Disease, Illness and Condition Library
General Anxiety Disorders
times a useful response that may improve a person’s performance when facing life’s challenges and dangers. But in some people, anxiety cascades out of control. Anxiety disorders are characterized by either recurrent or persistent psychological and physical symptoms that interfere with normal functioning, continue in the absence of obvious external stresses, or are excessive responses to these stresses. Anxiety disorder may result form hyperactivity in certain areas of the brain or decreased activity of a neurotransmitter (a chemical message) called gamma-aminobutyric acid (GABA), which suppresses the action of neurons. Many forms of anxiety begin during adolescence or early adulthood, though anxiety can also appear for the first time in the mature years. Up to 20% of those age 65 and older have symptoms of anxiety that prompt them to seek out treatment. Symptoms Common psychological symptoms of anxiety include irritability, a “hyped-up” feeling, intense fear, worry, and difficulty concentrating. These symptoms could be accompanied by physical manifestations such as sweating, dry mouth, hot flashes or chills, dizziness, palpitations, muscle tension, trembling, or restlessness. Anxiety disorders are broken down into anxiety states (panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and post traumatic stress disorder) and phobic disorders. Panic Disorder The cardinal features of panic disorder are short lived, sudden attacks or terror and fear of losing control; attacks begin without warning during nonthreatening activities. Affected individuals frequently go to the emergency room or consult a cardiologist because their physical symptoms-severe difficulty in breathing; a pounding, rapid heart rate; and a choking sensation- may appear to be a heart attack. (Patients who suspect that they are having a heart attack should see a doctor immediately.) Panic attacks generally peak within 10 minutes and dissipate within 20 to 30 minutes. They are characterized by some blend of the following symptoms: * Shortness of breath or hyperventilation * Heart palpitations or a racing pulse * Discomfort in the chest * Dizziness or feeling faint * Choking, nausea, or stomach pain * Sweating * Hot or cold flashes * Trembling or shaking * Sense of unreality; felling detached from surroundings * Tingling or numbness * Fear of dying or losing one’s mind Symptoms of anxiety and depression are common in persons with panic disorder and in members of their family. While both panic attacks and symptoms of depression or anxiety may respond to antidepressant medications for some patients, others may require different medications for the panic disorder and for depression and anxiety. The incidence of panic disorder is 1 to 2% in both men and women. Attacks usually begin in a persons late teens or early 20s and often go undiagnosed and untreated. One study estimated that only 25% of those suffering with panic attacks receive proper care. The most common complication of panic disorder is agoraphobia-fear of being in public places, especially when alone-which develops as a result of trying to avoid situations that have triggered panic attacks in the past. Left untreated, panic attacks and agoraphobia can markedly restrict an individual’s lifestyle, since the person tends to avoid circumstances that might provoke another attack. Panic disorder is also associated with an increased frequency of major depression, alcohol and drug dependency, and suicide. Treatment Treatment of panic disorder often involves both psychotherapy and pharmacologic measures. Referral to a therapist experienced in treating panic disorder may be necessary. Growing evidence supports the effectiveness of cognitive and behavioral psychotherapy that involves graded exposure to situations that induce symptoms of anxiety. The mainstay of drug treatment has been the tricyclic antidepressants or MAO inhibitors; both are 80 to 90% effective in blocking panic attacks but require 6 to 12 weeks to take effect. High doses of alprazolam (Xanax), one of the newer benzodiazepines, can be effective within a few days and cause fewer side effects than the antidepressants. Unfortunately, like other benzodiazepines, alprazolam can be addicting. A relapse of symptoms occurs in 30 to 60% of patients 6 to 12 months after drugs are discontinued. In addition to these drugs, the SSRIs sertraline (Zoloft) and paroxetine (Paxil) have been approved by the FDA for the treatment of panic disorder. Beta- blockers, such as propranolol (Inderal) and atenolol (Tenormin), can halt physical symptoms of panic attacks but do not prevent the fear or panic itself. Additional Information about Panic Attacks Generalized Anxiety Disorder Generalized anxiety disorder (GAD) is characterized by recurrent, prolonged, and excessive anxiety or worrying. People with GAD typically agonize over