Anxiety Neurosis

Anxiety Neurosis Types & Symptoms

The Diagnostic and Statistical Manual of Mental Disorders classifies anxiety disorders into the following categories:

• Panic disorder with or without Agoraphobia
• Acute stress disorder
• Post-traumatic stress disorder
• Social phobia
• Specific phobias
• Obsessive compulsive disorder
• Generalized anxiety disorders
• Anxiety due to medical causes
• Substance induced anxiety disorders

Specific phobias and social anxiety disorders are the commonest amongst all these types. Post traumatic stress disorders and generalized anxiety disorders are next commonest. Often these conditions remain under-diagnosed because patients generally do not approach the physician or the psychiatrist for the treatment of these complaints.

Panic Disorder With Or Without Agoraphobia

Panic attacks are characterized by intense feeling of terror which generally strikes suddenly and is incapacitating to the patient. These episodes may last for variable periods and attain a peak by 10 minutes generally. Rarely, they may last up to one hour. In between the attacks the patient is constantly worried about getting another panic attack and hence avoids situations that may provoke a panic attack. Common symptoms of a panic attack are as follows:

Panic Attack Symptoms

• Chest Pains
• Pounding Heart
• Fear of dying
• Sweating
• Shortness of breath or a feeling of smothering or choking
• Shaking or trembling
• Feelings of unreality
• Terror
• Tingling or numbing
• A feeling of being out of control or going crazy
• Light-headedness or dizziness
• Nausea or stomach problems
• Flushes or chills

Patients generally seek medical advice considering this to be some medical crisis only to be told that this problem is psychological and not medical. Many patients often seek another opinion but they are told the same thing again. Such people land up self-medicating themselves which is harmful in the long run.

Patient may suffer from discrete panic symptoms but this would be termed as Panic disorder only when the attacks become frequent and the patient develops fear of getting another attack or fears the consequences of the attack.

Panic attacks may occur as such or may be accompanied by Agoraphobia. Patients with agoraphobia are afraid of places or situations in which they might have a panic attack and be unable to leave or to find help. Such patients generally fear being in places where they anticipate that they may get a panic attack and they may not be able to help themselves in the event of an attack. In clinical settings, agoraphobia is usually not a disorder by itself, but is typically associated with some form of panic disorder.

Acute Stress Disorder

This is a condition that is precipitated by exposure to a stressful or traumatic event recently and the response is of intense fear, helplessness or horror. After such an event the patient experiences a sense of emotional numbness, has reduced awareness about the surroundings (as if in a daze) and is often unable to recall an important aspect of the trauma. The patient persistently re-experiences the traumatic event and tries to avoid anything that reminds him of the trauma.

There are also marked symptoms of anxiety or increased arousal (e.g. irritability, poor concentration, difficulty in sleeping, hypervigilance, exaggerated startle response, restlessness, etc.). This causes much difficulty in functioning normally at home and at work. The patient gets these symptoms generally within few days to about 4 weeks after the stressful event. This phase may last anywhere up to 4 weeks.

Post-Traumatic Stress Disorder

Post- traumatic stress disorder (PTSD) is an anxiety disorder that develops after exposure to a traumatic or frightening event. Symptoms of this disorder generally develop about 3 months or later after the stressful or traumatic event. These symptoms usually last for more than a month. Some patients recover within 6 months whereas some of them may develop a chronic course lasting for years.

The trauma can be in the form of natural disasters, war, violence, accidents, etc. Few months after the traumatic event, the patient typically experiences strong feelings of fear, horror and helplessness. The patient repeatedly relives the traumatic event in the form of flashbacks and nightmares. Often there is a feeling as though they are re-experiencing the trauma all over again. Flashbacks are generally triggered by certain situations which bring back memories of the traumatic event. In some patients flashbacks can even occur spontaneously or without any recognizable trigger.

The patient begins to avoid situations or experiences that remind them of the original trauma and this can lead to fairly severe restriction in their activity. Sleep disturbances, depression, feeling detached or numb (derealization), easy startling are commonly experienced. Often there are feelings of loss of pleasure or interest in previously enjoyable activities (anhedonia). Women appear to be at greater risk than men for developing PTSD after traumatic experiences.

Social Phobia

Social Anxiety Disorder or social phobia is characterized by marked and persistent fear in one or more social situations. A person suffering from phobia will avoid or will be extremely distressed in social settings and this is the major difference between a shy person and a social phobic. A shy person may be uncomfortable in social situations, but his symptoms are not disabling.

