What are they?
Six types of; psychiatric disorders in which anxiety is one of the most important symptoms. The anxiety is a normal emotion in humans (and other animals) that meets an adaptive function, that is, is good for something, prepares for fight or flight when danger is perceived. However, given that human beings are more complex than animals, they may experience anxiety in the face of many more situations than these, and what in principle were adaptive mechanisms, can lead to a serious obstacle to performing daily life activities. . The six types discussed below(Generalized Anxiety Disorder, Panic or Anxiety Crisis Disorder, Social Phobia, Specific Phobias, Obsessive-Compulsive Disorder and Post-traumatic Stress Disorder) are the best known and studied but there are many patients with disorders of anguish that cannot be properly included in these categories and that, however, are medical aid subsidiaries.
Types of Anxiety Disorders
Generalized anxiety disorder (tag)
What is it?
The person suffering from generalized anxiety is practically all day restless, and for a large part of his life (although it takes at least six months with symptoms to be able to make the diagnosis). The patient with a GAD also has a tendency to worry excessively about almost anything or; following any unimportant detail; for example, after having seen a story related to an accident or illness you may be worried; all day because of the possibility that an acquaintance suffers an accident, or for suffering from a disease about which he read something. Another characteristic feature of GAD is the difficulty in falling asleep because he goes to bed turning to the worries that have hovered in his head throughout the day. Other symptoms of Anxiety are muscular pains and headaches (due to muscular tension), difficulty breathing with difficulty (dyspnea), nausea, dizziness and sweating, (due to hyperactivity of the vegetative or autonomous nervous system; which is responsible for preparing the individual for the fight or the escape from danger through various reactions in different organs of the body), irritability, nervousness and difficulty concentrating and attending to what is being done.
In the pharmacological treatment of GAD, benzodiazepines are often used, drugs that are well known and consumed worldwide. They are anxiolytic drugs that relieve anxiety shortly (minutes) after taking them, but their effect remains only as long as enough medicine continues to circulate in the blood. According to the time they remain active in the body (which is measured with the so-called half-life of the drug) it is spoken; of benzodiazepines; short, medium and long half-life; and based on this and other characteristics, it is decided which benzodiazepine is most suitable for each patient. Benzodiazepines are useful and quite safe drugs but they also have side effects and disadvantages; the main disadvantage is that they can generate dependence which forces; to a close vigilance and care, especially when interrupting it (after a period of several weeks of consumption it can never be done suddenly).
There are other alternatives to benzodiazepine treatment. Buspirone is an effective drug for the treatment of some cases of anxiety that does not create dependence, or the drowsiness that benzodiazepines produce, but it takes a few days to begin to take effect (this phenomenon is called latency time of the action of the drug ), and people who have already taken benzodiazepines on occasion for anxiety may not appreciate a sufficient effect. Moreover, when there are depressive symptoms (which, in fact, are very frequently associated with anxiety symptoms), some antidepressant may be associated with treatment, mainly those of the group of selective serotonin reuptake inhibitors (SSRIs) or serotonin and of norepinephrine (ISRNS).
Other possibilities of treatment of GAD are the different psychotherapies, alone or in combination with medications, depending on the severity. As in depression , the main types of therapy are those of dynamic orientation and those of cognitive-behavioral orientation. From the psychodynamic point of view, different approaches have been made to the understanding of the phenomenon of distress .; Basically, anxiety has been understoodas a product of the conflicts that take place in the unconscious of the individual; Through therapy, these conflicts are analyzed to make them aware, to solve them psychologically and, thus, stop producing anxiety. The cognitive-behavioral approach aims to re-educate the anxious individual to learn to control anxiety, to recognize how it is constructed and to modify the ways of thinking that lead to its appearance. It uses techniques such as relaxation, stress management and feedback or “biofeedback” (a technique in which through several instruments that measure physical changes such as muscle tension, etc., the patient learns to recognize the appearance of anxiety and control it , observing how the changes that were measured) and cognitive therapy are normalized.
Anxiety crisis or panic attacks
What is it?
In this type of disorder anxiety It is episodic (that is, it is not constant as in GAD), and the person who suffers from it has short moments of distress (usually less than one hour) very intense and without apparent trigger. The experience is the same as that faced with a sudden and serious threat, such as facing an assault on a fierce etc. As in the other disorders that have been exposed, the panic reaction is, in principle, an adaptive reaction in animals, that is, through it you learn, for example, that one should not face a tiger when it has suffered panic to see it. The problem in the case of the man who suffers a; Crisis distress disorder is that crises occur with nothing that apparently threatens the subject directly. The fact of experiencing an isolated panic crisis in a situation of sudden and intense stress does not imply a; distress crisis disorder, and is relatively normal. But when the crises recur they are usually of a relatively normal nature. But when the crises recur they are usually pathological in nature.
