifetime.
Panic disorder is a distinct clinical disorder consisting of recurrent, unexpected panic attacks. People with panic disorder experience at least a month of worrying about having another panic attack or about the possible implications of such an attack (such as dying, crashing their car, being unable to function).
12.How common is panic disorder?
Estimates from epidemiologic surveys show a 3.5% prevalence in the general population, with women being twice as likely as men to experience panic disorder (5% and 2%, respectively). Onset is typically before the age of 30 (often starting in adolescence), although the disorder may develop in some people later in life.
The course of panic disorder varies: approximately one-third of patients go into a stable remission; 45% have a more unremitting, chronic course of their symptoms; and the remaining 24% have an intermittent course, with remissions and relapses throughout their lifetime.
13.What causes panic disorder?
Panic disorder rates are 3 to 6 times higher in the families of people with panic disorder than in the general population. Neurotransmitter (Serotonin) imbalance in CNS is widely considered to be involved in the pathogenesis of panic.
14.What medications are beneficial in the treatment of panic disorder?
Several classes of medications have been shown to be beneficial in the treatment of panic disorder. Benzodiazepines have long been a mainstay of treatment. Tricyclic antidepressants (TCAs; imipramine, clomipramine) decrease the frequency and the intensity of panic attacks. SSRIs (fluoxetine, sertraline, paroxetine) are efficacious as well.
15.Are there other treatments available for panic disorder?
Medications alone are sometimes used to treat panic disorder. Relapse rates following discontinuation of medications may exceed 50%.
Cognitive behavioral therapy (CBT), used in combination with medications, is particularly useful in treating panic disorder—which often are the most disabling symptoms.