Anxiety
ANXIETY - definition
Anxiety is a chronic state of apprehension, a feeling characterized by unpleasant anticipation, premonition and uncertainty. Anxiety syndrome began to be recognized as an individual disease relatively late, at the end of the 19th century. The first descriptions of scientific research contain more descriptions of physical/somato-vegetative symptoms than psychological ones, and those somatic signs could not be explained by physical illness but by the effects of an overexcited nervous system, stress and fatigue. At some point in our lives, we all felt discomfort, fear, anxiety and tension, which in certain situations is desirable and useful, because it enables an individual to overcome life's challenges and leads to personality development. On the other hand, anxiety, which by its intensity or duration disables and significantly reduces the quality of life, is a subject of interest in modern society.
CAUSES - etiology
The combination of biological, psychological and psychosocial factors in the emergence of anxiety disorders is different, both for various disorders and for each individual. Genetic predisposition, that is, inheritance confirms its 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, represent one of the chemical correlates of these diseases. Then, long exposure to stressful situations and long-term accumulation of stress often precedes the development of panic attacks and phobic disorders. Also crucial are factors from the environment in childhood, that is, parenting. Negative experiences from childhood that were imprinted on our personality limit us, hinder the development of our connections and relationships. 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 a number of psychological symptoms, such as: constant worry about everyday activities, constant anticipation and expectation of unfavorable events, a drop in energy and reduced concentration for performing usual activities, isolation, self-isolation, distancing from close people. On the other hand, numerous physical symptoms are also present, for example: palpitations and rapid heart rate, sweating, muscle tension, shortness of breath, tightness in the chest and suffocation.
RISK FACTORS
TRAUMA
Children and adults who have experienced a stressful event (rape, abuse, neglect of children 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 anxiety;
ABSENCE OF EMOTIONAL INTELLIGENCE
emotions are signposts, and it is important to be able to "read" what they are telling us, if we sabotage and suffocate them or, on the other hand, overanalyze and enter into doubt, they can also lead to discomfort and restlessness;
DRUGS AND ALCOHOL
massive use and abuse can cause and worsen anxiety;
OTHER MENTAL DISORDERS
anxiety occurs as a symptom of other diseases, such as during depression;
DIVISION OF 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 his emotions, due to an excessive amount of fear and anxiety, which lasts for weeks and even months, and significantly affects the quality of life and daily functioning.
GAP is the most prevalent among anxiety disorders, its etiology is usually unknown and the cause itself is difficult to discover. About 2/3 of patients are women. It is most often found among divorced persons and widowers, housewives and unemployed persons, then in urban areas, where the pace of life is significantly accelerated.
The intensity of the symptoms varies during the day, although in the evening hours before going to bed they can be severe and cause insomnia, which additionally 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 anxiety disorders, and the main characteristics are repetitive compulsive thoughts and compulsive actions, which are unpleasant in content, happen against their will and the person perceives 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. The presence of only obsessive thoughts;
2. Presence of only compulsive actions;
3. Presence of compulsive thoughts and actions - found in 80% of patients
In order to fully understand OCD, we need to distinguish it from ordinary fear and anxiety. So, for example, someone may think that he didn't turn off the stove or the iron or that he left the apartment unlocked, although somewhere inside that person knows that he has done it, but in order to put his mind at ease, he has to go back and check if the action was done. Very often, this specific number of repetitions is repeated more and more, and in the background of this is the patient's unrealistic idea that in this way they will "prevent" the catastrophe. 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 based on the presence of obsessive thoughts and/or compulsive actions, which are the source of suffering and the patient's inability to perform daily activities.
OCD should be distinguished from mental disorders such as:
• Schizophrenia
• Depressive disorder
• Tourette syndrome
PANIC DISORDER (F41)
Panic disorder is characterized by frequent panic attacks, combined with constant worry about whether the attack will happen again and at what time, while avoiding activities that can cause an attack.
The frequency of panic disorder is 2 to 4% in the general population at some point in life. It is twice as common in women. It occurs in late adolescence and early adulthood.
Panic disorder is manifested by:
• Repetitive, unpredictable panic attacks, which represent a specific type of anxiety, accompanied by various physical symptoms, such as rapid heart rate or palpitations, tremors, tremors, feeling short of breath, sweating, dry mouth, pain or discomfort in the chest;
• Patients feel strong and very intense fear or discomfort between panic attacks;
• secondary fear of death, loss of control and sanity is almost always associated;
• half of the patients develop agoraphobic behavior - they avoid places and situations that they think are a potential cause of attacks, 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 or mentally ill, but has a certain problem, which he is unable or unable to deal with at the moment.
A panic attack occurs suddenly and abruptly, usually lasting 10 to 30 minutes, with the peak being reached in the first 5 to 10 minutes. Patients usually go to the doctor immediately, because the physical symptoms are very severe and they usually think that the physical illness is the disease in question, such as a heart attack, stroke, etc. it all depends on which physical symptom is the most pronounced. The doctor's duty is to take accurate anamnestic data, perform a physical examination, make an EKG and check thyroid hormones. If there is an absence of pathological elements, that is, a disease, it is important to diagnose a panic attack and give a referral to a psychologist and/or psychiatrist. But the most important thing is that the patient is given adequate help and that he returns to his daily routine step by step in a timely manner.
Panic disorder should be distinguished from physical diseases such as endocrinological (hormonal diseases), 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, terrorism, and includes intense fear, fright and helplessness. A person does not necessarily have to survive a dangerous event to become ill. Also, the sudden unexpected death of a loved one can cause upheaval.
The risk of developing 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, a few weeks later or even a few years.
Symptoms of reliving the stressful event (flashbacks)
a) The patient feels or behaves as if the event is happening right now (through the feeling of reliving the trauma, illusion, hallucination), in a very vivid and disturbing way;
b) Present daily fantasies, 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 dullness, broken connection with emotions
c) Feeling of alienation
Symptoms of excessive excitement (hypersensitivity):
a) Difficulty sleeping
b) Irritability
c) Difficulty with concentration
A detailed assessment and analysis by a psychiatrist together with a psychotherapist decides on the type of therapy, whether it is possible to treat with psychotherapy alone or whether medication therapy is also included.
SOCIAL ANXIETY
A condition that represents a form of apprehension, worry, restlessness and/or nervousness, or avoidance of contact with other people. This anxiety disorder appears as an excessive and irrational fear when expressing opinions in small groups, talking to people they don't know, public appearances, talking on the phone or any other situation where they are exposed to the views and judgments of other people. Physical symptoms are present such as heart palpitations, shortness of breath, sweating, shaking of the body, then fast or slow speech, stuttering, avoiding looking into the eyes of the interlocutor, difficult focus. A person is afraid to say something that should not be done, and not to embarrass himself in front of others, he strives for perfectionism and the right for this reason, if he is not sure about something, he does not fulfill the task and gives up, he perceives it as a personal failure and incompetence. Social anxiety is accompanied by feelings of shame and embarrassment.
PHOBIAS (F40)
A state of irrational fear of a certain object or situation. Fear and apprehension interfere with daily activities, work or relationships, cause mental restlessness. People suffering from phobias avoid situations or objects that cause discomfort and anxiety. The frequency of agoraphobia is 2.7-5.8%, social phobias 1.2-2.2%, and specific phobias 4.5-11.8%.
Manifestations
a) Agoraphobia (Greek Agora-square)
It represents the fear of open spaces and crowds, closed spaces with many people, travel or any other situation where self-isolation is not possible, that is, escape to one's own house. It manifests itself as a classic panic attack, that is, the inability to self-control one's emotions. The main feature is avoiding places or situations that make them restless and afraid, which significantly affects the quality of life. People who suffer from agoraphobia often carry with them medicines, amulets and insist on being accompanied by people who give them security.
b) Social phobia
Anxiety occurs due to irrational fear of other people and social situations, such as public speaking, meeting people of the opposite sex or unknown people. A person avoids all situations that can lead to a panic attack and anxiety, which leads to mental restlessness and diminishes that person's potential.
c) Specific (isolated) phobias
They are limited to narrowly specific situations.
