anxiety

Anxiety Disorders

Anxiety Disorders affect about 18% of adults aged 18 years and older a given year, causing them to be filled with fearfulness and uncertainty.
Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public for the first time), anxiety disorders last at least 6 months and can get worse if they are not treated.
Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse, cardiac problems, and endocrine disorders. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.

The main types of anxiety are:

Separation Anxiety Disorder
Selective Mutism
Specific Phobia
Social Anxiety Disorder (Social Phobia)
Panic Disorder
Panic Attack (Specifier)
Agoraphobia
Generalized Anxiety Disorder
Substance/Medication-Induced Anxiety Disorder
Anxiety Disorder Due to Another Medical Condition
Other Specified Anxiety Disorder
Unspecified Anxiety Disorder SHAPE \* MERGEFORMAT 



Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic, exaggerated worry and tension, even when there is little or nothing to provoke it.
The patient anticipates disaster and is overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.
Epidemiology:
GAD affects 10% of the adult population
About twice as many women as men.
Although it\ affects all age groups the most common patient seek help are the adult group.

Signs and symptoms:

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.
People with GAD cant seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants.
They cant relax,
Startle easily,
And have difficulty concentrating.
Often they have trouble falling asleep or staying asleep.
Autonomic nervous system over-activity lead to the physical symptoms (Somatic manifestations) that often accompany anxiety include
fatigue,
headaches,
tachycardia
muscle tension,
muscle aches,
difficulty swallowing,
trembling, twitching,
irritability,
sweating,
nausea,
lightheadedness,
Frequency.
feeling shortness of breath,
and hot flashes.
8. When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they dont avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
Complications:
Other anxiety disorders,
Depression,
Substance abuse often accompany GAD, which rarely occurs alone.


Deferential diagnosis
1-thyrotoxicosis
2-mitral valve disease
3-pheochromocytoma
4-hypoglyceamia

Treatment:

In general, anxiety is treated with medications, specific types of psychotherapy, or both.
General considerations:
1-If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified.
2- Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
1- Medications
Medication will not cure anxiety but it can keep it under control while the person receives psychotherapy.
Medication must be prescribed by physicians, usually psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy.
a-Antidepressants
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.

Tricyclics like
Imipramine
trimipramine
and amitryptiline
MAOIs like
Phenelzine
Tranylcypromine
b-Anti-Anxiety Drugs : High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily.
c-Beta-Blockers : small doses (up to 40mg\day ) of propranolol can be used in anxiety. It can help controlling the sympathetic over activity features.
2-Psychotherapy
Supportive psychotherapy
Cognitive-Behavioral Therapy