Basically a social phobic has fear of negative evaluation and he is intensely worried that he will do or say something that will make others think poorly of him. They tend to think that they are less socially competent than others. They often believe that everyone notices smallest mistakes which they make and may greatly exaggerate the severity of the negative judgments about those mistakes. When an event such as a presentation or a party is unavoidable for such a person, he may worry for days or even weeks prior to the event. Common things that make a social phobic anxious are public speaking, informal conversations in small or large groups, dating, interacting with authority figures, eating, writing, or other public performances.

Heredity may predispose a person to develop social phobia but in most cases it requires a trigger from the environment for full blown development of the disorder.

Specific Phobias

Fear of various things is a common phenomenon but an excessive, persistent and irrational fear of certain things or situations is termed as phobia. When the phobia is about some specific object or situation, it is termed as specific phobia. The individual is often not able to find out the rationale behind this fear but he just cannot seem to face these or overcome these fears.
Some common things which cause such phobias are listed below:

Animals: Spiders, lizards, cockroaches, rats, dogs, snakes, insects, etc. are few of the most common animals to which patients report phobias.

Environmental: Fear of water, heights, fire, storms, darkness, etc.

Situational: Fear of going in elevators, closed places, crowded places, tunnels, bridges, etc.

Fear of injections, injury, sight of blood, etc. are few common phobias; such patients usually faint at the sight of blood or injury.

Usually for many individuals the phobic stimulus is easy to avoid. When the feared object is easy to avoid, people with phobias may not feel they need treatment. In certain cases, however, specific phobias can become impairing or individuals may go to excessive lengths to avoid exposure to the feared object or situation. In these cases, treatment is recommended. This is particularly important, as individuals with a single Specific Phobia are likely to develop additional phobias of similar objects or situations over a period of time.

Specific phobias tend to run in families and very often family members have fear of similar objects or situations i.e. a common “theme” of fear. In general, phobias appear in adolescence and adulthood. Adult- onset phobias tend to show a more stable course, with only a small percentage of these disappearing without treatment.

Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is characterized by the presence of obsessions and compulsions. Obsessions and compulsions are unreasonable and in excess and they cause marked distress to the patient.

Although Obsessive-Compulsive Disorder usually begins in adolescence or early adulthood, it may begin in childhood. Generally the onset is gradual, but occasionally acute onset has been noted in some cases. The majority of individuals have a chronic waxing and waning course, with exacerbation of symptoms that may be related to stress.
Obsessions Include the Following:

• Recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and cause anxiety or distress
• Thoughts, impulses, or images that are not simply excessive worries about problems in real life
• Patient makes attempts to ignore or suppress these thoughts or tries to neutralize them by thinking about other things
• Patient recognizes that these thoughts, impulses, or images are the product of his mind and not imposed from outside

Compulsions Include the Following:

• Repetitive behaviors, such as washing hands repeatedly, ordering, and checking locks and doors again and again, etc. The patient feels driven to repeat these actions and these must be carried out in order to relieve the anxiety.
• Any other typical behavior or mental acts that the patient carries out in order to reduce distress or anxiety.

The point to be noted is that the patient realizes that these obsessions and compulsions are unreasonable and in excess (except in case of children). These obsessions and compulsions cause marked distress to the patient and are time consuming (taking more than an hour daily) and cause marked interference in the patient’s routine functioning. For e.g.: patient may be obsessed with cleanliness and may spend hours daily in washing himself and taking repeated baths. He may be spending lot of time washing his hands because he feels that they get dirty even if he does not do anything to dirty them. Compulsions are not realistically connected to the things which they are designed to neutralize. They are meant to reduce the anxiety or distress of the patient and not to provide any pleasure or gratification.

The most common compulsions involve washing and cleaning, counting, checking, requesting or demanding assurances, repeating actions, etc. When attempting to resist a compulsion, the patient may have a sense of increasing anxiety or tension that is often relieved by yielding to the compulsion. In the course of the disorder, after repeated failure to resist the obsessions and compulsions, the patient may give in to them; he no longer experiences a desire to resist them, and may incorporate the compulsions into his or her daily routines.

