Anxiety Neurosis What is normal anxiety? Anxiety can be described as a feeling of alarm or worry.

It may be about something specific or it may be non-specific in nature. A certain amount of anxiety is normal and helps improve our performance and allows people to avoid dangerous situations. This normally lasts for a short period causing no impairment in social or occupational functioning. When this anxiety is prolonged and affects social or occupational functioning, it's abnormal and accounts for anxiety disorder. General presentation of Anxiety disorders Patients often experience a state of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation, often to a degree that normal physical and psychological functioning is disrupted. This may be precipitated due to several reasons which are generally easily identified by the patient himself. The anxiety is of a greater degree than just everyday worries and patients do mention that they are not able to control these worries. They are frequently accompanied with physical symptoms as well. These symptoms have to present for most days at least for several weeks at a time. Anxiety disorders also manifest as physical symptoms along with psychological symptoms. Some of the common things that patients experience are as follows: :: Feeling that something undesirable or harmful is about to happen (edginess and apprehension) :: Dry mouth; swallowing difficulty; hoarseness :: Rapid breathing and heartbeat, palpitations :: Twitching or trembling :: Muscle tension; headaches; backache :: Sweating :: Difficulty in concentrating :: Dizziness or faintness :: Nausea; diarrhea; weight loss :: Sleeplessness :: Irritability :: Fatigue :: Nightmares :: Memory problems

:: Sexual impotence Anxiety Neurosis Causes There are more than one reasons why patients develop Anxiety disorders.Researchers and scientists are trying to find out more about the biological, psychological, and social factors which influence the development of anxiety disorders as there is still a lot more to learn about the role of these. The following are all believed to play a role in the occurrence of anxiety disorders:

Genetics and heredity Chemical imbalances in the brain Personality types Social factors Medical conditions Drugs and other substances

Genetics and Heredity: There is clear evidence that anxiety disorders tend to run in families. If a parent or a sibling of a person suffers from an anxiety disorder, there are higher chances of that person developing this disorder. These findings suggest that a genetic factor combined with certain social factors predisposes certain people to develop anxiety disorders. Chemical imbalances in the brain: Scientists strongly believe that brain chemistry plays a role in the onset of anxiety disorders. When there is an imbalance of chemicals (such as serotonin and dopamine) in the brain a person can feel anxious or depressed. Personality types: People with certain types of personality are more prone to develop anxiety disorders. For e.g.: people who have low self-esteem and poor coping skills may be more prone for anxiety development. The basic nature of an individual makes one vulnerable to specific types of disorders including anxiety. Social factors: The role of social factors in the development of anxiety disorders is being studied by researchers and a relationship has been seen between anxiety disorders and long-term exposure to abuse, violence, poverty, etc. Such life experiences affect an individual's susceptibility to these disorders. Growing up in a family where fear and anxiety are constantly seen by children can teach them to become anxious.

Medical causes: Sometimes anxiety may be caused due to the presence of medical illnesses such as certain neurological disorders, endocrinological disorders, cardiopulmonary disorders, etc. Drugs and other substances: Anxiety can be caused due the usage of certain drugs like amphetamines, certain over-the-counter medicines, tranquilizers, steroids, contraceptive pills, hormonal treatment, etc. Generalized anxiety disorders The onset is generally around childhood or adolescence but cases with lateonset anxiety symptoms are also seen. Generalized anxiety disorder is characterized by excessive anxiety and worry. This occurs for most of the days for at least 6 months, about a number of events or activities. Generally the anxiety is about work, daily events or performances. The patient finds it difficult to control the anxiety about various things and this is often associated with few or most of the following features:

Restlessness Irritability Difficulty in concentrating Sleep disturbances (difficulty in falling asleep, frequent waking in the middle) Easy fatigue

