Generalized anxiety disorder
Generalized anxiety disorders are characterized by almost constant anxiety, regardless of external events. Destructive in the disorder is not so much the level of anxiety, usually also limited, but the fact of its persistence. It is a state of prolonged anxiety, a vague sense of threat, worrying about, undermining one's own competences, giving up plans. It is always stretched over time, with varying intensity in its course. The dominant symptoms are diverse, but include complaints of persistent nervousness, tremor, muscle tension, sweats, dizziness, palpitations, nausea and upper abdominal complaints. Often, fears are expressed that the patient or someone close to him / her is ill or injured. There are often vegetative symptoms, tension in various muscle groups, sleep disorders, attention. Patients often in this condition report to general practitioners for fear of their own life and health, with the conviction that there is a serious somatic illness. The treatment of choice is, as in other anxiety disorders, psychotherapy. Pharmacological treatment experts recommend in severe or resistant to psychotherapy cases. However, first of all physicians are under the obligation to rule out alleged somatic diseases. The purpose of pharmacotherapy of generalized anxiety disorder is to effectively alleviate or eliminate axial symptoms of the disease, co-morbidities, preventing relapse and, at the same time, not risking addiction to benzodiazepines.
Night fears
Night-time anxiety is a sleep disorder classified as parasomnia characterized by extreme horror and a temporary inability to regain full consciousness. The disorder usually occurs shortly after falling asleep, in the fourth stage of the deep NREM sleep phase. The patient most often sits on a bed, rarely gets up from bed, screaming or moaning in horror. Despite the open eyes, there is no full awareness and often fail to wake up. After an attack lasting usually from a few seconds to several minutes, the patient calmly falls asleep and usually does not remember the attack later. Nighttime fears differ from another type of parasomnia - nightmares - in several respects. First of all, in the case of night fears, the patient does not fully wake up, and his full awakening is often impossible. Secondly, the patient reacts negatively to physical touch (eg embrace) by pushing off a person trying to calm him down. Thirdly, the patient usually does not remember the course of the incident. Fourthly, night terrors occur in the NREM sleep phase, while nightmares occur in the REM sleep phase. Night fears are thought to be a sleep disorder related to somnambulism. The disorder is most common in children, aged from six months to 12 years. Most often it happens between the third and fourth year of life. According to various estimates, between 1% and 6% of children occur, regardless of race and sex.
Fears in connection with heartache
In recent years, the incidence of acute myocardial infarction has decreased, while the number of people admitted to the hospital due to chest pain has increased. The creation of chest pain observation departments has allowed to improve the diagnosis and risk stratification, as well as to reduce the number of admissions to the hospital. In the case of patients with confirmation of the etiology of coronary ailments, the developed strategy is effective. However, patients with non-coronary pain are a bigger problem. This group of patients does not appear to be burdened with an increased risk of death, however, it is exposed to frequent rehospitalisations.According to the literature, even after elimination of the cardiac cause of pain, persistent ailments adversely affect the quality of life.
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
Private office tel. 22 833 18 68
00-774 Warsaw, Dolna 4 lok. 15
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Phobia
Anxiety and mental irritation triggering an unpleasant emotional tension (fear, feeling disgusted), appearing in specific situations or in relation to certain objects, people or circumstances. Social phobia is a fear of being judged by others leading to avoiding social situations. More comprehensive social phobias are usually associated with low self-esteem and fear of criticism. They may have complaints about blush, trembling, nausea or sudden urination; a person experiencing these secondary manifestations of anxiety sometimes thinks that these are primary problems. Symptoms may increase until panic attacks. The main symptom of social phobia (social anxiety) is not the fear of contact with a specific person or group of people, but rather the failure to deal with a social situation in which we can be judged. It is an intense and persistent fear of being in the spotlight, being observed by others, the need to carry out tasks in relation to others, meeting new people. The patient adopts a strategy of increased control over their behavior, then disorganization and convincing the patient - compromising behavior. These concerns concern individual events (a simple form of social phobia) or most interpersonal contacts (a generalized form). In the second case there are significant disruptions of psychosocial functioning. Sometimes phobia can be clearly specific (isolated), limited to such situations as: proximity of animals, staying at altitude (acrophobia), thunder, darkness, flying, staying in a closed space (claustrophobia), passing urine or stool in public toilets, eating certain dishes, dental treatments, blood sight or other effects of injury. Although the liberating situations are specific, contact with them causes panic like in agoraphobia or social phobia. This condition is always an indication to start treatment. The basic methods of treating social phobia are psychotherapy as the main method of treatment and pharmacotherapy. Because not only the deficit in dopaminergic conduction is important in the formation of social anxiety disorder, but also the influence of neurotransmitters such as serotonin, noradrenaline and gamma-aminobutyric acid (GABA), therefore, effective drugs in this disease entity are preparations that act on the aforementioned neurotransmitter systems. In international standards of care, the drugs of choice are antidepressants from the SSRI group. The dosage of SSRIs is similar to that of panic attacks. In the initial period, as a complementary treatment, benzodiazepines with significant potency may be used, which relieve the tendency to anxiety well. And in this case, however, should not be given long-term, because, as research has shown, this is associated not only with the risk of addiction, but also with data on rapid recurrence of symptoms even after slow and gradual withdrawal of long-term benzodiazepines.
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Agoraphobia
Agoraphobia is a clearly defined group of phobias including fear of leaving the home, being in shops, crowds or public places, or before traveling alone on trains, buses or airplanes. A frequent symptom is panic attacks. As secondary symptoms, obsessions and social phobias tend to be secondary. Avoidance of the above-mentioned situations is remarkably intensified and people with agoraphobia generally rarely experience fear, because they can effectively avoid situations that raise concerns. Stan described for the first time by Westphal in 1872 as a morbid fear of large, open spaces.
Anticipation anxiety
Above anxiety reaction to the uncertainty of future events. "I'm scared because I feel that I will be afraid there." Too much fear affects the action, and in extreme cases it can even lead to the resignation of ambitious goals. Due to the perceived "fear of the future", the individual may remain at the average level of intentions, because the anxiety connected with it is still bearable. It can also take an attitude of "not leaning" beyond the barrier of tolerable anxiety.
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dr med.Janusz Krzyżowski
Psychiatrist
Private office tel. 22 833 18 68
00-774 Warsaw, Dolna 4 lok. 15
