Panic Disorder With Agoraphobia
Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks and panic disorder. Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.
For example, you may begin to avoid:
- Crowded places such as shopping malls or sports arenas.
- Cars, airplanes, subways, and other forms of travel.
- Social gatherings, restaurants, or other situations where it would be embarrassing to have a panic attack.
- Physical exercise in case it triggers panic.
- Certain food or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.
- Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.
Mental Health Conditions: Depression And Anxiety
Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:1
- Feeling sad or anxious often or all the time
- Not wanting to do activities that used to be fun
- Feeling irritable easily frustrated or restless
- Having trouble falling asleep or staying asleep
- Waking up too early or sleeping too much
- Eating more or less than usual or having no appetite
- Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
- Having trouble concentrating, remembering details, or making decisions
- Feeling tired even after sleeping well
- Feeling guilty, worthless, or helpless
- Thinking about suicide or hurting yourself
The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.
The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental, and psychological factors.2 Everyone is different but the following factors may increase a persons chances of becoming depressed:1
Howanointedsmiledrops Stress Panic Attacks Work Naturally
Drug And Alcohol Misuse
Some studies have shown that conditions that cause intense anxiety, such as panic disorder, can also increase your risk of developing an alcohol or drug problem.
The side effects or withdrawal symptoms of both prescribed medication and illegal drugs can increase the symptoms of anxiety.
Smoking and caffeine can also make your anxiety symptoms worse, so you should try to give up smoking and limit the amount of caffeine in your diet.
Dont Fight A Panic Attack
Fighting a panic attack can often make it worse. Trying to resist the attack and finding youre unable to can increase your sense of anxiety and panic.
Instead, during a panic attack, reassure yourself by accepting that although it may seem embarrassing, and your symptoms may be difficult to deal with, the attack isnt life-threatening. Focus on the fact that the attack will evetually end and try your best to let it pass.
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Causes Of Anxiety Disorders
If an anxiety disorder is diagnosed, drug therapy or psychotherapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment… read more , alone or in combination, can significantly relieve the distress and dysfunction for most people. Benzodiazepines are commonly prescribed for acute anxiety. For many people, antidepressants, Drug Therapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment… read more such as selective serotonin reuptake inhibitors , work as well for anxiety disorders as they do for depression. Specific treatments depend on which anxiety disorder is diagnosed.
Different Types Of Anxiety Disorder
Anxiety disorders fall into several categories. Here are a few of them:
- Panic disorder can be associated with cardiac disease or mistaken for heart attack. Feelings of extreme agitation and terror are often accompanied by dizziness, chest pains, stomach discomfort, shortness of breath, and rapid heart rate.
- Post-traumatic stress disorder a condition that can follow a shocking or frightening incident or sudden, life-threatening event such as a violent crime, major accident, or heart attack. A person suffering from PTSD often has trouble dealing with anything associated with the incident that caused their condition, and experiences feelings of jitteriness and detachment.
- Obsessive-Compulsive disorder People with OCD will manage unreasonable thoughts and worries by performing the same actions over and over. For example, an individual obsessed with perceived cardiovascular symptoms that have been checked and cleared by a physician may compulsively research them or find new ones for hours on end.
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Treatment Of Anxiety Disorders
The treatment of anxiety disorders should begin with a consideration of the type of symptoms and their nature, severity, intensity, frequency, and duration. Psychiatric conditions and/or medical conditions that frequently occur together should also be taken into account. Treatment choices will often depend partly on the patients preference.
First-line medications for treating GAD are similar to those for SAD: SSRIs or serotonin norepinephrine reuptake inhibitors. Benzodiazepines may be useful for patients who experience anxiety symptoms when starting either of these or for patients who have failed to respond. Supportive counseling, insight-oriented psychotherapy, CBT, and group therapy may also be helpful. Education aimed at healthy lifestyles, proper nutrition, exercise, and minimizing caffeine is recommended.
While patients presenting with spontaneous panic attacks may benefit from an SSRI or SNRI and education, use of a benzodiazepine would not be indicated. In contrast, patients with cue-induced panic attacks may benefit from an SSRI or SNRI and may also require a benzodiazepine in severe cases. Guidance in the area of stress management and coping skills is also of benefit.
Preventing A Further Attack
It may help to:
- read a self-help book for anxiety based on the principles of cognitive behavioural therapy ask your GP to recommend one
- try complementary therapies such as massage and aromatherapy, or activities like yoga and pilates, to help you relax
- learn breathing techniques to help ease symptoms
- do regular physical exercise to reduce stress and tension
- avoid sugary food and drinks, caffeine and alcohol, and stop smoking, as all they can all make attacks worse
For more help, read how to deal with panic attacks.