An anxiety crisis can be experienced in many ways, but the most normal thing is to notice that it is difficult to breathe, that you feel chest pain, tingling in the hands and feet, feeling of clamping around the mouth (paraesthesia), and even muscle cramps and dizziness All these “physical” symptoms; They are accompanied by intense anguish and the feeling that one is going to die or go crazy shortly. As these symptoms are very similar to those experienced when you have a heart attack, many people who suffer from them go first to the hospital or cardiologist, and it is usually a non-psychiatrist who explains that they have suffered a anxiety crisis (usually usually indicate before some complementary examinations – electrocardiogram, analysis – which are usually negative) .; The patient may worry about whether he is “going crazy”, to which other typical symptoms of this crisis contribute, such as the feeling that one is not oneself (depersonalization) or that the reality around him is strange or changing ( derealization). The first thing to do in these cases is to reassure the patient, because although the crises are lived as very threatening, in reality there is no vital danger, and in fact once it has been triggered it is aggravated by the anxiety of the person who experiences it , and thus a vicious circle is created (the more anxiety the more symptoms, and the more symptoms the more anxious the subject becomes). It is very frequent; that the hyperventile anxious patient (that is, breathes faster than normal), and that this causes alterations in blood gases, which produce symptoms.
A common problem of those who present an anxiety crisis is that they gradually avoid the circumstances that they believe caused them, which ends up developing a phobia of places or agoraphobia (this symptom is explained later in the section; of the phobias) that can end up completely or partially confining the subject at home with an irrational fear of leaving the protection provided by your home. At the end of a bad evolution they can end up unchaining at home too. However, there are effective treatments against anxiety crises and these extremes should never be reached.
Pharmacological treatment consists of the aforementioned benzodiazepines, which have the advantage of cutting the crisis in a short time. Some are taken or placed under the tongue and act very quickly, so that the person suffering from anxiety crisisYou can always carry them in your pocket if you present one at any time. However, the most effective treatment, although in the longer term, are different antidepressants; as serotonin reuptake inhibitors that, by a mechanism of action independent of their antidepressant effect, manage to control seizures in a variable period of time a few weeks. Normally, until the antidepressant begins to take effect, treatment with benzodiazepines is continued, which is then gradually withdrawn, to maintain the antidepressant about six months after the last crisis. Many people resist the prospect of such a long treatment, but it is clear that it compensates for being free from crisis. Also useful are psychotherapies (associated with medication),
Phobias; (agoraphobia, social phobia, simple phobia)
What is it?
Agoraphobia is an irrational and extreme fear of open spaces and crowded places such as department stores, public transport, in agglomerations, etc .; Like all phobias, they suppose a fear that the patient himself considers excessive and irrational despite which they cannot avoid feeling, and when they are exposed to what they fear (the phobic stimulus) a panic attack is triggered. The problem of agoraphobia, as has already been said, is that the subject progressively avoids places, public transport, etc., to the point that, for example, going to usual places can become a long journey through which he avoids large avenues, or going to the workplace becomes a walk of hours for not being able to take the subway; In the end, the severe agoraphobic patient can stay at home,
The person suffering from social phobia suffers anxiety symptomswhen exposed to situations in which it is observed by a crowd or a small group of people; Thus, for example, given the fact of giving a lecture, attending a party or any other social event, the subject suffers from tachycardia, sweats, tremor, and other anxiety symptoms already described. This leads the individual to avoid such social situations and for that reason appears before others as someone extremely shy, who hardly speaks and does not leave. The treatment is similar to those already described for other phobias,
In specific phobias, the phobic stimulus is unique, for example: a person may have a phobia for dogs, another for airplanes, another for heights, etc., and may develop adequately in daily life; provided you are not exposed to your specific phobic stimulus. On many occasions these people never consult for their disorder since it does not represent an important limitation for them, until there is a change in life (such as, for example, an ascent that forces a person with phobia to make multiple plane trips to fly).
