Disease of Fear and Palpitation-Anxiety Disorder

Mr. Ram Bahadur is a 25 year male . He is a student. He walking on the road, suddenly saw  death body on the road. He felt discomfort. He developed fearfulness, palpitation, breathing difficulty, fear of going something wrong and  fear of dyeing.  Since then he worries about going to be  stop his heart beat. He thinks that he has  problem of heart  and consulted to  the cardiologist. However he found that his heart was in the normal condition. Now he is treating with psychiatrist and getting better. Now it is known that he has problem  with Generalized anxiety disorder (GAD). Doctor told that he need to  treat  for few months.

What is anxiety disorder? 

Anxiety is a normal part of life. It can even be useful when it alerts us to danger. But for some people, anxiety is a persistent problem that interferes with daily activities such as work, school or sleep called anxiety disorder.. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to health concerns and other problems. In some cases, anxiety is a diagnosable mental health condition that requires treatment. Generalized anxiety disorder, for example, is characterized by persistent worry about major or minor concerns. Other anxiety disorders — such as panic disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) — have more specific triggers and symptoms. In some cases, anxiety is caused by a medical condition that needs treatment.

Whatever form of anxiety you have, medications, counseling or lifestyle changes can generally help. Symptoms of Anxiety

1.             Psychological       -    Fearful anticipation

                                      -    Irritability

                                      -    Restlessness

                                      -    Poor concentration

                                      -    Worrying thoughts

2.             Physical

          Gastro- intestinal -    Dry mouth

                                      -    Difficulty in swallowing

                                      -    Epigastria discomfort

                                      -    Excessive wind

                                      -    Frequent or loose motions

          Respiratory           -    constriction in the chest

                                      -    Difficulty inhaling

                                      -    Over brrathi9ng

          CVS                     -    Palpitations

                                      -    Discomfort in chest

          Genito - urinary    -    urgency of maturation

                                      -    Failure of erection

                                      -    Menstrual discomfort

                                      -    Amenorrhea

          Neuro-muscular

          System                 -    Tremor

                                      -    Prickling sensation

                                      -    Tinnitus

                                      -    Dizziness

                                      -    Headache

                                      -    Aching muscles

3.             Sleep disturbance -    Insomnia

                                      -    Night terror

4.             Other symptoms   -    Obsessions           

                                      -    Depersonalization

Types of anxiety disorder

Anxiety disorders can be divided into three broad categories, although in practice there is considerable overlap between then:

·      Generalized anxiety disorders

·      Panic disorder

·      Phobic anxiety disorders, including agoraphobia, social phobia and specific phobia

1.      Generalized anxiety disorder  (GAD):In GAD,

·      Symptoms of anxiety are present most of the time over a period of at least two weeks and often considerably longer.

·      There does not seem to be a direct cause for the anxiety which is often as severe when the patient is at home or when they are out.

·      This type of anxiety occurring without an obvious stressor is some \times called "free floating anxiety.

·      GAD occurs in about 2% of the population and is more common in women then men with onset usually in early adult life.

·      It tends to occur against a background of chronic social problems, including marital difficulties, unemployment and lack of support.

2.             Panic disorder:

          Panic attack: Panic attacks can occur in any of the anxiety disorders. They are brief but very intense episodes of anxiety. An extreme sense of fear is usually present. It may begin suddenly or build gradually to a crescendo. Hyperventilation is common with shallow and rapid breathing that flushes carbon dioxide from the body resulting in a respiratory alkalosis. This causes symptoms of palpitation, chest pain, sweating, dizziness, and feelings of pins and needles around the mouth dexterities, and muscle spasms. There is often a fear of losing control or, Because of the similarities of symptoms with ischemic heart disease, a fear of dying.

          In panic disorder

·      There are repeated panic attacks occurring over a short period of time.

·      Unlike the panic attacks that can occur in phobic anxiety disorders, they are not predictable of in response to a particular at5ressor.

·      In contrast to generalized anxiety disorder, symptoms are not present between attacks.

·      The disorder occurs in about 0.8% of the population and is slightly more common in women then men.

·      It is most likely to being in early adulthood.

3.             Phobic  disorder: In phobic disorder symptoms of anxiety occur repeatedly and predictably in response to a particular object, situation or thought. The degree of anxiety is quite out of proportion to the circumstances.

          For example, while most people would be wary of approaching a large aggressive looking dog an individual with a phobia about dogs might become anxious if a small well behaved dog passes on the other side of the road or when shown a photograph of a dog. They might stop walking in public places in order to avoid dogs, and therefore lead and extremely restricted life style.

          Avoidance is a characteristic feature of phobias and account for a great deal of disability. Some patients will go to extraordinary lengths to avoid they fear.

