Anxiety

Anxiety disorders may include phobias ( for example, acrophobia, the fear of heights), obsessive compulsive disorders ( for example the constant hand washing described above)or post- traumatic stress disorder.

June 12, 2015, 5:45 p.m. Published in Magazine Issue: Vol: 09 No. -1 June. 12- 2015 (Jestha 29, 2072)

It is natural to be worried or fearful every now and then, but sometimes  these feeling become persistent ( over weeks to months to years), overwhelming, and interfere with daily existence.Often there are feelings of intense panic, and perhaps even a sense of doom. Some people may start hyperventilating (rapid breathing) accompanied by sweating and trembling with palpitations (being aware of the heart beating). Some patients start re-experiencing the feeling of traumatic events in the past which in the first place may have triggered these symptoms.Other patients may feel an irresistible urge to perform certain rituals ( for example constant hand washing) without any purpose. The patient may know this is irrational behavior but is unable to help himself. All these symptoms can be categorized under a broad umbrella of anxiety disorder, a common problem in the general population.

Anxiety disorders may include phobias ( for example, acrophobia, the fear of heights), obsessive compulsive disorders ( for example the constant hand washing described above)or post- traumatic stress disorder. Although there is no blood test which will show an anxiety disorder, it is important to make sure that certain common medical problems which simulate an anxiety attack are ruled out. These include certain heart and lung diseases, thyroid diseases, asthma, drug abuse and alcohol withdrawal. Once it is clear that these medical problems are not the cause of the anxiety disorder  then a treatment strategy needs to be planned. In some medical texts it is said that people who live in developing countries are less anxious than in the West. This difference is clearly changing rapidly.

Although the environment we grow up in definitely molds our thinking, there is good evidence that anxiety disorder probably has a strong genetic contribution.  

Medications for anxiety disorders and depression are often the same, but anxiety is different from depression.People with depression have to get over their depression first with proper treatment before they can be productive; but in general patients with long terms anxiety disorder may continue to be active and contribute to society.

Amazing as this may sound, there are many people with anxiety disorders that have lead very successful lives. Bill Russell, the star center for the famous basketball team in the US, the Boston Celtics, used to be so nervous that he vomited profusely before almost every game he played in. (And yet he was a dominant player of his time, even if he played in the preMiachel Jordan days). In fact on nights he did not vomit his team mates worried about the outcome of the game.Charles Darwin, the father of the theory of evolution suffered from social anxiety and found it very difficult to leave his house. Hugh Grant, the famous UK actor suffers from so much stage fright that he has often strongly considered quitting making movies.

In a sense it would be cool to be like Clint Eastwood in the movies about the American West or to project an image similar to the unfazed actor Paul Newman. But it is important to realize that for many with anxiety disorders just coping with their biology is certainly possible.

Indeed it is important for family and friends to re assure people with anxiety disorders that they can keep going. Broad treatment plans include psychotherapy ( also known as cognitive behavioural therapy or psychological counseling ). Lifestyle changes such as avoiding alcohol and coffee may be helpful especially if these are clear triggers for the problem. Quitting smoking may also be helpful as the nicotine in the cigarette can increase the heart rate and blood pressure and cause anxiety. Relaxation techniques such as meditation and regular exercise is almost always helpful. With the advice of a doctor anti anxiety  medicationmay help. And what is not emphasized enough is the importance of restful sleep in a quiet environment in the management of anxiety disorders

Buddha Basnyat.jpg

Buddha Basnyat MD

Buddha Basnyat, MD, MSc, FACP, FRCP, Director of the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu.

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