All of us experience stress and anxiety in our lives. We are all familiar with the sources of stress and anxiety. They include financial concerns, work deadlines, providing for our children, countless tasks to do and errands to run, heavy traffic, relationships with co-workers, family relationships, and the list goes on. The irony is that the responses of our physical bodies that are designed to protect us can turn against us when stress and anxiety is without relief or prolonged. Under stress, our heart rate and blood pressure increase to provide our brains with more blood flow for oxygen and nutrients. Our blood sugar increases to provide us with more energy as we would need in a crisis. Our blood is routed away from our intestines in order to provide energy for the large muscles in our arms and legs for fight or flight. If the source of our stress and anxiety subsides after a brief period of time, our bodies return these functions to their normal process. If the source of our stress and anxiety remains constant then our physical responses become harmful to our health. We begin to experience insomnia, joint and muscle inflammation and pain, fatigue, hypertension, perhaps heart constriction, indigestion, higher cholesterol levels, impotence, either lack of or excess appetite resulting in weight loss or weight gain, weakened immune system making us vulnerable to colds and flu, and so on. Emotionally we experience feelings of irritability, impatience, lack of sexual interest, lack of concentration, depression, restlessness, excessive alertness and reaction to normal external stimuli, or feelings of being constantly overwhelmed and helpless.
Our bodies need time to recover from being in crisis mode due to stress and anxiety in order to restore normal physical balance and functioning. We need a break from and relief from the stress and anxiety in order to maintain our health. Some of us have had experience with prescription, synthetic drugs to ease anxiety and stress, but have suffered the potentially harmful and discomforting side effects which, ironically added to our feelings of stress and anxiety. Fortunately, many of us have discovered substances provide by nature that our bodies readily absorb and utilize to deal with stress and anxiety without the possible harmful side effects of prescription, synthetic drugs.
When dealing with stress and anxiety, our bodies need a proper balance of vitamins and minerals that can be obtained in multivitamin formulas some of which are specially created to provide extra stress protection with calcium, potassium, magnesium, a full spectrum of B vitamins and pantothenic acid.
Essential fatty acids provide us with Omega 3 and Omega 6 which help balance blood sugar levels, blood pressure, and provide our neurotransmitters in our brain to function quickly and efficiently. Essential fatty acids help reduce joint and muscle inflammation and fatigue, and enhances the functions of our respiratory and intestinal digestive system providing our muscles organs, and brains with the oxygen and nutrients needed to deal with stress and anxiety. Flaxseed oil with lignans and fish oils which have been filtered to remove heavy metals can provide us with the essential fatty acids that we need for dealing with stress and anxiety.
GABA i.e. Gamma-aminobutyric Acid, which is an amino acid, effects the neuro-receptors in our brain. This helps us deal with stress and anxiety by lowering over-reaction to potentially stress causing stimuli and enables us to be detached in an emotionally healthy way providing us with the calmness and poise we need to deal efficiently and effectively with what we are presented.
Herbs e.g. skull cap and passion flower can help us relax and receive the rest and sleep that we need. L-tyrosine is an essential amino acid often used to treat insomnia, depression and anxiety as well as helping to control appetite and elevate our mood. Melatonin and herbal formulas are available to us to provide the restful, restoring sleep we need in order to deal with anxiety and stress.
Aromatherapy which is the use of aromas from plant essential oils can be added to our baths, used in massage oils, or released into our living space with aromatherapy candles. As we inhale these aromas, they quickly reach our brain and help provide us with feelings of calm and relaxation. The aromatherapy essential oils that are most effective in easing stress and anxiety are bergamot, cypress, geranium, jasmine neroli, rose, sandalwood and ylang-ylang. Lavender is the most popular essential oil used to provide us with a feeling of calm and well being.
These are just a few of the all natural substances and formulas available to us to help keep our bodies healthy as we experience the stress and anxiety that accompanies our too often hectic and prolonged stressful life experiences. Other all natural formulas that increase the functioning of our brains in the areas of attention, concentration and performance are also available to us. Our bodies need extra help in dealing with stress and anxiety. Cognitively and emotionally we need breaks and periods of rest and release from stress and anxiety. The safest, non-addictive way to obtain the help we need for dealing with stress and anxiety is with all natural health care products that do not present the possibility of harmful side effects that actually increase stress and anxiety.
Tuesday, June 16, 2009
Natural Stress and Anxiety Relief
What Causes Social Anxiety?
Social Anxiety Disorder is a fear of social situations that involve interaction with other people. People who have social anxiety often fear that they are being watched, judged, and evaluated by other people. It is often mistaken for shyness or low self-esteem. There are many different causes of social anxiety, however, the cause of social anxiety in some people simply cannot be explained.
A common cause of social anxiety is a traumatic social experience. If a person is 'picked on' or made fun of during childhood, they are likely to develop social anxiety. Social Anxiety can even develop during adulthood, as a result of a traumatic social experience. Some researchers believe that adult onset social anxiety, due to a traumatic social experience, is the easiest social anxiety to treat, because the person simply needs to regain their self-confidence. This isn't necessarily so for everyone.
Another common cause of social anxiety is a learned response. If a child has parents who have social anxiety, there is a good chance that the child will learn to fear social situations as well. As children, we learn everything from the people who are around us the very most. Alternately, some people who have vivacious, outgoing parents develop social anxiety as a result. They have underlying fears that make them feel that they could never live up to the standard that their parents have set - so, instead of being outgoing, they withdraw, and develop social anxiety as a result.
Furthermore, social anxiety can develop due to misleading or inaccurate information. For instance, if a girl is a tomboy as a child, and she is often discouraged from playing sports and climbing trees - while being encouraged to play with dolls, she could develop social anxiety. She would succumb to social pressure from friends and family members to 'do what girls do, not what boys do.' This could become a big problem as she grows up. Dating could become a problem, because she will not feel that she is not feminine, or 'lady like' enough for any boy to be interested in her - she likes sports after all. The thought process is totally inaccurate, but it is what she learned as a child. She would be confronted with the issue over and over as time goes by, and eventually, she would develop social anxiety - never feeling like she fits in, and always feeling like she is being judged.
Researchers now also believe that social anxiety can be inherited genetically. Research has shown that identical twins, who share identical genes, experience similar social anxiety symptoms, while fraternal twins, who do not share identical genes, do not experience similar social anxiety symptoms. Research in this area is still ongoing.
The causes of social anxiety vary from person to person. Often, the cause can be found through therapy. Therapists agree that once the underlying cause of social anxiety is found, most people are able to begin dealing with their social anxiety in effective, successful ways.
Monday, June 15, 2009
Anxiety Disorders
Anxiety Disorders
Introduction
Medicine, psychiatry, and dualism:
In the past, psychiatric diagnoses have been regarded as ‘mental' in nature, in contrast to the ‘physical' nature of medical diagnoses. This distinction reflects the absence of gross pathology in most psychiatric disorders, and the fact that these conditions usually present with disturbed mental states or behaviour rather than physical symptoms.
Underling this division of illnesses into physical and mental, is the assumption that a parallel distinction can be made in healthy people ‘body-mind dualism'. This has and continues to exert a profound influence on medical thinking.
Co-morbidity means the occurrence of two disorders. The term has been extended to describe the co-occurrence of prominent mental symptoms and bodily pathology since these patients are usually given a psychiatric and a physical diagnosis. In particular neither of these diagnoses may lead to effective treatment because a focus on either may lead to neglect of the other. An example is the widespread neglect of depression in patients with medical disease.
Somatization some patients have somatic symptoms but no evidence of bodily pathology. It is then unclear whether their illness should be categorized as medical or as psychiatric. In the past these conditions were generally given the medical diagnosis of functional illness (function is abnormal but there is no pathology). Now these conditions are usually given the psychiatric diagnosis of somatoform disorder. Such patients receive both a medical diagnosis (organic disorder) and a psychiatric diagnosis such as somatoform disorder (functional disorder) and the resulting confusion and controversy is well illustrated by literature about the condition called Chronic Fatigue Syndrome (CSF) or Myalgic Encephalomyelitis (ME).
Modern (integrated) approach:
New scientific knowledge, such as the demonstration of the neural basis to many psychiatric disorders (esp. with the functional imaging and genetics) has shown that crude dualistic thinking is untenable. Evidence for the effect of psychiatric disorder on the outcome of medical conditions such as MI (Frasure-Smith et al 1993) has pointed to the same conclusions.
Mind and brain are now increasingly regarded as two side of the same coin. This shift implies that psychiatric disorders are no more distinct from medical conditions than the higher nervous system is from the rest of the body. As Eisenberg (i986a) put it, psychiatry has to become less ‘brain-less' and medicine less ‘mind-less'. Correspondingly medical and psychiatric care need to be more integrated.
