-IBIS-1.5.0-
tx
mental/emotional
anxiety
diagnoses
definition and etiology
definition:
A neurotic disorder characterized by apprehension, uncertainty and fear directly out of proportion to any known cause, and often elevated to attacks of intense panic associated with physiologic changes. Full names: "Anxiety Neurosis", "Anxiety Disorder" or "Anxiety Reaction".
etiology:
Anxiety can be physiological and/or psychological and there may be a genetic tendency.
The physiologic factors involved stem around arousal of the autonomic nervous system in the manner of a "fight or flight" response to fearful inner impulses and emotions. This stress response results in the characteristic body sensations often seen in a person in a panic attack (see "signs and symptoms").
The psychologic factors are individual to the patient but usually some sort of emotional stress precedes anxiety. The emotional stress may be easily identifiable (such as the loss of a job or relationship), or may be subconscious and harder to uncover: such as when hidden inner emotional drives of neediness, sexuality, and aggression are kept from the patient's conscious mind by psychological defenses. When these troubles are aroused by a social or environmental occurrence that extremely stimulates the patient, the episodes of anxiety can represent the individual's fear of losing control of these repressed conflicts and, in turn, his actions.
Another reason for anxiety is known or subconsciously hidden trauma that certain situations or events can trigger, reverting the patient to the traumatic event and setting up the resulting fight or flight response.
signs and symptoms
Acute panic attacks from anxiety neurosis occur episodically over a period of time. They are self-limited and generally last from 2 minutes to 2 hours, and can sometimes end as soon as the person leaves the situation that triggered the attack.
The patient experiences the alarm of terror for no obvious reason. It may supersede rational thought as it ushers in a horrible dread that an unknown and nameless catastrophe will occur.
The somatic changes associated with this type of severe anxiety include:
Tachycardia, palpitations, precordial pain usually noted as sticking or sharp, and occasional escape beats.
Cold sweats and/or general sweating are common.
Fine tremors of the hand.
Dizziness.
Overall motor weakness.
"Butterflies in the stomach", nausea and sometimes diarrhea.
Respiratory changes often produce hyperventilation from the patient responding to a sense of air hunger. If the hyperventilation progresses it can lead to secondary alkalosis and the sensations of pins and needles in the fingers, toes and around the mouth, as well as muscle stiffness in the extremities.
The patient may observe a feeling of being unconnected with the people and objects around him, and a sense of unreality.
The hyperventilation combined with this feeling of unreality can often be the reason that the anxious patient's situation can be prolonged or worsened as he feels as if he will lose consciousness and/or die.
chronic anxiety: Although the symptoms are the same as those in the acute attack, they are less severe and less debilitating. Symptoms can often be of a longer duration, lasting days, weeks, or months.
The patient notices:
A general and undefined sense of tension, apprehension or dread.
A tendency to startle easily.
An uneasiness in the normal situations of life such as work or shopping.
A vague, persistent fear of the future.
Somatic signs often include:
Generalized fatigue, insomnia.
Weight loss or gain.
Headaches, and other symptoms related to the chronic subacute stimulation to the autonomic nervous system.
Although able to function on a basic level, the patient suffers a varying amount of dysfunction in personal relationships and daily activities.
Work is often hurt by fatigue and related inability to maintain concentration.
Pancreatic hypoglycemia invokes anxiety< nights; insomnia (Easley).
Liver hypoglycemia invokes anxiety all day long (Easley).
course and prognosis
The course of mild anxiety tends to be long-term, emphasized by acute panic attacks of various intensities and frequencies. About a third of all anxiety patients recover, with men having a better prognosis than women. As a patient reaches middle age, the anxiety has a tendency to become less severe and troublesome.
differential diagnosis
Acute Anxiety Attack:
Myocardial infarction.
Grave's disease.
Pheochromocytoma.
Chronic Anxiety:
Chronic viral fatigue syndrome.
Post-traumatic stress syndrome.
Vitamin and/or mineral deficiency.
footnotes