The anxiety causes significant distress and impairment in various areas of functioning. The course of generalized anxiety disorders is chronic and usually gets worse during periods of stress. The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the actual likelihood or impact of the feared event. The person finds it difficult to keep worrisome thoughts from interfering with his daily activities and has difficulty stopping the worry. During the course of the disorder, the focus of worry may shift from one concern to another. In children suffering from Generalized Anxiety Disorder, there is a tendency to worry excessively about their competence with their friends or the quality of their performance. Anxiety due to medical causes Anxiety may be a symptom of a number of medical conditions as well and hence it is necessary to rule out these conditions before we testify the patient to be suffering from anxiety disorder. Few of them have been listed below: 1) Neurological illnesses can cause symptoms similar to those found in

anxiety disorders and hence these illnesses must be ruled out before concluding the symptoms to be that of anxiety disorders. Following are few of the examples of such neurological disorders: a. Cerebral vascular insufficiency: Transient Ischemic Attacks (TIA) lasting from 10-15 seconds up to an hour (brief blocks in the blood vessels of the brain causing temporary loss of brain blood supply) b. Anxiety states and personality changes following head injury c. Infections of the central nervous system d. Degenerative disorders of the nervous system Alzheimer's dementia Multiple sclerosis: May be marked early on by vague and changing medical complaints Huntington's chorea: May present early as anxiety or other functional disorder before the movement disorder is evident. It always has a positive family history e. Toxic Disorders Lead Intoxication: loss of appetite, constipation and colicky abdominal pain followed by irritability and restlessness Mercury intoxication: from contaminated fish Manganese intoxication: from industrial exposure Organophosphate insecticides (similar to nerve gas): from chemical or insecticide exposure f. Partial complex seizures 2) Endocrine disorders also frequently present with symptoms of anxiety and these can be the differential diagnosis for anxiety disorders. Common examples would be: a. Hyperthyroidism (increased thyroid hormone) commonly presents as anxiety and is one of the most common endocrine abnormalities. Most common in 20 to 40 years old women. b. Adrenal hyperfunction or Cushing's syndrome: This has a variety of causes, including tumors of the pituitary or adrenal glands or from steroids given to treat other illnesses. Anxiety is a common feature as also abnormal hairiness, acne, change in fat distribution, decreased menstruation in women and impotency in men. c. Hypoglycaemia (decreased blood glucose): Usually associated with a history of diabetes and insulin or other hypoglycaemic medications. Rarely this occurs from an insulin secreting tumor. d. Hypoparathyroidism (decreased parathyroid hormone): Almost always associated with a history of thyroid surgery. It often presents with

overwhelming anxiety, either with or without personality changes. e. Menopausal and premenstrual syndromes. 3) Cardiopulmonary disorders: Often presents with shortness of breath, rapid breathing, complaints of chest pain, chest pain that are worse with exertion. a. Angina b. Pulmonary embolus c. Arrhythmias (irregularities of heart beat) d. Chronic obstructive pulmonary disease (COPD) e. Mitral valve prolapse (generally harmless) 4) Pheochromocytoma (epinephrine secreting tumours) Substance induced anxiety disorders Substance induced anxiety is commonly missed out because very often the physician may not take detailed note of the medication that the patient has been continuing since long and these medicines may be the culprits in inducing anxiety symptoms in the patient. Common medications and drugs which can induce anxiety symptoms are as follows: Non-psychotropic medications: Sympathomimetics (often found in non-prescription cold and allergy medications): epinephrine, norephinephrine, isoproteronol, levodopa, dopamine hydrochloride, dobutamine, terbutaline sulfate, ephedrine, pseudoephedrine Xanthene derivatives (asthma medications, coffee, colas, over-the-counter pain remedies): aminophylline, theophylline, caffeine Anti-inflammatory agents: indomethacin Thyroid preparations Insulin (due to hypoglycemic reaction) Corticosteroids Others: nicotine, ginseng root, monosodium glutamate Psychotropic medications: Antidepressants (including MAO-inhibitors), drugs for treatment of attention deficit disorders (on rare occasions cause anxiety-type syndromes) Tranquilizing drugs: benzodiazepines (paradoxical response most common in children and in elderly), antipsychotics (akathisia may present as anxiety)

 Anticholinergic medications can cause a delirium which, in early stages, may easily be confused with anxiety: scopolamine and sedating antihistamines (found in over-the-counter sleep preparations) antiparkinsonian agents, tricyclic antidepressants, antipsychotics Other Drugs: Caffeine-intoxication or withdrawal Nicotine-withdrawal even more than acute intoxication Stimulants-cocaine, amphetamines, etc. Alcohol or alcohol withdrawal Drug withdrawal is a common cause of anxiety symptoms. A large number of drugs can cause withdrawal states with symptoms of anxiety or even agitation. All sedative hypnotics, tricyclic anti-depressants and anti-cholinergics can cause withdrawal symptoms.