Anxiety disorders are the most prevalent mental disorders in the general population. Approximately one in four adults has anxiety disorders at some point in his life. Anxiety is an unpleasant state that involves a complex combination of emotions including fear, apprehension and worry.
It is often accompanied by physical sensations such as palpitations, sweating, headache, shortness of breath, chest pain etc. These disorders are usually the result of over load of mind. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.
It is also common in children and adolescents. There are differential onsets of anxiety disorders in respect to specific age. Specific phobias in middle childhood, over anxious disorders in late childhood, social anxiety disorder in middle adolescence, Panic disorder in late adolescence, Generalized anxiety disorders in young adulthood and Obsessive-compulsion disorders in early adulthood. Girls are more likely to have an anxiety disorders than boys. Sensitivity to anxiety predicts the frequency and intensity of Panic attacks.
Phobia is a fear, a known factor which is supposed to be due to unawareness. We first have to assess the pathological fear structure and then we try to let the patient understand lower the emotional reactivity by Cognitive behavioral therapy (CBT). Social anxiety disorder or Agoraphobia is when a person is afraid from attending social gatherings. It is particularly found in mid-adolescents. The parents always try to happily pacify this incident by a thought that their children are trying to concentrate in studies or profession. So it is rarely clinically diagnosed as the patient does not think it is a psychiatric problem. Panic disorder in late adolescents comprise of several future related problems which they can not estimate due to their short vision. Here also the parents or friends come to rescue him, ignoring his psychological maladaptation. Generalised anxiety disorders in young adulthood are found due to several personal and professional confrontations. They become inflexible to any kind of hardcore situation and become anxious with the reactivity. These patients usually comes to a psychiatrist by presenting their emotional vulnerability. These patients usually visit a psychiatrist alone, but it is strongly suggested to attend the patient along with his family member as they have usual suicidal tendency. Lastly it’s the turn for Obsessive-compulsion disorders which is predominantly found in early adulthood. Here the patients have persistent and recurrent thoughts which become compulsive. The patient can not retrieve himself by those thoughts. In Indian culture “cleanliness (Shuchi), premature ejaculation, decrease in breast size and length of penis” are common compulsive thoughts.
Chemicals & Hormones Responsible For Anxiety: The neurochemical aspect of stress prepares a person for threat in multiple ways, through increased attention, vigilence, modulation of memory, planning and preparation of action. All these result into biological changes like increased heart rate, blood pressure and rapid modulation of energy.
Corticotrophin releasing hormone(CRH) are increased by stress. It activates the fear related behaviors. Galanin which is present in our body is a protein structure, contains 30 amino acids. It involves in number of physiological and behavioral functions, including learning and memory, pain control, food intake, cardio vascular regulation and obviously anxiety. Acute stress increases Dopamine release. Different types of acute stress result in increased serotonin turnover in multiple brain areas.
Fear and anxiety normally constitute adaptive responsee to stress. These emotional and behavioral sets arise in response to different stimuli.
Almost 20% of total population of India is suffering from treatable Anxiety disorders.
Firstly proper history has to be taken to elicit any medical problem. The common medical problems where anxiety is found are Thyrotoxicosis, Hypoparathyroidism, increased blood sugar and high blood pressure
Medicines which contain Shilajit, Aswagandha, Brahmi, Jatamansi, Kushmand, Vacha, Shankhpushpi, Khurasani Ajwain and Mukta pishti are very effective. Clinically Cognitive behavioral psychotherapy(CBT) is very fruitful. Psychotherapy along with medication is found to have very good outcome. The other effective therapy is Shirodhara.
Psychotherapeutic sessions should be for 30 mins. It should be performed once in a week. Total sittings should be 6-8 times.
Case Report: A 17 years old girl, younger of two siblings from family of good socio-economic condition came to OPD (Reg. No. 9401) with the complaint of headache, heaviness of head and night terrors for last three months. After taking proper history from the informant she has been diagnosed as a patient of Generalized Anxiety Disorder (G.A.D). Initially she was given
Cap. Nervocalm (D.A.V) 1 cap twice daily, Cap. Shilajit 1 cap twice daily, Muktapisti (65mg) twice daily
After 1st week she was feeling 50% relief. The same treatment continued for another two weeks, she was feeling much better than earlier. Then the first phase of Supportive psychotherapy has done after one week. From the next week Cognitive behavioral therapy (CBT) has been performed for six consecutive sessions. Between the course of time two sessions of family counselling were given. Medicines were stopped after one month of resuming the treatment. Now the patient is in her normal social life without any problem.
Conclusion: Though psychotherapy is very helpful but the main problem is non adherence to treatment by the patient, specially the young generation who is easily vulnerable with stress disorders. In these cases it it very necessary to treat them very carefully and patiently by a trained psychiatrist. The psychotrophic drugs are helpful to increase the psychological sophistication of the patient. With the advise of psychiatrist session should be started.