Generalized Anxiety Disorders

The onset is generally around childhood or adolescence but cases with late- onset anxiety symptoms are also seen. Generalized anxiety disorder is characterized by excessive anxiety and worry. This occurs for most of the days for at least 6 months, about a number of events or activities. Generally the anxiety is about work, daily events or performances. The patient finds it difficult to control the anxiety about various things and this is often associated with few or most of the following features:

• Restlessness
• Irritability
• Difficulty in concentrating
• Sleep disturbances (difficulty in falling asleep, frequent waking in the middle)
• Easy fatigue

The anxiety causes significant distress and impairment in various areas of functioning. The course of generalized anxiety disorders is chronic and usually gets worse during periods of stress. The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the actual likelihood or impact of the feared event. The person finds it difficult to keep worrisome thoughts from interfering with his daily activities and has difficulty stopping the worry. During the course of the disorder, the focus of worry may shift from one concern to another. In children suffering from Generalized Anxiety Disorder, there is a tendency to worry excessively about their competence with their friends or the quality of their performance.

Anxiety Due to Medical Causes

Anxiety may be a symptom of a number of medical conditions as well and hence it is necessary to rule out these conditions before we testify the patient to be suffering from anxiety disorder. Few of them have been listed below:

1. Neurological Illnesses
   It can cause symptoms similar to those found in anxiety disorders and hence these illnesses must be ruled out before concluding the symptoms to be that of anxiety disorders. Following are few of the examples of such neurological disorders:
   • Cerebral vascular insufficiency: Transient Ischemic Attacks (TIA) lasting from 10-15 seconds up to an hour (brief blocks in the blood vessels of the brain causing temporary loss of brain blood supply)
   • Anxiety states and personality changes following head injury
   • Infections of the central nervous system
   • Degenerative disorders of the nervous system
   • Alzheimer’s dementia
   • Multiple sclerosis: May be marked early on by vague and changing medical complaints
   • Huntington’s chorea: May present early as anxiety or other functional disorder before the movement disorder is evident. It always has a positive family history
   • Toxic Disorders
   • Lead Intoxication: loss of appetite, constipation and colicky abdominal pain followed by irritability and restlessness
   • Mercury intoxication: from contaminated fish
   • Manganese intoxication: from industrial exposure
   • Organophosphate insecticides (similar to nerve gas): from chemical or insecticide exposure
   • Partial complex seizures
2. Endocrine Disorders
   • Hyperthyroidism (increased thyroid hormone) commonly presents as anxiety and is one of the most common endocrine abnormalities. Most common in 20 to 40 years old women.
   • Adrenal hyperfunction or Cushing’s syndrome: This has a variety of causes, including tumors of the pituitary or adrenal glands or from steroids given to treat other illnesses. Anxiety is a common feature as also abnormal hairiness, acne, change in fat distribution, decreased menstruation in women and impotency in men.
   • Hypoglycaemia (decreased blood glucose): Usually associated with a history of diabetes and insulin or other hypoglycaemic medications. Rarely this occurs from an insulin secreting tumor.
   • Hypoparathyroidism (decreased parathyroid hormone): Almost always associated with a history of thyroid surgery. It often presents with overwhelming anxiety, either with or without personality changes.
   • Menopausal and premenstrual syndromes.
3. Cardiopulmonary disorders:
   Often presents with shortness of breath, rapid breathing, complaints of chest pain, chest pain that are worse with exertion
   • Angina
   • Pulmonary embolus
   • Arrhythmias (irregularities of heart beat)
   • Chronic obstructive pulmonary disease (COPD)
   • Mitral valve prolapse (generally harmless)
4. Pheochromocytoma (epinephrine secreting tumours).

Substance induced anxiety disorders

Substance induced anxiety is commonly missed out because very often the physician may not take detailed note of the medication that the patient has been continuing since long and these medicines may be the culprits in inducing anxiety symptoms in the patient. Common medications and drugs which can induce anxiety symptoms are as follows:

Non-psychotropic medications

• Sympathomimetics (often found in non-prescription cold and allergy medications): epinephrine, norephinephrine, isoproteronol, levodopa, dopamine hydrochloride, dobutamine, terbutaline sulfate, ephedrine, pseudo-ephedrine
• Xanthene derivatives (asthma medications, coffee, colas, over-the-counter pain remedies): aminophylline, theophylline, caffeine
• Anti-inflammatory agents: indomethacin
• Thyroid preparations
• Insulin (due to hypoglycemic reaction)
• Corticosteroids
• Others: nicotine, ginseng root, monosodium glutamate

Psychotropic medications

• Antidepressants (including MAO-inhibitors), drugs for treatment of attention deficit disorders (on rare occasions cause anxiety-type syndromes)
• Tranquilizing drugs: benzodiazepines (paradoxical response most common in children and in elderly), antipsychotics (akathisia may present as anxiety)
• Anticholinergic medications can cause a delirium which, in early stages, may easily be confused with anxiety: scopolamine and sedating antihistamines (found in over-the-counter sleep preparations) antiparkinsonian agents, tricyclic antidepressants, antipsychotics

Other Drugs

• Caffeine-intoxication or withdrawal
• Nicotine-withdrawal even more than acute intoxication
• Stimulants-cocaine, amphetamines, etc.
• Alcohol or alcohol withdrawal

Drug withdrawal is a common cause of anxiety symptoms. A large number of drugs can cause withdrawal states with symptoms of anxiety or even agitation. All sedative hypnotics, tricyclic anti-depressants and anti-cholinergics can cause withdrawal symptoms.

Anxiety Neurosis Diagnosis

The diagnosis of anxiety disorders is made on the basis of clinical presentation. It is often complicated by the large number of causes and types of anxiety and also by the range of disorders that may include anxiety as a part of their symptoms. Many patients who suffer from anxiety disorders have features or symptoms of more than one disorder giving a mixed picture.

A doctor examining an anxious patient will usually begin by ruling out diseases that are known to cause anxiety and then proceed to take the patient’s medication history, in order to exclude side effects of prescription drugs. Most doctors will ask about caffeine consumption to see if the patient’s dietary habits are a factor. The patient’s work and family situation will also be discussed.

Laboratory tests for blood sugar (for diabetes) and thyroid function (for Hyperthyroid or Hypothyroid) are also commonly done. There are no laboratory tests that can diagnose anxiety, although the doctor may order some specific tests to rule out disease conditions. Although there is no psychiatric test that can provide definite diagnoses of anxiety disorders, there are several short-answer interviews or symptom inventories that doctors can use to evaluate the intensity of a patient’s anxiety and some of its associated features. These measures include the Hamilton Anxiety Scale and the Anxiety Disorders Interview Schedule (ADIS).

Homeopathy Medicines for Anxiety Disorders

Besides some of the following ingredients, the product contains Dr Singhal Homeo’s international Patented, Research based, highly effective medicines
Dr Singhal Homeo’s patented molecules

• Argentum Nitricum
• Lycopodium Clavatum
• Silicea
• Thuja Occidentalis
• Syphilinum
• Natrum Muriaticum

Argentum Nitricum

This is one of the most important medicines for anxiety related disorders. This drug that is prepared from the nitrate of silver. It specifically affects the mind causing neurotic effects. It also has curative effects on the affectations of the nervous system, digestive system, reproductive system, respiratory organs, musculo-skeletal system, etc.

The patient is very nervous and impulsive by nature; extremely hurried in whatever he does. He dreads situations that may cause him anxiety and tries to avoid getting into such situations. Multiple phobias such as fear of darkness, evil, fear of heights, tall buildings, of passing certain places, etc. anticipatory anxiety which causes diarrhea before any important event or function. Intense apprehension and worry about trifling matters. All this anxiety causes much brain fag and the patient feels as if time passes too slowly. Physical symptoms of anxiety very marked such as trembling of hands and feet, palpitations in the chest, shortness of breath, dizziness and fainting, dryness of mouth, stammering, excessive sweating, etc.

All in all a very good drug for generalized anxiety disorders, social and specific phobias, stress disorders, panic attacks and also for agoraphobia.

Lycopodium Clavatum

Lycopodium is prepared from the spores of a fungus called as club moss. It is an inert substance until it undergoes the process of potentization to reveal its latent curative powers.

Lycopodium is a deep acting, constitutional remedy having a very wide sphere of action. It positively affects the mental sphere, general nutrition, urinary system, gastrointestinal system, reproductive system, lungs, skin, etc.

It is frequently used for the treatment of generalized anxiety disorders, social phobia, nephrotic syndrome, urinary infections, dyspepsia, pneumonia, liver diseases, ascites, skin complaints like eczema, abscesses, acne, urticaria, etc.

A few common indications of this drug are:
Intense fear of going in public places and performing in public. The patient dreads public appearance even if his profession demands it. Intense fear of not being able to perform well and fear of negative evaluation by others. Anticipatory anxiety is marked and there is total loss of self confidence. Constant apprehension and fear of breaking down under stress.

Silicea (Silica)

It is one of the splendid acts of homeopathy that substances labeled as inert can also be used efficiently to treat a large variety of disorders. Silica is the example of one such substance, which is chemically inert in its natural form, but after undergoing the process of potentization it gets transformed into a wonderful, deep acting remedy. Silica is in true sense called as polycrest remedy as it has a broad spectrum of action, useful for a wide range of disease processes. In fact this remedy has helped Homeopaths world over to treat so-called surgical conditions gently without requiring knife.

