Anxiety Disorder: The General Overview On Anxiety Disorder

There are over 4 million people who suffer from anxiety disorders in America and even though the disorder is very prevalent, it is not an easy disorder to live with. People who suffer from anxiety disorders face many challenges everyday. Each one of the sufferers has their own hard experience with the disorder and has trouble dealing with them. Most people who suffer from anxiety disorders suffer from excessive worry, fear and low self esteem.

What is an Anxiety disorder?

Anxiety disorder is a syndrome of ongoing anxiety and continuous worry about events or situations that are not significant. The thoughts and worries are excessive and inappropriate. The condition can often be chronic and debilitating.

Anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder and social phobia, are considered the most prevalent psychiatric disorders in the United States.1

Initially the tem anxiety neurosis was coined by Freud to describe GAD, but now it is superseded by the International Statistical Classification of Disease (known as ICD-10) terminology and is known as Generalised Anxiety Disorder (GAD).

What are the symptoms of anxiety disorder?

People with generalized anxiety disorder suffer from worry or anxiety and a number of physical and psychological symptoms. These symptoms include:

Symptoms of the body:

• Excessive physiologic arousal
  • Muscle tension
  • Irritability
  • Fatigue
  • Restlessness
  • Insomnia

Symptoms of the mind:

• Distorted cognitive processes
  • Poor concentration
  • Unrealistic assessment of problems
  • Worries
• Poor coping strategies
  • Avoidance
  • Procrastination
  • Poor problem-solving skills

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Case story of anxiety disorder:

What causes Anxiety disorders?

• Heredity
• Neurochemical factors: Loss of regulatory control of cortisol over HPA axis
• Stress
• Living alone
• Divorced or seperated

What Illnesses are likely to present as Anxiety disorder?

• Thyrotoxicosis.
• Phaeochromocytoma.
• Hypoglycaemia.
• Anxiety disorders
• Depression
• OCD
• Dementia

How common is Anxiety disorder?

The lifetime prevalence of GAD is approximately 4 to 6 percent in the general population and is more common in women than in men.

The incidence of neurotic disorders is thought to be around 1 adult in 6. Of these, the diagnosis of GAD was found to be between 1.5-3.6%.(3)

Statistics:

Generalized anxiety disorder occurs more often in women, with a sex ratio of about 2 women to 1 man (Brawman-Mintzer & Lydiard, 1996). The 1-year population prevalence is about 3 percent.

Approximately 50 percent of cases begin in childhood or adolescence. The disorder typically runs a fluctuating course, with periods of increased symptoms usually associated with life stress or impending difficulties. There does not appear to be a specific familial association for general anxiety disorder. Rather, rates of other mood and anxiety disorders typically are greater among first-degree relatives of people with generalized anxiety disorder.

• About 2.8% of the U.S. population (4 million Americans) have GAD during a year’s time.
• GAD most often strikes people in childhood or adolescence, but can begin in adulthood, too. It affects women more than men.

How is Anxiety disorder diagnosed?

Anxiety disorder commonly overlaps with other psychiatric disorders (e.g., major depression, substance abuse, panic disorder) and these disorders can often occur concomitantly with Anxiety.

Generally, Anxiety disorder should be considered a diagnosis of exclusion after other psychiatric disorders have been ruled out.

Diagnostic criteria for Anxiety disorders: (DSM-IV-TR) :

(Source: American Psychiatric Association)

1. At least 6 months of “excessive anxiety and worry” about a variety of events and situations. Generally, “excessive” can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation.
2. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met.
3. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms:
   1. Feeling wound-up, tense, or restless
   2. Easily becoming fatigued or worn-out
   3. Concentration problems
   4. Irritability
   5. Significant tension in muscles
   6. Difficulty with sleep
4. The symptoms are not part of another mental disorder.
5. The symptoms cause “clinically significant distress” or problems functioning in daily life. “Clinically significant” is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning.
6. The condition is not due to a substance or medical issue

How is it treated?

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Non-medical treatments(therapy) should be the treatment of choice for people with mild anxiety, it teaches them skills to deal with the core symptoms of anxiety disorders.

The physiological arousal can be decreased by using relaxation techniques and biofeedback.

Cognitive therapy helps patients to understand their cognitive distortions by viewing their worries more objectively, enabling them to make better decisions to manage their anxiety.

Cognitive- behavioural therapy (CBT) is the technique of choice for an effective and lasting response in Anxiety Disorders.

• It must be delivered by well trained professionals.
• The optimum duration of therapy is around 16 to 20 hours, delivered in a weekly session of 1 or 2 hours and completed within four months.
• If offering briefer CBT, it should be about 8-10 hours, and should be designed to integrate with structured self-help materials.

Read the main article on Cognitive Behavior therapy for more information.

Medical treatment for Anxiety disorder:

The medical community recommends a selective serotonin reuptake inhibitor (SSRI) or venlafaxine as the first choice.

In case of no reply to the medicine i.e. if one SSRI is not appropriate or if there is no improvement after a 12-week course, then another SSRI can be tried in the patient. How the patient responds to an SSRI depends on his/her unique body metabolism and type of neuro chemical imbalance.

In a few cases long-term treatment and doses at the upper end of the indicated dose range may be necessary

At the beginning of treatment, patients are educated about:

• Side-effects of the drug
• Patients can be told about the initial increase in anxiety during the starting days of treatment.
• Possible withdrawal symptoms
• Time taken to see the full effect of the drug
• Time course of treatment
• Need to take medication as prescribed

If there is no improvement observed within 12 weeks of starting an antidepressant, a drug from a different class can be tried.

A combination therapy and drug treatment is known to be very effective in treating anxiety disorders.

Counselors and psychotherapists play an important role in the recovery process of a patient suffering from anxiety disorders. A patient can learn effective coping skills from counselors that can increase their self-belief and can give the patient an upper hand in dealing with their anxiety symptoms.

Self help tips:

• Be around people who show compassion in relationships and understand your disorder.
• Remove one stressor at a time: Pay close attention to what’s triggering your anxiety. Try and assess whether your worries are real or unfounded. Narrow down on your major fears and stressors and create a plan to address and remove one stress at a time.
• Learn a few deep breathing techniques and use them whenever you feel anxious, fearful or nervous. Deep breathing has been proven to reduce anxiety and calm down the thoughts.
• Develop a lifestyle and an environment around you that is satisfactory and peaceful.

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Two herbal remedies that are often used for the treatment of anxiety are Valeriana officinalis (valerian), a root extract, and a beverage made from the root of Piper methysticum (kava-kava).

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References:

1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51: 8-19.
2. Information from American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:435-6, and Gelder M. Psychological treatment for anxiety disorders. In: the clinical management of anxiety disorders. Coryell W, Winokur G, eds. New York: Oxford University Press, 1991:10-27
3. Carter RM, Wittchen HU, Pfister H, et al; One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress Anxiety. 2001;13(2):78-88.