Anxiety Neurosis

All people experience fear and anxiety. Fear is an emotional, physiologic, and behavioral reaction to a recognised external threat. Anxiety is an unpleasant emotional state that has a less clear source. Anxiety is a response to stress, such as the break-up of an important relationship or exposure to a life-threatening disaster.

One theory holds that anxiety may also be a reaction to a repressed sexual or aggressive impulse that's threatening to override the psychologic defences that normally keep such drives in check. As such anxiety indicates the presence of psycologic conflict. This is the commonest form of psychoneurosis characterised by lack of concentration, loss of interest and unforeseen fears due to adaptation to environmental stress. It may thus be said that anxiety is often accompanied by physiologic and behavioral changes similar to those caused by fear.

Because of these similarities, people often use the terms anxiety and fear interchangeably. Anxiety can arise suddenly, as in panic, or gradually over minutes, hours or days. The anxiety itself can last for any length of time, from a few seconds to years. It ranges in intensity from barely noticable qualms to full blown panic. In fact anxiety serves as one element in a wide range of flexible responses that are essential for people to survive in a dangerous world. A certain amount of anxiety introduces an appropriate element of caution in potentially dangerous situations.

Most of the time, a person's level of anxiety makes appropriate and imperceptible shifts along a spectrum of consciousness from sleep through alertness to anxiety and fear and back again. Sometimes, however, a person's anxiety response system operates improperly or is overwhelmed by events; in this case, an anxiety disorder can arise. People react differently to situations. The ability to tolerate anxiety varies among people, and determining what constitutes abnormal anxiety can be difficult.

However, when anxiety occurs at inappropriate times or is so intense and long-lasting that it interferes with a person's normal activities then it is properly considered a disorder. Anxiety disorders can be so distressing and interfere so much with a person's life that they can lead to depression at the same time. Others develop depression first and then anxiety disorder later. Anxiety disorders, as told earlier, are the most common type of psychiatric disorder. The diagnosis of an anxiety disorder is based largely on its symptoms. Depression and anxiety neurosis are most common anxiety disorders.

Depression and Anxiety Neurosis: Depression

Depression is an affective disorder with disturbance of mood. It like anxiety (with which it is associated), is upiquitous and is a reality of everyday life. It frequently presents in the form of somatic complaints with negative medical workup. It can be a normal reaction to a wide variety of events and must be evaluated as such. Depression may occur alone or combined or in cycle with mania.

Depression usually presents with misery and malaise associated with poor self-consciousness and self-abnegation without hope.

Aetiolog : Not clearly known.

Predisposing Causes :

1. Heridity is an important factor.
2. Constitution : These patients are of pyknic built, obese and muscular development is poor.
3. Exposure to stress is important.
4. Organic diseases depressing the vital powers may play some role e.g. various viral diseases, candiova scular diseases, anaemia, myxoedema, cardinoma etc.

Clinical Features :

Manic depression may be present. Besides, various somatic manifestations are-loss of appetite, loss of weight, amenorrhoea, pressure headache, backache, constipation, retardation of physical activity etc.

Treatment

1. Supportive psychotherapy-sympathetic attitude towards the patient, encourangement or reassurance should be given.
2. Antidepressive drugs - a. Tricyclic antidepressants e.g. Imipramine or Amitriptyline 50-75 mg tbs for a period of 3-6 months. b. Monoamine oxidase inhibitor drugs e.g. Iproniazid 150-300 mg daily. Phenelzine 34-90mg daily. Nialamide 50-150mg daily.
3. Electroconvulsive therapy -
   This is also helpful in some cases, particularly when there is high risk of suicide.

Anxiety Neurosis

This is the commonest form of psychoneurosis characterised by lack of concentration, loss of interest and unforeseen fears due to adaptation to environmental stress.

Antiology :

1. Many patients appear to have personality traits of high anxiety and poor tolerance of stress.
2. Unexpected life events which the patient cannot handle.
3. Unexpected disasters such as floods, accidents and terrorist activities.
4. Sexual background

Clinical Features :

These are devided into 2 groups- psychological and somatic. If somatic symptoms predominate the patient is likely to regard himself as physically ill.

Symptoms of Anxiety Disorder:

Treatment :

1. Explanation and reassurance.
2. Specific relaxation techniques should be tought.
3. Change of place may be effective.
4. Diazepam 2-10mg t.d.s for 3 wks.
5. Benzodiazepines also may be used.
6. Beta-adrenoceptor blocking drug i.e. proprano-lol 30-80mg daily.
7. Amtriptyline 50-150mg at night.
8. MAO inhibitor i.e. phenelzine 15mg q.d.s

Prognosis: Good

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