every day concerns, such as job responsibilities, finances, health, family well being, or even such minor matters as household chores, car repairs, or personal appearance. The focus of anxiety may swing regularly from one concern to another, and sensations may vary from mild tension and nervousness to feelings or dread. GAD affects 2 to 3% of the population. While people with GAD know that the intensity, duration, or frequency of their anxiety and worry are well out of proportion to the likelihood or impact of the feared event, they still have difficulty controlling their emotions. Perpetual anxiety may impair concentration, memory, and decision making ability, decrease attention span, and lead to a loss of confidence. Normal activities, such as working, socializing with friends, or maintaining intimate relationships, may become complicated or impossible. GAD may also produce a range of physical symptoms, including heart palpitations, sweating, headaches, and nausea. Some GAD sufferers, not realizing that GAD is a treatable illness, become accustomed to their condition and presume that it is normal to feel on edge all the time. But the constant anxiety can also lead to alcohol or drug abuse. The physical symptoms of GAD, along with alcohol or drug abuse, are often what finally compel a person to seek treatment. Treatment Despite its more chronic course, GAD responds better to treatment than does panic disorder. Psychotherapy benefits many people, either by itself or in combination with mediation. In addition, relaxation techniques, such as deep breathing exercises or meditation, may relieve symptoms of GAD. Venlafaxine (Effexor) and paroxetine have both received FDA approval for the treatment of GAD, but also used are other serotonin and norepinephrine reuptake inhibitors, SSRIs, tricyclics, buspirone, and benzodiazepines, such as alprazolam and diazepam (Valium). Persistent GAD symptoms can lead to depression and abuse of alcohol and drugs-especially of benzodiazepines. Treatment with benzodiazepines should be limited to short (five to seven day) courses to avoid dependence. Buspirone and antidepressants may be better choices because they do not cause dependence or withdrawal symptoms. Caffeine and Generalized Anxiety Disorder Cutting back on caffeine consumption may help ease the symptoms of GAD. On study found that the effects of caffeine on blood pressure, pulse rate, and brain activity were strongest in those with GAD. In addition, more subjects with GAD reported that caffeine heightened subjective symptoms of anxiety. Obsessive Compulsive Disorder Obsessive compulsive disorder (OCD) is marked by recurrent, repetitive thoughts (obsessions), behaviors (compulsions), or both that a person recognizes as unreasonable, unnecessary, or foolish yet is invasive and cannot be resisted. People with OCD do not necessarily have both obsessions and compulsions, but either one often interfere with day to day activities and relationships with others. Obsessions are recurring and persistent thoughts, ideas, or impulses, sometimes aggressive or violent, that seem to invade a person’s consciousness. The sufferer tries to suppress or ignore these uncomfortable thoughts and often recognizes that they are unrealistic. Typical obsessions are fear of contamination from germs, thoughts of violent behavior (such as harming a friend or family member), fear of making a mistake or harming oneself or others, and a constant need for reassurance. Compulsions are ritualistic, recurring and purposeful behaviors that are performed according to certain rules or stereotypical patterns. The behavior, while clearly excessive, relieves tension and discomfort. Common compulsions are rechecking to be sure doors are locked, windows are closed, and the iron is unplugged; counting stairs while walking; excessive neatness; rearranging and straightening the contents of a desk; and repetitive hand washing that accompanies an obsession with dirt and germs. OCD occurs in 2 to 3% of the population. It most often starts in the teens or the early 20s, however, studies demonstrate a high occurrence of OCD in those over age 65. Embarrassed and upset by their behavior, the majority sufferers try to keep it secret; they often function with only minimal disruption of their daily activates. But obsessive thoughts or compulsive behaviors may be common or distressing enough to become incapacitating. Probably the most frequent complication is depression; others include alcoholism, abuse of sleeping pills or tranquilizers, and marked interference with normal social and occupational behaviors. While some people with OCD experience spontaneous remission, in most, the illness has an episodic course with periods of partial remission. In about 10% of sufferers, the course of OCD is chronic and unchanged. Treatment As with panic disorder, OCD may improve with a combination of medication and cognitive and