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How Anxiety Affects Performance
The effects of anxiety on performance can be shown on a curve. As the level of anxiety increases, performance efficiency increases proportionately, but only up to a point. As anxiety increases further, performance efficiency decreases. Before the peak of the curve, anxiety is considered adaptive because it helps people prepare for a crisis and improve their functioning. Beyond the peak of the curve, anxiety is considered maladaptive because it produces distress and impairs functioning.
What Increases Your Risk
Your risk for panic attacks and panic disorder may be higher if you:
- Have a family history of panic disorder. You are also at increased risk if you have a parent with either depression or bipolar disorder.
- Have other conditions associated with panic disorder or panic attacks, such as depression.
- Drink alcohol, use illegal drugs, chain-smoke cigarettes, or drink large amounts of coffee or other caffeinated beverages.
- Take medicines known to trigger panic attacks, such as those used to treat asthma or heart problems.
- Have had previous, unexpected panic attacks.
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How Does Panic Attack Occur
It usually occurs when you start feeling like something is fluttering around your stomach, breaking out in a cold sweat, trembling and shaking, or sensing impending danger for no apparent reason. In some cases, you may feel like you are going to die the next minute. While many people may experience these occurrences in specific situations, in many cases, they have no idea what triggers these experiences.
This will lead you to avoid any situation that you fear and can cause an attack. In some cases, you may even feel embarrassed about these attacks. That is why some patients may not open up about the situation or pull away from family and friends to hide the situation. At worst, they may resort to alcohol as a coping mechanism. All these can ruin a persons life. Seeking professional help will likely get you a lasting solution for calming a panic attack.
Anxiety And The Development Of Heart Disease
Its my view and my personal clinical experience that anxiety disorders can play a major role in heart disease, says McCann. I believe that a really careful look at anxiety would reveal the ways it can severely impact heart disease, both as a contributing factor and as an obstacle in recovery.
A natural reaction to a sudden heart attack can be similar to post-traumatic stress disorder:
- Youre likely to be shocked by your near-death experience and extremely hesitant to do the things you used to do.
- You might constantly relive the life-threatening event, and avoid the activity or place associated with the heart attack.
- Recurring anxious thoughts may impede your ability to get regular sleep.
- Your thoughts about what lies ahead may be extremely negative and cause a drastically foreshortened outlook of the future.
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Enhancing Healthcare Team Outcomes
There is no cure for panic disorder, and it can present in a number of ways, thus making the diagnosis difficult. The majority of patients with panic disorder present to the emergency department and hence the role of the nurse and emergency clinician cannot be overemphasized. The patient needs a thorough education on the disorder and understands that the symptoms are not life-threatening. The patient needs to be told about the different treatments available and the need for compliance. Plus, the pharmacist should caution the patient against the use of alcohol or recreational drugs. The patient should be taught to recognize the triggers and avoid them. Before starting any drug therapy, the patient should be informed about the side effects and benefits. In addition, the family should be educated by the nurse and clinician in helping the patient overcome unrealistic fears and other behaviors. Finally, the patient should be educated on a healthy lifestyle by adopting good sleep hygiene, exercise, and a healthy diet. The patient should be advised against any herbal supplements without first speaking to the primary care provider. A team approach to the care of these patients will lead to the best outcomes.
Panic Disorder: When Fear Overwhelms
Do you sometimes have sudden attacks of anxiety and overwhelming fear that last for several minutes? Maybe your heart pounds, you sweat, and you feel like you cant breathe or think clearly. Do these attacks occur at unpredictable times with no apparent trigger, causing you to worry about the possibility of having another one at any time?
An untreated panic disorder can affect your quality of life and lead to difficulties at work or school. The good news is panic disorder is treatable. Learn more about the symptoms of panic disorder and how to find help.
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Social Phobia: Social Anxiety Disorder
Social anxiety disorder is among the most common mental disorders on a lifetime basis. Prevalence ranges from 12% to 14% of the population.3 The hallmark of SAD is the marked and persistent fear of one or more social or performance situations. There is the fear that one will act in a way that will be humiliating or embarrassing. In some cases, exposure to the feared situation may lead to a panic attack.
Generalized SAD is characterized by fear and/or avoidance of multiple social situations and is the most common form of SAD among patients presenting to a primary health-care provider.3 The onset is usually in childhood or early adolescence and is believed to stem from genetic as well as environmental factors. Research has shown that parents who have SAD tend to be overprotective and are overly sensitive to social disapproval themselves.4
Possible Medical Reasons For Anxiety
A useful mnemonic device, THINC MED, developed by Georgetown University psychiatrist Robert Hedeya, MD, helps doctors determine potential medical causes of anxiety:
T : Brain tumors cause a wide range of psychological symptoms, including anxiety, personality changes and hallucinations, along with physical symptoms. Adrenal gland tumors produce excess adrenaline, which can trigger anxiety, along with headache.