The ‘biopsychosocial' approach which can be further divided into predisposing, precipitating and perpetuating causes can go a long way to bridge the gap and most importantly, serve the patient.
Anxiety Disorders
Abnormal state in which the most striking features are mental and physical symptoms of anxiety, occurring in the absence of organic brain disease or another psychiatric disorder
Symptoms of anxiety:
Psychological arousal
- Fearful anticipation
- Irritability
- Sensitivity to noise
- Restlessness
- Poor concentration
- Worrying thoughts
Autonomic arousal
- Gastrointestinal: dry mouth, difficulty swallowing, epigastric discomfort, excessive wind, frequent loose motions
- Respiratory: constriction in the chest, difficulty inhaling
- Cardiovascular: palpitations, discomfort in the chest, awareness of missed heart beats.
- Genitourinary: Frequent or urgent micturation, failure of erection, menstrual discomfort, amenorrhoea
Muscle tension
- Tremor
- Headache
- Aching muscles
Hyperventilation
- Dizziness
- Tingling in the extremities
- Feeling of breathlessness
Sleep Disturbance
- Insomnia
- Night terror
Although all the symptoms can occur in any of the anxiety disorders, there is a characteristic pattern in each disorder which will be described later. The disorders share many features of their clinical picture and aetiology but there are also differences:
- In generalized anxiety disorders, anxiety is continuous-though it may fluctuate in intensity.
- In phobic anxiety disorders, anxiety is intermittent, arising in particular circumstances.
- In panic disorder, anxiety is intermittent but its occurrence is unrelated to any particular circumstances.
The Classification of anxiety disorders (ICD-10):
- Phobic anxiety disorder:
Agoraphobia (with or without panic disorder)
Social phobia
Specific phobias
- Panic Disorder
- Generalized anxiety disorder
- Mixed anxiety and depression disorder.
(OCD in ICD-10 is diagnosed separately, in the DSM-IV it is under anxiety disorder)
Generalized Anxiety Disorders
Clinical Picture
The symptoms in GAD are persistent and are not restricted to, or markedly increased in, any particular set of circumstances. All the previously mentioned symptoms can occur, but there are characteristic pattern comprised of the following features:
- Worry and apprehension that are more prolonged than those oh healthy people. The worries are widespread and not focused on a specific issue as they are in panic disorder (on having a panic attack) or social phobia (on being embarrassed). The person feels that theses widespread worries are difficult to control.
- Psychological arousal which may be evident as irritability, poor concentration, and sensitivity to noise. Some patients complain of poor memory.
- Autonomic overactivity experienced most often as sweating, palpitation, dry mouth, epigastric discomfort, and dizziness. Some patients ask for help without mentioning the psychological symptoms of anxiety.
- Muscle tension often as restlessness, trembling, inability to relax, headache (usually bilateral and frontal or occipital) and aching in shoulders and neck.
- Hyperventilation which may lead to dizziness, tingling in the extremities and, paradoxically, a feeling of shortness of breath.
- Sleep disturbance include difficulty falling asleep and persistent worrying thoughts. Sleep often intermittent, unrefreshing, and accompanied by unpleasant dreams. Some patients have night terrors in which they awake suddenly feeling intensely anxious. Early morning waking is not a feature of GAD and its presence strongly suggests a depressive disorder.
- Other features include tiredness, depressive symptoms, obsession symptoms, and depersonalization. These never prominent. If so, another diagnosis should be considered.
Clinical signs
The face appears strained, the brow is furrowed, and the posture is tense. The person is restless and may tremble. The skin is pale and sweating is common, especially from the hand, feet, and axillae. Readiness to tears, which may at first suggest depression, reflects the generally apprehensive state.
Note that there is no clear dividing line between GAD and normal anxiety. They differ both in the extent of the symptoms and the duration (in DSM-IV 6 month, in the ICD-10, more flexible; symptoms should have been present on most days at least several weeks at a time, and usually several month'
Comorbidity is common:
- Anxiety and depression
- Schizophrenia
- Dementia
- Substance misuse
- Physical illness e.g. Thyroid disease, hypoglycaemia.
Epidemiology:
Life time rate 4-5 %
Incidence 3% per year
Aetiology:
Biopsychosocial, Interaction between stressful events, genetic causes, early experiences, personality and social circumstances.