behavioral psychotherapy. An significant recent pharmacologic advance is the effective use of SSRIs, such as citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine, and sertraline, in treating this illness. The FDA recently approved paroxetine and sertraline for the treatment of OCK (both have also been approved for panic disorder); fluvoxamine also has received approval. Improvements, which may take six to eight weeks of drug therapy, are more likely for compulsions than for obsessions. Additional Information about OCD Post Traumatic Stress Disorder A diagnosis of PTSD is made when a person experiences the following symptoms after witnessing or experiencing an event that involved actual or threatened serious physical injury or death, or after learning that this type of event happened to a family member or someone else close to them: Strong feelings of fear, horror, and helplessness because of the event; Reliving the traumatic event through intrusive, vivid, and painful memories sometimes referred to as “flashbacks.” This symptom may manifest itself as nightmares about the event Steering clear of any situations or circumstances that remind the person of the trauma, and avoiding conversations about the traumatic event; Behaving as if one is still in danger; typical behaviors include inappropriate anger, irritability, sleep difficulties, and an exaggerated startle response. To diagnose PTSC, these symptoms must persist for longer than one month and seriously affect the person’s social life, occupation, or other important functions. In some people, symptoms of PTSD may not begin until months or even years after the trauma. This is called delayed onset PTSD. Treatment Successful treatment requires a mixture of psychotherapy – aimed at desensitizing the individual to the traumatic experience-and medication. The FDA approved the SSRI sertraline (Zoloft) for the treatment of this condition in 1999. The tricyclics amitriptyline and desipramine (Norpramin) are generally used to treat the mood disturbances and anxiety that accompany PTSD. Phobic Disorders The hallmarks of phobic disorders are persistent, irrational fears and avoidance of the specific things (for example, animals, heights, or closed spaces) or activities that induce these fears. The diagnosis of a phobic disorder is made only when the phobia considerably impairs the individual’s social or occupational performance. National Institute of Mental Health statistics suggest that such extreme irrational fears afflict 10% of all people, and some research suggests that phobic disorders are among the most common psychiatric diagnoses in those over 65. A common type of phobia is social phobia, which effects between 3 and 13% of the population. Social phobia is an unwarranted fear of embarrassment in social situations. While most people feel some anxiety about being in a situation that forces them to meet and talk to new people, social phobia causes such an extreme reaction to this everyday aspect of life that it interferes with daily functioning. Treatment When treatment is needed, behavioral therapy may help desensitize the person to the thing or situation that causes the fear. The therapist can teach the patient to use relaxation techniques when overcome by fear. Recent studies have shown that the antidepressants paroxetine (Paxil) and fluvoxamine (Luvox), both SSRIs, can relieve social phobia. MAO inhibitors and benzodiazepines are also used. Beta blockers, such as propranolol (Inderal), may reduce the physical symptoms of performance anxiety but are not suggested for ongoing treatment. Continue Reading about Phobias Helpful Lifestyle Measures for Anxiety Treatment of anxiety does not always require medication. The use of antianxiety drugs is based in part on whether patients can endure their symptoms while learning to manage them through measures such as becoming educated about the causes of anxiety; undergoing psychotherapy; or using techniques such as progressive muscle relaxation, biofeedback, or, less commonly, yoga, self hypnosis, or mediation. In general, these non drug approaches are designed to give people with anxiety a feeling of control over their symptoms. Patients can also help themselves by getting enough sleep, exercising (which aids sleep and improves self esteem), and avoiding caffeine and alcohol.
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| Mimicking Anxiety Symptoms Some medical conditions and drugs can either cause anxiety or mimic its symptoms. These medical conditions include alcohol withdrawal, asthma, heart attack, overactive thyroid, and even deficiency in folate or vitamin B12. Drugs that might cause or mimic anxiety symptoms include bronchodilators, such as ephedrine (a dangerous component of many weight loss drugs) or epinephrine; psychostimulants, such as methylphenidate (Ritalin); and thyroid hormone. |
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