Are different:
1. Animal phobias
2. Phobias from natural phenomena (height, weather, water)
3. Phobias of blood/injection/injury
4. Phobias of situations (vehicles, elevators, bridges, clowns)
Social phobia has the most favorable prognosis, followed by agoraphobia with panic disorder, and then specific phobias.
DIAGNOSTICS
In order to rule out the development of a physical illness, the general practitioner should first recommend that laboratory tests and analyzes be done. If the physical examination is negative, the diagnosis is made by a psychiatrist and a psychologist.
Long 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 kind of anxiety disorder. Choosing a psychotherapist is not an easy task and it's perfectly fine if someone doesn't like you at first and you change them and look for an adequate person for you, the most important thing is not to give up and be persistent in its goal, because it is a process, like everything else in life. Psychotherapy is a process in which we reveal personal, painful and intimate things, thereby striving 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 people. Also, in order to learn more about ourselves, our emotions and the way they are expressed, and with the help of certain tools to establish control over emotions.
PHARMACOTHERAPY (DRUGS)
Medicines can be used to regulate and neutralize symptoms and feelings of tension and anxiety. The most common and most effective way to treat anxiety disorders is a combination of medicines and psychotherapeutic methods. Research and practice have shown that antidepressants from the SSRI group (selective serotonin reuptake inhibitors), or tricyclic antidepressants, which are prescribed for six months to a year, have the best effect.
Side effects of antidepressants are:
o Vertigo;
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 remove the feeling of tension, anxiety and fear, which leads to calmness, another name is psycho sedatives).
Side effects of anxiolytics are:
o Drowsiness;
o Uncertainty in walking (ataxia);
o They affect the reduction of alertness and movement coordination;
o Benzodiazepines, although they are relatively safe, it is advised that the treatment lasts as short as possible;
CHANGE OF LIFE HABITS
A large number of people have a milder form of anxiety, and by changing lifestyle habits, it is possible to reduce the level of stress and anxiety, and bring everything under control.
1. Eat healthy
Foods rich in tryptophan (milk, bananas, soybeans, nuts, sesame seeds, chicken), vitamin B (green vegetables, rice, eggs) and omega-3 fatty acids (salmon, chia seeds, nuts, avocado) can have a beneficial effect. on the body and be a suitable stimulant for improving mood.
2. Sleep is crucial
Sleep is a physiological process that is necessary for life in order to face everyday stress, prevent fatigue, preserve energy, and renew the mind and body.
3. Be physically active
Besides being important for physical health, it is also important for mental health. It increases the level of mood, by stimulating the secretion of dopamine.
4. Avoid consumption of alcohol and drugs
Abuse of alcohol and drugs leads to damage to both physical and mental health.
Although they reduce the symptoms of anxiety at the moment of use, in the long term, they only increase and intensify the 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 important people
The support and understanding of family, friends and other close people can be the most important when treating mental disorders.
8. Supplementation of the Ashwagandha plant
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. Apparatus LUCHA T8
Lucha T8 is a device that reduces the level of stress in the body and synchronizes our brain waves with nature and the natural frequencies of the earth's vibration, strengthens the immune system and removes pain.
REMEMBER
Everything you feel right now is human and natural.
Everything you struggle with, someone else is struggling with.
It's okay to have bad days.
Persistence is the most important thing, so don't give up.
You are not strange, twisted and ugly, you are part of nature, LET GO.
Be gentle with yourself.
You have the right to everything.
Sources
• Psychotherapy, textbook for medical students, edited by Aleksandra Nedic and Olga Živanović;
• https://psihobata.com/anksioznost/panicni-poremecaj-f41-0/
• https://www.stetoskop.info/psihologija-danas/anksioznost
• https://savetovalistemozaik.com/o-obsesivno-kompulsivnom-poremecaju/
• https://medtim.rs/lecenje-anksioznosti/