The pharmacological treatment of these phobias is usually done with benzodiazepines at the time of exposure to the phobic stimulus, accompanied by some form of specific psychotherapy. Behavioral techniques are useful and quick in their effect. The so-called systematic desensitization consists in presenting progressively more phobic stimuli to the patient as the fear is overcome (for example, in the phobia of dogs, a photo of a dog could first be shown, then a tape of a barking dog, then approach at a distance to a tied dog, etc., … until being able to touch and pet a loose dog). The flood technique (which, for obvious reasons, it is accepted by a smaller number of patients than the previous one) consists of suddenly presenting the phobic stimulus until the subject lives it as the non-dangerous stimulus that it is actually (due to the extinction of his anxiety response). There are other techniques. Psychoanalytic type psychotherapy is also used, although the effects of this are usually longer term, and it is more aimed at the subject understanding the reason for his phobia than eliminating it in a short period of time. Of course, several types of therapy can be combined depending on each case. and it is more aimed at the subject understanding the reason for his phobia than eliminating it in a short period of time. Of course, several types of therapy can be combined depending on each case. and it is more aimed at the subject understanding the reason for his phobia than eliminating it in a short period of time. Of course, several types of therapy can be combined depending on each case.
Obsessive compulsive disorder (OCD)
What is it?
In the TOC the life of a person can be impoverished and trapped in endless repetitive and ritual behaviors. Rituals and superstitions are widespread in humanity, and their purpose seems to be to give security and a sense of control over life conditions that are unpredictable. There are very superstitious people, who develop ritual behaviors associated with fortuitous events; Many of these people, if asked, will not know very well why they do it, but still do not want to stop. Obsessive-compulsive disorder is, in some way, an exaggeration to the limit of these behaviors. The main symptoms of this disorder are obsessions and compulsions, terms that do not mean exactly the same in psychiatric language as in colloquial. In psychiatry, obsessions are thoughts that are defined as intrusive and parasitic, because whoever has them lives them as strangers, not voluntarily thought and cannot get rid of them despite considering them extremely unpleasant. Compulsions however, are acts that the person performs to get rid of the anxiety that the obsessions produce, and that although he could avoid if he wanted to, and in fact he may be able to do so, it increases his anxiety so much that in the end he ends up repeating the compulsion once more, despite knowing that it makes no sense or rationality. For example, a patient may think of his father as if he had died; this thought comes to mind insistently, even though he knows that his father lives and is healthy, and that he does not consciously desire any harm for him (obsession); To prevent the thought from coming to mind, the patient may, for example, begin not to step on the cobblestones, so that he feels that if his father steps on them, he will die (compulsion). If asked about what he thinks and does he will say that it is all absurd, that he knows perfectly well that his father is not going to die even though he steps on the streaks, but he can’t stop doing it because, if he tries, the anxiety is so much that he eventually succumbs to compulsion. Of course, within this disorder there are degrees (in the previous example, from having to step on the stripes from time to time to go out to the street, to stay locked in a room for fear of stepping on any line, and that its shadow rubs a line of any wall). Very frequent compulsions are those of washing associated with cleaning obsessions, or checking compulsions (for example, see if the gas or the door has been closed when leaving home innumerable times to the point of; taking hours to end the check task). which eventually succumbs to compulsion. Of course, within this disorder there are degrees (in the previous example, from having to step on the stripes from time to time to go out to the street, to stay locked in a room for fear of stepping on any line, and that its shadow rubs a line of any wall). Very frequent compulsions are those of washing associated with cleaning obsessions, or checking compulsions (for example, see if the gas or the door has been closed when leaving home innumerable times to the point of; taking hours to end the check task). which eventually succumbs to compulsion. Of course, within this disorder there are degrees (in the previous example, from having to step on the stripes from time to time to go out to the street, to stay locked in a room for fear of stepping on any line, and that its shadow rubs a line of any wall). Very frequent compulsions are those of washing associated with cleaning obsessions, or checking compulsions (for example, see if the gas or the door has been closed when leaving home innumerable times to the point of; taking hours to end the check task). until he was locked in a room for fear of stepping on any line, and his shadow brushes a line of any wall). Very frequent compulsions are those of washing associated with cleaning obsessions, or checking compulsions (for example, see if the gas or the door has been closed when leaving home innumerable times to the point of; taking hours to end the check task). until he was locked in a room for fear of stepping on any line, and his shadow brushes a line of any wall). Very frequent compulsions are those of washing associated with cleaning obsessions, or checking compulsions (for example, see if the gas or the door has been closed when leaving home innumerable times to the point of; taking hours to end the check task).
The pharmacological treatment of OCD; It is usually done with specific antidepressants that have proven effective in these disorders (one of tricyclic structure and virtually all serotonin reuptake inhibitors), to which a specific type of benzodiazepines is sometimes added and, sometimes, if the effect is not desired, other drugs such as neuroleptics or mood stabilizers. For mild or moderate cases, cognitive-behavioral psychotherapies that also help to alleviate the most serious cases associated with the above-mentioned drugs are useful.
Posttraumatic Stress Disorder (PET)
What is it?
As the name implies, this disorder occurs after having suffered an extremely traumatic event, such as a major catastrophe, an assault or an attack. Of course, any human being, having suffered a stress of great intensity has an adaptive period of time; in which there may be symptoms of anxiety and depression that disappear progressively and even if you never forget what happened, you learn to overcome it .; It is not easy to define where normality ends and stress disorder beginspost-traumatic, (although surely this is not the most important, nor the priority task of the psychiatrist, but the way to better help patients suffering from PTS symptoms after major trauma and tragedy).
The symptoms of PET are mainly anxious, although depressive symptoms such as sadness, feelings of guilt for having survived, or for not having been able to avoid what happened, etc., also occur. Sleep disturbances are characteristic, with insomnia and nightmares related to the stressful event. There are also difficulties in concentrating, a tendency to relive the event in the form of live images (reviviscences or “flashbacks”) and to recall the event after any stimulus that is associated (for example, a slamming door revives an explosion, etc.). The likelihood of suffering from these symptoms depends on the person’s characteristics and what happened, so it is less likely to occur if the victim can do something after the catastrophe, such as helping other victims, participating in rescue tasks; after an earthquake, etc. PET is presented more likely after acts of aggression and human cruelty, than after natural or fortuitous traumatic events.
Treatment requires crisis interventions (to avoid them) and supportive psychotherapy and others. Pharmacological treatment of anxious symptoms is usually done with benzodiazepines and antidepressants if necessary. For the treatment of reviviscences or “flashbacks” mood stabilizers are used.
What is bipolar disorder?
Bipolar disorder is characterized by elevations and decreases in mood of a pathological nature, that is, it is not about the normal mood changes that everyone experiences based on life events, but about the alternation of depressive episodes (same as those described in the previous section of depression ), with other episodes of exaggerated euphoria (mania or manic episodes). These episodes may vary in intensity and severity; Euphoria episodes can vary from hypomania (the least intense form) to mania with psychotic symptoms (the most severe form).
In general, these manic episodes are characterized by euphoric mood, which is experienced as an experience of being able to do everything and, frequently, irritability when the person who suffers it takes the opposite or when they try to contain in their extravagant ideas or inappropriate behaviors, since generally the person suffering from a manic episode can waste all their money and that of their family or even buy without money all kinds of goods that are unnecessary; You can start a lot of hobbies to abandon them shortly after starting; can dress in a quirky way; eating habits can become capricious; and sleep needs decrease so that you can, for example, start incessant domestic activities at dawn that alter family rest. On the other hand, As the person who suffers a manic episode feels especially energetic, he may feel that he has special powers and, in some cases, may develop psychotic symptoms such as delusions of megalomaniac character (the person believes to be someone important or famous) or erotomaniacs (believes to be sexually irresistible or that people fall madly in love with him). Uninhibited behavior can lead the patient to have unprotected risky sex, with the consequent risk of transmission of sexually transmitted diseases or unwanted pregnancies. Even in the mildest cases (called hypomania), in which the patient may seem at first to be funny, pleasant and funny, the inappropriate and automatic nature of these behaviors is revealed,
Types of bipolar disorders
There are several types of bipolar disorder.
In Type I, severe depressive episodes alternate with severe manic episodes.
In Type II, depressive episodes alternate with others of hypomania. The rest of the types are more rare. When a person suffers four or more cycles a year of depression and / or hypomania or mania, he is considered to be a fast cyclist. Various antidepressants can cause a depressed patient to enter the manic phase, or a patient with bipolar disorder to become a fast cycler. Cyclothymia is at the mildest end of the bipolar disorder, in which the person alternates throughout life cycles of good and bad mood without reaching the characteristics of major depression or mania (it would be the equivalent of dysthymia in disorders depressants)
Bipolar disorder has effective treatment, with so-called mood stabilizers, of which lithium salts are the best known. Lithium is an element that is found in a very small amount in the human body. Several decades ago it was accidentally discovered that it controlled bipolar disorder. It is not uncommon for popular misunderstanding that what happens in bipolar disorder is a lack of lithium, but it is not so; nobody has lithium in the body in sufficient quantity to be detected unless given as a treatment. Lithium in excessive quantity is very toxic; levels are therefore determined periodically, to verify that they are within the effective and unsafe limit (although like all drugs, even within therapeutic levels it has side effects). In addition to lithium there are other mood stabilizers. They are, all of them, drugs that are used for the treatment of epilepsy (except a calcium antagonist that is used as an antihypertensive and for the heart), some of them for a long time. At the time of initiating treatment, if the individual is in full manic phase, they are used; also neuroleptics, which are drugs for the treatment of psychoses (they are used to treat hallucinations and delusions in the manic phase).