12 May 2020 Author : Daniel Barrocas Anxiety is part of normal emotions and is known, better or worse, by everyone. Therefore, when anxiety is not normal, it is easily devalued and stigmatized as a disease . It is estimated that about 20% -25% of the population has some type of anxiety disorder. Of these, few seek medical advice timely, and this delays treatment and can worsen the prognosis. Anxiety treatment is generally quite effective. What is anxiety and how does it manifest? Anxiety is a normal emotion, which is part of the set of physical and emotional reactions to various external stimuli. Therefore, within certain limits, it is normal and even adaptive . It can be defined as a state of fear or a fear motivated by factors such as the anticipation of a potentially unpleasant situation, the perception that one will be in danger, being threatened or vulnerable to the environment and other people. Anxiety may have several symptoms , for example: Psychic symptoms: such as fear, anticipated fear, restlessness, change in concentration / attention; Physical symptoms: dry mouth, difficulty swallowing, abdominal discomfort, nausea, flatulence, changes in intestinal transit, tachycardia, palpitations, chest tightness, genital-urinary changes, sexual dysfunction, muscle tension, headache, diaphoresis (excessive sweating), insomnia. Anxiety as an adaptive mechanism In situations of perceived threat or anticipation of an unpleasant or dangerous situation, there is a stimulation of the sympathetic nervous system that prepares the organism to respond adequately, that is, fight in the face of a threat or face a potential flight. Among other manifestations, stimulation of the sympathetic nervous system causes : Physical changes: such as increased heart rate, respiratory rate and sweating; Cognitive changes: such as increased concentration and attention. In this way, the organism is brought into a state of alarm in relation to the external and internal environment. When threat control is achieved, the effect of the sympathetic nervous system decreases, and the parasympathetic nervous system is stimulated. This triggers contrary responses, such as decreased heart and respiratory rate, reduced attention and concentration and decreased alertness, thus moving to basal, non-anxious state. This adaptive mechanism is normal and useful in many situations , for example: Situations of real physical danger, for example riding a bicycle on a very busy road. In this case, physical and cognitive activation leads the driver to be more attentive, with awakened reflexes to avoid potentially dangerous situations; Situations experienced as potentially unpleasant, for example an exam, in which controlled anxiety makes us be more attentive and focused. What are anxiety disorders If the anxiety experienced is excessive for the situation, or even arises without any trigger, it ends up causing an inability to respond and unpleasant and dysfunctional symptoms for the patient. In these situations, anxiety is maladaptive, and begins the field of anxiety disorders . Anxiety disorders are often accompanied by other psychiatric illnesses, either as a cause or a consequence. The simultaneous existence of depressive and anxious symptoms in the same patient is very prevalent, just like alcohol consumption or anxiolytic medicines abuse to reduce symptoms. Both the consumption of toxics and the coexistence with other diseases, aggravate the prognosis and hinder the treatment of anxiety disorders. According to the most recent classifications, the following are considered as the main anxiety disorders: Specific phobia; Panic disorder; Agoraphobia; Generalized anxiety disorder. Generalized anxiety disorder This disease is characterized by the more or less constant presence of anxiety symptoms , without any triggering event, neither for aggravation or relief. Among the symptoms of generalized anxiety disorder , the following stand out: Physical manifestations characteristic of hyperactivity of the nervous system; More intense and sustained concern / fear regarding most or all aspects of daily life, without an understandable reason for this concern; Excessive alertness, with irritability, difficulty concentrating, reduced tolerance to noise; Muscle tension, which often manifests as muscle pain; Alteration of the sleep pattern, with insomnia, nightmares, and non-restorative sleep. What causes generalized anxiety disorder It is not possible to identify a single cause for this disease. It is accepted that it is caused by stress-inducing factors that act on a personality predisposed to anxiety. This predisposition may be genetic related and / or due to current and past environmental / family facts. The relative weight of these factors is not completely understood. In neurobiological terms, the generalized anxiety disorder appears to be due to a dysfunction of the system that causes physiological anxiety, leading to the maintenance of the state of anxiety that occurs in these patients. Brain structures such as the amygdala, the thalamus, the hippocampus and the ventral-lateral prefrontal cortex, and neurotransmitters, such as norepinephrine, serotonin and gamma amino-butyric acid (GABA) are involved in this disease, contributing to excessive activation and maintenance anxiety or an inability to "shut down" and reduce symptoms. How the diagnosis is made The diagnosis of generalized anxiety disorder is based on the clinical observation of the patient since there are no diagnosis tests to confirm or exclude the diagnosis. However, to exclude physical causes that may be at the origin of the symptoms, it may be necessary to resort to clinical analyzes and other diagnostic tests. Generalized anxiety disorder is often accompanied by other psychiatric disorders, such as depression, and other anxiety disorders, like social phobia or panic disorder. The presence of comorbidities worsens the prognosis. Treatment of generalized anxiety disorder The treatment of this frequent and limiting disease is generally highly effective. As in most anxiety disorders, it is based on medication (psychopharmacology) and psychotherapy , whenever possible combined to optimize the therapeutic response: Antidepressants from the families of selective serotonin and of selective serotonin and norepinephrine reuptake inhibitors are the most frequently used, mainly for its favorable side effect profile. Anxiolytics are sometimes combined with antidepressants to accelerate the therapeutic response, but always with the objective of reducing their use as early as possible due to the risk of dependence. However, this risk is reduced if these drugs are used in adequate doses and periods, the benefit being much greater than the risk. Other symptoms that are present, such as insomnia, may be the target of specific medication, but for a short time. Regarding psychotherapy, the cognitive-behavioral approach is the most studied and has the more favorable results. Alcohol abuse, consumption of illegal substances and the inappropriate use of medications, are frequent in generalized anxiety disorder and worsen its prognosis, making adherence to treatment and its effectiveness difficult. The stigma in relation to psychiatric illnesses in general and the devaluation of anxiety, mean that, with some frequency, patients take a long time to seek specific medical help. This situation worsens their quality of life, worsens the prognosis of generalized anxiety disorder, and increases the worsening of eventual concomitant illnesses, whether psychiatric or physical, and can even constitute a relevant risk factor for the patients life. Meet the psychiatry team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
