Fittestmind.net

A Psychiatric & De-Addiction Center

ANXIETY /

By: Dr.Layeeq-ur-Rahman Khan

Introduction

Anxiety is a state of uneasiness...

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Causes

Psycho-analytic Theories...

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Separation Distress:

Early separation distress...

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Genetics

Anxiety tends to run in families...

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Treatment

Medication to treat anxiety is...

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Introduction

  • Anxiety is a state of uneasiness that occurs in anticipation of internal or external danger.
  • The lifetime occurrence of the anxiety is about 15 percent.
  • Women are more likely to have anxiety disorder than men

Causes

Psycho-analytic Theories:
  • Freud proposed that anxiety is a signal to the ego (self) to take defensive action against the pressures from within.
  • If anxiety rises above critical level of intensity it may emerge with all the fury of a panic attack.
  • Impulse anxiety is seen as being related to the primitive, diffuse discomforts of infants when they feel overwhelmed with needs over which their helpless state provides no control.

Separation anxiety refers to the stage of somewhat older children, who fear the loss of love or even abandonment by their parents if they fail to control and direct their impulses in conformity with their parents’ standards and demands.

The fantasies of castration are reflected in the castration anxiety of the adult.

Superego anxiety is the direct result of the final development of the superego (Moral teachings of Right & wrong) that marks the advent of the pubertal period.Sullivan placed emphasis on the early relationship between mother and child and on the importance of the transmission of the mother’s anxiety to her infant.

Separation anxiety refers to the stage of somewhat older children, who fear the loss of love or even abandonment by their parents if they fail to control and direct their impulses in conformity with their parents’ standards and demands.

The fantasies of castration are reflected in the castration anxiety of the adult.

Superego anxiety is the direct result of the final development of the superego (Moral teachings of Right & wrong) that marks the advent of the pubertal period.

Sullivan placed emphasis on the early relationship between mother and child and on the importance of the transmission of the mother’s anxiety to her infant.

Behavioral Theories:

Anxiety is a conditioned response to specific environmental stimuli.

Social Learning:
  1. A person may learn to have an internal response of anxiety by imitating the anxiety response of his/her parents.
  2. Growing up with anxious parents or siblings influences the development of anxiety in any individual.
Cognitive Theories:
  • Faulty, distorted, or counter-productive thinking patterns accompany or precede anxiety.
  • Patients overestimate the degree of danger and the probability of harm in a given situation.
  • Patients underestimate their abilities to cope with perceived threats to their physical or psychological well-being.
Existential Theory:

Person becomes aware of a profound nothingness in his life due to lack of faith in any divine power. Anxiety is the person’s response to this vast void of existence and meaning. Existential concerns have increased since the development of nuclear weapons.

Biological Theories:
  • It is well substantiated by work demonstrating that part of brain called amygdala sub serves the fear response without any reference to conscious memory.
  • Anxiety is represented as a result of some abnormal combination of neurochemical and neurohormones within the brain which cause overstimulation of an otherwise normal system.
  • Certain persons are more susceptible to the development of an anxiety disorder on the basis of a biologically based sensitivity to the development of this effect.
James-Lange theory:

Stimulation of the autonomic nervous system (ANS) causes certain cardiovascular, muscular, gastrointestinal, and respiratory symptoms. The subjective anxiety is response to these peripheral phenomena.

Patient, with panic attacks, has an ANS that

  • Exhibits increased sympathetic tone,
  • Adapts more slowly to repeated stimuli,
  • Responds excessively to moderate stimuli.

Separation Distress

  • Early separation distress changes function of certain part of brain that endures for lifetime resulting in anxiety.
  • Anxiety Causing Substances:
  • Exposure to certain Anxiety Causing Substances like Carbon dioxide etc leads to transient anxiety attack.
  • Disordered Systems:
  • Disordered serotonergic, noradrenergic, and respiratory systems cause anxiety.
  • Post Traumatic Stress Disorder:
  • A part of brain called hippocampus may show neuronal degeneration in patients with posttraumatic stress disorder, probably as a result of increased effects of central chemical glucocorticoid.
  • There may be loss of memory for the original traumatic event in these patients as hippocampus is critical for memory function.

Genetics

  • Anxiety tends to run in families.
  • Abnormal genes must be etiologically relevant.
  • A susceptibility to develop anxiety is inherited.
  • Individuals inherit a temperament like shyness, hyperactive autonomic nervous system responses, or behavioral inhibition.
  • Depending on a variety of life circumstances, anxiety develops.
  • More powerful anxiety genes require less stress to be expressed.
  • A variety of environmental influences activate latent genes through complex biochemical process, and these operate in central nervous system.

COGNITIVE-BEHAVIORAL Psychotherapy:

Many different techniques are incorporated into standard cognitive-behavioral packages for anxiety including

  • breathing retraining,
  • deconditioning,
  • cognitive restructuring,
  • relaxation,
  • exposure,
  • and psycho education.

These treatments are given as first-line approaches to patients who.

  • refuse
  • cannot tolerate medication
  • want these treatments in combination with medication.
Prologue:

Anxiety is a common psychological disorder that needs early diagnosis, proper treatment, compliance & support of family members.

Treatment:

  • Medication to treat anxiety is centuries old if we include alcohol.
  • Some drugs called Benzodiazepines are used only for the temporary relief of extreme anxiety. Long term administration of benzodiazepines is used for patients who do not respond to, or cannot tolerate, antidepressants.
  • The patients of anxiety are known for sensitivity to even relatively minor adverse effects.
  • Anxious patients generally maintain fear of physical sensations,
  • Treatment is started at relatively low doses of the selected medication, with slow increment to a fully therapeutic dose.
  • Anxiety disorders are, in general, chronic illnesses that often require long-term therapy.
  • Thus the medication selected must be well tolerated and safe even if the patient continues to take it for a prolonged period.
  • Antidepressant medication is increasingly seen as the medication treatment of choice for the anxiety disorders.
  • Certain drugs called Selective Serotonin Reuptake Inhibitors (SSRIs) are more effective than benzodiazepines and easier to discontinue.
  • Certain drugs known as Mono Amine Oxidase (MAO) inhibitors are given only to patients who do not respond to trials with several medications.