Symptoms anxiety

Under certain circumstances, anxiety is an appropriate emotional response. We expect a person to feel sad after a signihcant loss such as the death of a loved one, and it is eqnally reasonable for a person to feel fearful and anxious when faced with a frightening situation such as a painful or risky medical procedure. Indeed, in the context of the fight or flight reaction readily witnessed in nature when a predator is lurking near its intended prey, the physical and mental symptoms of anxiety can indeed be adaptive. This anxiety clearly serves as an appropriate alarm that potential danger is nearby and readies the individnal for a self-protective response. 

The symptoms of anxiety are both mental and physical. Mentally, anxious people often describe themselves as worried, keyed up, restless, or on edge. They experience difficulty concentrating and often describe their minds as going blank. Anxious people also describe a variety of physical symptoms that impact on nearly every organ system (see Table 5.1). 

Cardiovascular Rapid pulse, bounding heartbeat, palpitations, profuse sweating, clammy hands 

Gastrointestinal Nausea, vomiting, diarrhea, dry mouth, lump in throat, butterflies Musculoskeletal Restlessness, muscle tension, pacing, muscle pain Neurological Dizziness, lightheadedness, fainting, headache, tremulousness, tingling 

Urinary Frequent urination, difficulty initiating urination 

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Verheul et al. (2004) pooled data from seven European acamprosate studies in an effort to identify patient-related predictors of response to the medication. Although they examined a number of potential predictors, including patients level of physiological dependence before treatment, family history of alcoholism, age of onset of alcoholism, baseline anxiety symptom severity, baseline craving, and gender, none was shown to interact with acamprosate treatment. These findings led the authors to conclude that, although the effect size for acamprosate was moderate, the medication can be considered potentially effective for all patients with alcohol dependence. 

Symptoms of a major depressive episode usually develop over days to weeks, but mild depressive and anxiety symptoms may last for weeks to months prior to the onset of the full syndrome. Left untreated, major depressive episodes typically last 6 months or more, but a minority of patients experience chronic episodes that can last for at least 2 years. Approximately two-thirds of patients will recover fully from major depressive episodes and return to usual mood and full functioning, whereas the other third will have partial remission and may continue to experience detrimental effects.3... 

O The goals of therapy for generalized anxiety disorder are to acutely reduce the severity and duration of anxiety symptoms and restore overall functioning. The long-term goal in generalized anxiety disorder is to achieve and maintain remission. 

Anxiety is a normal response to stressful or fearful circumstances. Most people experience some degree of anxiety in reaction to stressful situations, such as final exams or giving a speech. This allows an individual to adapt to or manage the stressful/threatening situation. Anxiety symptoms generally... 

Imipramine treatment resulted in a higher rate of remission of anxiety symptoms than trazodone, diazepam, or placebo (e.g., 73% versus 69% versus 66% versus 47%) in an 8-week controlled trial of DSM-III-diagnosed GAD patients. Antidepressants were more effective than diazepam or placebo in reducing psychic symptoms of anxiety. The use of TCAs generally is limited by bothersome adverse effects (e.g., sedation, orthostatic hypotension, anticholinergic effects, and weight gain). 

Assess patients for improvement of anxiety symptoms and for return to baseline occupational, social, and interpersonal functioning. With effective treatment, the patient should have no or minimal symptoms of anxiety or depression. While drug therapy is being initiated, evaluate patients more frequently to ensure tolerability and response. Increase the dose in patients exhibiting a partial response after 2 to 4 weeks on an antidepressant or 2 weeks on a benzodiazepine. Individualize the duration of treatment because some patients require up to one year of treatment.27... 

The importance of adenosine deaminase in the duration and intensity of sleep in humans has been noted recently (Retey et al. 2005). Animal studies suggest that sleep needs are genetically controlled, and this also seems to apply in humans. Probably, a genetic variant of adenosine deaminase, which is associated with the reduced metabolism of adenosine to inosine, specifically enhances deep sleep and slow wave activity during sleep. Thus low activity of the catabolic enzyme for adenosine results in elevated adenosine, and deep sleep. In contrast, insomnia patients could have a distinct polymorphism of more active adenosine deaminase resulting in less adenosine accumulation, insomnia, and a low threshold for anxiety. This could also explain interindividual differences in anxiety symptoms after caffeine intake in healthy volunteers. This could affect the EEG during sleep and wakefulness in a non-state-specific manner. 

It may be that any peripherally adversive stimulus — especially one that stimulates sympathetic activity — thus has the potential to activate brain areas of prime importance in the formation of anxiety symptoms. As a result of pharmacological challenge studies, biochemical assays, neuroimaging and studies of animal models, a number of centrally acting neurotransmitters, and their relevant neural circuits, are implicated in anxiety. These neurotransmitters include norepinephrine, serotonin, GABA, neuropeptide Y, cholecystokin and substance P. 

Anxiety symptoms may be associated with medical illnesses (Table 68-5) or drug therapy (Table 68-6). About 50% of patients with GAD have irritable bowel syndrome. 

Anxiety symptoms may be present in several major psychiatric illnesses (e.g., mood disorders, schizophrenia, organic mental syndromes, and substance withdrawal). 

Common Medical Illnesses Associated with Anxiety Symptoms... 

Initially, anxious patients should be monitored once to twice weekly for reduction in anxiety symptoms, improvement in functioning, and side effects. The Visual Analog Scale may assist in the evaluation of drug response. 

Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer prognosis. 

The SSRIs produce fewer sedative, anticholinergic, and cardiovascular adverse effects than the TCAs and are less likely to cause weight gain than the TCAs. The primary adverse effects include nausea, vomiting, diarrhea, headache, insomnia, fatigue, and sexual dysfunction. A few patients have anxiety symptoms early in treatment. 

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