          There are three types of phobic disorder:

·      Agoraphobia

·      Social phobia

·      Specific phobia

Agoraphobia:

In agoraphobia

·      Anxiety occurs in a wide range of situations, most commonly crowded places, particularly busy markets, shopping center, and on public transport.

·      There is often fear of losing control in public, by fainting or collapsing, or of being unable to get out of a building.

·      Symptoms tend to gradually escalate over time so that more and more places are avoided until eventually the patient cannot leave their own home. Some can only go out if accompanied by some one. Home is thought of as a safe place, and symptoms of anxiety are less prominent there although often n not entirely absent. 

·      Depressive symptoms are common, and it is important to be alert for a coexisting depressive disorder when assessing these patients.

·      Agoraphobia has a prevalence of 0.6% in the general population.

·      It is more common in women, with symptoms usually beginning in early adulthood.

·      It tends to be chronic disorder that fluctuates in severity.

Social phobia:

In social phobia:

·      The anxiety symptoms are provoked by social situation in which one feels on display in some way, such as speaking to an audience, eating in public, going to the cinema.

·      The impact of the phobia depends upon the job and lifestyle of the individual.

·      For example

·      A teacher who is unable to speak in public will be severely disabled, whereas an office worker may function well despite having a similar fear.

·      Unlike other workers phobias, it occurs as frequently in men as women.

·      Alcohol abuse is a common complication, as alcohol is often in an effort to gain control of the anxiety symptoms.

Specific phobia:

In specific phobias:

·      A particular object arouses anxiety. The object can be virtually anything, although thunderstorms and animals are moat often implicated.

·      This is the commonest, and generally the least serious or disabling of the phobic anxiety disorder.

·      The degree of disability dose depend upon the ease with which phobic object can be avoided.symptomscauses

Causes

As with many mental health conditions, the exact cause of anxiety disorders isn't fully understood. It's thought that anxiety disorders may involve an imbalance of naturally occurring brain chemicals (neurotransmitters) such as serotonin, dopamine or norepinephrine. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to becoming anxious. Inherited traits also are a factor.

risk-factors

Risk factors

Things that may increase your risk of developing an anxiety disorder include:

·         Being female. Women are more likely than men to be diagnosed with an anxiety disorder.

·         Childhood trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life.

·         Stress due to an illness. Having a chronic health condition or serious illness such as cancer can cause significant worry about the future, your treatment and possibly your finances.

·         Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, ongoing worry about finances or a death in the family.

·         Personality. People with some personality types are more prone to anxiety disorders than are others. In addition, some personality disorders, such as borderline personality disorder, may be linked to anxiety disorders.

·         Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.

·         Substance use. Drug or alcohol abuse can cause or worsen anxiety.

complications

Complications

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical health conditions, including:

·         Depression (which often occurs with anxiety disorder)

·         Substance abuse

·         Trouble sleeping (insomnia)

·         Digestive or bowel problems

·         Headaches

·         Teeth grinding (bruxism)

preparing-for-your-appointment

treatments-and-drugs

Management

Drugs are:

·      Antidepressants, beta blockers   and benzodiazepines 

·         Psychotherapy

-          Reassurance and explanation that "not a life threatening situation"

-       Supportive psychotherapy

-       Relaxation exercise, yoga, massage, mediation etc.

-       Behavioral therapy techniques for phobic anxiety disorders.

-        

Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here are a few things that you can do:

·         Get exercise. Exercise is a powerful stress reducer; it can improve your mood and keep you healthy. It's best if you develop a regular routine and work out most days of the week. Start out slowly and gradually increase the amount and intensity of the exercise you do.

·         Eat well. Avoid fatty, sugary and processed foods. Include foods in your diet that are rich in omega-3 fatty acids and B vitamins.

·         Avoid alcohol and other sedatives. These can worsen anxiety.

·         Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.

·         Make sleep a priority. Do what you can to make sure you're getting enough quality sleep. If you aren't sleeping well, see your doctor.

·         Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.

How Can We Be Mentally Healthy?

·      Don’t do deep thinking.

·      Don’t believe traditional false things like witch, ghost, etc

·      Try to be happy whatever you got but don’t forget to do hard working

·      Take as  a good way for your friends success.

·      Don’t abuse Alcohols & Drugs.

·      Do healthy competition on daily life.

·      Don’t be too moral and don’t expect it from other also.

·      Express your problem to other (ventilations).  

·      Make the environment peace and healthy.

·      Break difficult work into different fraction and try to finish one by one.

                                                                Dr C P Sedain,Neuropsychiatrist,                                                                                                                    

                                                                    Chitwan Medical Collage,Chitwan