Silica positively influences the mind, bones and joints, mucous membranes, skin, cellular tissue, nerves, glands, lungs, digestive system, etc. Silica is one of the frequently used medicines for complaints of anxiety disorders, depressive states, styes, chalazion, vitiligo, eczema, lichen planus, herpes, urticaria, asthmatic bronchitis, pneumonia, tuberculosis, trigeminal neuralgia, complaints of nails, tonsillitis, etc.

It’s frequently used for generalized anxiety disorders, social phobias and specific phobias. Generally very nervous and timid patients who are afraid of stressful situations like public performances and exams, etc. They startle from the slightest noise due to nervousness. Marked anticipatory anxiety is an important feature of this drug.

Thuja Occidentalis

This is a drug prepared from a plant Thuja Occidentalis commonly known as Arbor Vitae. This is deep acting remedy with a wide sphere of action. It is a constitutional remedy, of great use in many disease processes. It has profound action on the mental sphere, respiratory organs, skin, genito-urinary organs, joints, nervous system, glands, kidneys, blood, etc. It is a good drug not only for physical complaints but also for affection of the mind. For example it can be very useful in anxiety disorders, psychotic states, depression, etc.

Its one of the frequently indicated remedies for asthmatic bronchitis, inveterate skin troubles and chronic stubborn skin conditions like lichen planus, psoriasis, eczema, warts, pyoderma, etc.

Thuja is one of the very good remedies for generalized anxiety disorders and obsessive compulsive neurosis. The patient generally gets anxious over trifles and cannot concentrate on whatever he does. He has many fixed ideas and he finds it difficult to get rid of them. Social phobia is also commonly seen in these patients who begin to get nervous and get twitching on being approached by strangers. Overall a very good drug for controlling anxiety states.

Syphilinum

This is a drug that is prepared from the syphilitic virus by the process of potentization. It belongs to a group of homeopathic drugs called as Nosodes which are prepared from disease products or diseased tissues. The remedy prescribed does not contain the original drug substance in the material form but it contains only the dynamic powers of that substance. This is achieved through the process of potentization in homeopathy
Syphillinum is a deep acting, polycrest remedy affecting multiple systems of the body.

It positively influences the mind, sensorium, skin, gastrointestinal tract, genito-urinary system, nerves, bones, etc. It is a very helpful remedy to combat hereditary syphilitic tendencies in patients.

Syphillinum is frequently used in the homeopathic treatment of obsessive compulsive disorders, anxiety states, vitiligo, recurrent abscesses, osteomyelitis, trigeminal neuralgia, alcohol dependence, rheumatic complaints, etc. It’s a useful drug to combat diseases that are destructive in nature and are deep-seated.

An important feature of these patients is that they repeatedly wash their hands and they feel compelled to do so in order to relieve their anxiety. Marked fear of night time, the patient dreads the approach of night. There is intense anxiety and a constant feeling that he (the patient) may go insane.

Natrum Muriaticum

This in a wonderful example of a drug prepared from an inert substance like common salt. After undergoing the process of Potentization, the inner healing powers of common salt are brought to surface and thus is borne a deep-acting constitutional remedy. Natrum muriaticum is one of the most commonly used medicines in homeopathy It can be used for a wide range of disease processes and has a very broad spectrum of action. It can effectively tackle diseases affecting the mind, skin, gastrointestinal organs, nose, lungs, kidney, metabolism, muscles, head, hormonal system, etc. It is one of the commonly used remedies for acute stress disorders, post-traumatic stress disorders, generalized anxiety disorders, lichen planus, migraine, urticaria, eczema, vitiligo, asthma, etc.

Natrum muriaticum is an excellent remedy for diseases affecting the general nutrition of the body and for anemia, fevers, thyroid affections, etc. Not only the physical ailments but also the psychic affections come under the domain of this wonderful drug. Anxiety disorders, depressive states, mood swings, irritability, etc can be well tackled with this remedy. All in all, this is a multi-faceted drug that can be used for many of the disorders affecting mankind.

It’s a good drug for acute stress disorder and post-traumatic stress disorder that has been triggered by the sudden death of someone close. The patient, in such cases, repeatedly re-experiences the traumatic event in the mind and constantly broods over it. Sleep disturbances are a common occurrence. Startling at slightest noise, spells of intense anxiety, trembling of extremities are other common occurrences.