Areas of the brain most likely involved: the amyygdala, the hippocampus.
Na, 5-HT, GABA and recently CRH (corticotrophin releasing hormone)
Prognosis
Duration is important and the longer the GAD the worse the prognosis.
Co-morbidity (physical or psychiatric) worsen the prognosis
However GAD has a very good prognosis if treated.
Treatment
- Counselling: involving clear plan, explanation, reassurance, problem solving, advice about life style (e.g caffeine)
- Relaxation training has to be regular to work
- CBT (Cognitive -Behavioural Therap)
- Medications:in the short term, long acting BDZ (not more than 3 weeks, risk of addiction). For the long term, antidepressant are effective, SSRI first line and Venelafaxine is 2nd line.
Phobic anxiety disorders:
1. Specific phobia
Same core symptoms as GAD, but occur in particular circumstances, there may be anticipatory anxiety. Grouped into:
- Situation(e.g. crowded places)
- Objects (e.g. spiders)
- Natural phenomena (e.g. Thunder)
The following specific phobias will be described briefly:
Phobia of dental treatment: 5% of adults.
Phobia of flying: CBT or behavioural treatment (desensitization is effective)
Blood injury phobia: unique in that fainting does occur, tensing works effectively with behavioural treatment.
Phobia of choking: exaggerated gag reflex (usually past experience). Desensitization works.
Phobia of illness: though recognised as irrational and not resisted.
Epidemiology:
Incidence 4.4 %per year
Prevalence 4% in M and 13 % in F.
Most start in childhood.
2. Social phobia
Clinical picture:
Inappropriate anxiety, experienced in social situations in which the person feels observed by others and could be criticized by them. Avoidance and escape are characteristic. Can be generalised or specific (e.g. public speaking). Associated with depression and substance misuse
Two discrete social phobias require separate consideration:
- Phobia of excretion: patient become anxious and unable to pass urine in public lavatories, or fear of incontinence, patient arrange their lives so as never to be far from a lavatory.
- Phobia of vomiting: fear of vomiting in public places, feeling of nausea and anxiety.
Prevalence 7%. M=F (seeking treatment). F>M (community).
Treatment with psychotherapy or medication (SSRIs and ? blockers).
3. Agoraphobia
Patients are anxious when they are away from home, in crowds, or in situations that they cannot leave easily. They avoid these situations, feel anxious when anticipating them, and experience other symptoms. Especially panic attacks and fear of fainting and loss of control. Anticipatory anxiety is common, also depression, depersonalization and substance misuse.
Epidemiology:
Life time prevalence 6-10% F>M
Usually begins in mid twenties (later than social or specific phobias)
Panic disorder:
Clinical features:
Symptoms (at least 4) , more than 4 attacks in 4 weeks, or one attack followed by 4 weeks of persistent fear. Symptoms are:
- Shortness of breath and smothering sensation
- Choking
- Palpitation and accelerated heart rate
- Chest discomfort or pain
- Sweating
- Dizziness, unsteady feelings or faintness
- Nausea or abdominal distress
- Depersonalization or derealization
- Numbness or tingling sensations
- Flushes or chills
- Trembling or shaking
- Fear of dying
- Fear of going crazy or doing something uncontrolled.
Epidemiology:
Life-time prevalence is 5%.
Herdedibility is high, up to 30-40%.
F>M 2:1
Amongst men mortality is higher from cardiovascular disorders.
Mixed anxiety and depressive disorder
This diagnosis is reserved when the diagnostic criteria for depression or GAD are not severe enough to meet the criteria. Mild illness
Influence of culture on anxiety disorders:
In several cultures the presenting symptoms of anxiety disorders are more often somatic than psychological. e.g. Koro ,occur amongst Chinese men , there are episodes of acute anxiety, lasting 30 min to a day or two, the person complain of palpitation, sweating, pericardia discomfort and trembling. At the same time he is convinced that the penis will retract into the abdomen and that when this process is complete he will die.
References
•1. Stevens L, Rodin I. Psychiatry: An illustrated colour text, Churchill Livingstone 2001
•2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006
•3. World Health Organization (WHO). ICD-10 Classification of mental and behavioural disorders. Churchill Livingstone
•4. American Psychiatric Association (APA). DSM-IV-TR. Fourth Edition Text Revision. APA Publication