Anxiety Disorders

Anxiety disorders are the most common psychiatric disorders in India. The symptoms of anxiety have two components: the awareness of the physiological sensations (palpitations and sweating ) and the awareness of being nervous or frightened. Anxiety affects the motor and visceral functions as well as it affects thinking, perception and learning. Anxiety has a great impact on emotion, attention and concentration.

Epidemiological studies have shown that one in four people meet the diagnostic criteria for anxiety disorders and women are more likely to have an anxiety disorder than men. There are a lot of psychological- psychoanalytic and cognitive- behavioural, existential and biological theories about causes of anxiety.

From a psychiatric point of view, anxiety disorders are classified into 

(1) Panic disorder

(2) Specific and social phobias

(3) Obsessive-compulsive disorder 

(4) Post-traumatic stress disorder (PTSD)

(5) Generalised anxiety disorder

(6) Anxiety disorders due to a general medical condition

(7) Substance-induced anxiety disorder

(8) Anxiety disorder not otherwise specified.

Panic disorder is characterized by the spontaneous, unexpected occurrence of panic attacks that consists of discrete periods of intense fear varying from several attacks in a day to only a few attacks during a year. Panic disorder is often accompanied by agoraphobia, the fear of being alone in public places.It is a very common disorder with prevalent in all age groups though females are affected more frequently. A panic attack is a key feature of this disorder and criteria for a panic attack is –A discrete period of intense fear or discomfort, with few (at least four) of following symptoms which develop abruptly and reaches a peak within ten minutes.

(1) palpitations, pounding heart, or accelerated heart rate

(2) sweating

(3) trembling or shaking

(4) shortness of breath

(5) feeling of choking

(6) chest pain or discomfort 

(7) nausea or abdominal distress

(8) feeling dizzy, unsteady, lightheaded, or faint

(9) the feeling of unreality or feeling of being detached from oneself

(10) fear of losing control or going crazy

(11) fear of dying

(12) numbness or tingling sensation

(13) chills or hot flushes

A panic attack can occur in other mental disorders like specific phobias, PTSD etc. In panic disorder, there are recurrent unexpected panic attacks for the duration of one month (at least) and there is persistent concern about having panic attacks. It can occur along with features of agoraphobia i.e. the fear of being in public places, particularly places from which a rapid exit would be difficult during the course of a panic attack. Depressive symptoms are often present in cases of panic disorder and agoraphobia and need special attention in the treatment programme.

Phobia

Phobia is excessive fear of special object, circumstances or situation. Social phobia is also termed as social anxiety disorder and have excess fears of humiliation or embarrassment in various social settings (public speaking, ‘shy bladder’). Phobias are the most common mental health disorder in India. A specific phobia can be excessive, unreasonable fear of flying, heights, animals, seeing blood, receiving injection while social phobias are marked and persistent fear of the social situation.

Obsessive-Compulsive Disorder –

The essential feature of OCD is a symptom of recurrent obsessions or compulsions sufficiently severe to cause marked distress to the person. The obsession and compulsion are time-consuming and interfere significantly with the person’s normal routine, occupational functioning, social activities and interpersonal relationship.

Obsession – recurrent and intrusive thought, feeling, idea or sensation, thus obsession is a mental event. Compulsion, on the other hand, is behaviour pattern and is described as conscious, standardized, recurrent behaviour (counting, checking, avoiding).

Post-traumatic stress disorder (PTSD) –

PTSD is a syndrome that develops after a person sees, is involved, or hears of an extreme traumatic stressor. The person reacts to this experience with fear and helplessness, persistently relives the event, and tries to avoid being reminded of it. In acute stress disorder, the disturbance lasts for 2 days and a maximum of 4 weeks of the traumatic event. The traumatic event can be assault, violence, riots, war, accidents i.e. the events that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others.

Generalized anxiety disorder –

Persons who seem to be pathologically anxious about almost everything are classified in generalized anxiety disorder. In  G.A.D. there is excessive anxiety and worry about several events or activities, the worry is difficult to control and is associated with somatic symptoms. The primary symptoms of G.A.D. are anxiety, motor tension (shakiness, restlessness, headache), autonomic hyperactivity ( breathlessness, sweating, palpitations) and cognitive vigilance (irritability). Abdominal discomfort e.g. pain, diarrhoea are often misinterpreted for gastrointestinal illness.

Anxiety disorder due to a general medical condition –

There are many medical conditions which are associated with anxiety. Hyper and hypothyroidism, hypoparathyroidism, vitamin B12 deficiency, cardiac arrhythmias, hypoglycemia are few of the medical conditions which can cause panic attacks, generalised anxiety disorder or obsessions and compulsions.

Treatment

With proper and adequate treatment, most of the patients with different anxiety disorders have a dramatic improvement. The two most effective treatment strategies are pharmacotherapy and cognitive- behaviour therapy. Family and group therapy are sometimes advised with psychoeducation and counselling session for the entire family to understand the psychosocial difficulties of the disorder. Underlined depression, drug dependence or personality disorder needs special attention and care. Ketamine infusion therapy in experts hand helps to control the symptoms (of severe anxiety and distress) rapidly within few days as medication might take a few weeks for its therapeutic effect.

The overall prognosis (outcome) of anxiety disorder is usually very good.