H : Thyroid problems are among the most common medical causes of anxiety, either because the gland is overactive or underactive . Parathyroid and adrenal gland conditions can trigger anxiety, too. The female hormone estrogen can also prompt anxiety when the menstrual cycle fluctuates and during menopause.
I :Lyme disease from tick bite infections can trigger anxiety and other psychological symptoms. Untreated Strep infections can cause the neurological tics sometimes seen with anxiety disorders. Guillain-Barre syndrome, a rare neurological disorder that can follow a viral infection, may trigger anxiety as well .
N : The symptoms of vitamin deficiency/overload, malabsorption and poor nutrition can mimic emotional disorders. For example, anxiety may be the first symptom of B12 deficiency.
C : Head trauma, even when mild, can trigger anxiety and other psychological symptoms. Anxiety is also seen with chronic or progressive neurological conditions, such as Alzheimers, myasthenia gravis and Guillain-Barre.
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How Are They Treated
Treatment for panic attacks and panic disorder includes counseling, especially cognitive-behavioral therapy . Medicines may also help. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.
How Are These Disorders Treated
The treatment youll get depends on the type of disorder youre struggling with. A mental health practitioner might recommend one or a combination of therapies, according to the Cleveland Clinic. Your doctor might prescribe an anti-anxiety drug, psychotherapy , or cognitive behavior therapy, in which you learn to recognize and change the thoughts and actions that lead to your feelings.
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Physical Conditions That Could Be Causing Your Anxiety
Anxiety symptoms may be giving you important clues about your health.
General Anxiety Disorder is a common mental health condition thats typified by anxious feelings taking over, making it difficult to get on with ordinary life. Treatment is usually talking therapy, sometimes combined with medication.
NHS Choices lists numerous anxiety symptoms, including feelings of dread, sweating, shortness of breath, panic attacks, fatigue, irritability and trouble concentrating. But though anxiety is a medical condition in its own right, there can sometimes be a physical reason for your symptoms – and treating it can bring the anxious feelings to an end.
So if you think you have a problem with anxiety, its important not to self-diagnose. Instead, head to your GP to have any other causes ruled out first.
According to a group of doctors writing in the journal Psychiatric Times, there are six key systems in the body that can cause these anxiety-type symptoms. They are cardiorespiratory , neurological , metabolic , chronic illness, digestive and endocrine . Heres a closer look at what these include:
1. Haywire hormones
Adrenal dysfunction happens when the adrenal glands, which produce our hormones, go wrong. When they produce the wrong amount of one or more of our hormones, it can cause fatigue, disorientation, increased heart rate and trouble concentrating – all typical anxiety symptoms.
2. Overactive thyroid
4. Heart disease, heart failure and heart attack
5. Sleep apnea
Underlying Illnesses That Can Seem Like Anxiety
There’s recently been a growing awareness surrounding what anxiety is and how difficult it can be to manage, thanks in large part to people sharing stories about mental health. This is great fighting stigma and giving people space to be vulnerable is always helpful. But, as it turns out, sometimes what seems like it’s anxiety can actually be a sign of a separate medical illness.
The conditions span a wide range and are categorized in seven groups. Health issues that may seem like anxiety can be cardiac, endocrine, GI-related, inflammatory, metabolic, neurological, and respiratory. Within those groups, conditions that might first present like anxiety include irritable bowel syndrome, cardiac arrhythmias, hypoglycemia, and rheumatoid arthritis. Psychiatric Times also lists 30 categories of medications that can cause anxiety, including antidepressants and NSAIDs like naproxen. Here’s the list of all 47 illnesses that may seem like anxiety, and here are the 30 kinds of medications that may cause it.
It sounds surprising, but Miami-area licensed clinical psychologist Erika Martinez, Psy.D., tells SELF that mental health professionals are trained to look out for these things. That is, you don’t need to immediately worry that any doctor treating you for anxiety may have missed something big!
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Diagnosing And Treating Anxiety
Its important to differentiate normal anxiety from the more severe type. Does the anxiety interfere with your family life or keep you from being productive in your professional life? Does it restrict you from engaging in the activities you like? If the answer is yes, then its the kind of anxiety that may require some degree of therapy or medical attention.
Depending on the duration, severity, and type of anxiety, treatment can include therapy, medication, or a combination of both. A common and effective method of treatment is cognitive behavioral therapy , which involves three main components: