Anxiety: Pathophysiological aspects and its treatment

Anxiety is a complex mental health disorder characterized by excessive worry and fear, often accompanied by physical symptoms such as restlessness, increased heart rate, and muscle tension. The pathophysiology involves dysregulation of neurotransmitters, including gamma-aminobutyric acid (GABA), serotonin, and norepinephrine, as well as hyperactivity in the amygdala and hypothalamic-pituitary-adrenal (HPA) axis. Chronic anxiety can lead to significant impairment in daily functioning and increase the risk of comorbid conditions like depression. Treatment options include pharmacological approaches, such as benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs), which aim to restore neurotransmitter balance. Non-pharmacological therapies, such as cognitive-behavioral therapy (CBT), mindfulness, and lifestyle modifications, play a vital role in long-term management. An integrative approach combining medications and therapy often yields the best outcomes for anxiety disorders.

1. Anxiety: Pathophysiological aspects and its treatment Prepared By: Vaidehi Vadhvana Ph.D. Scholar

2. Introduction Fear is an automatic neurophysiological state of alarm characterized by a fight or flight response to a cognitive judgement of present or imminent danger (real or perceived).  Anxiety is linked to fear and manifests as a future-oriented mood state that

3. Consists of a complex cognitive , affective , physiological , and behavioral response system associated with preparation for the predicted events or circumstances perceived as threatening.  One of the most common psychiatric disorders.

4. Etiology Anxiety disorders appear to be caused by an interaction of biopsychosocial factors.  Genetic susceptibility interacts with situations that are stressful or traumatic to produce clinically significant syndromes.

5. Anxiety can be caused by the following conditions Medications Herbal medication Substance abuse Trauma Childhood experiences Panic disorders

6. Pathophysiology The significant mediators of anxiety in the central nervous system are thought to be norepinephrine , serotonin , dopamine , and gamma-aminobutyric acid (GABA). ANS especially the sympathetic nervous system, mediates most of the symptoms.

7. Characteristic Symptoms of Pathological Anxiety Pathological anxiety is characterized by several important symptoms that differentiate it from normal anxiety: 1. Excessive Worry: Persistent and excessive worry about various aspects of life, often without a clear or realistic cause. 2. Physical Symptoms: These can include increased heart rate, sweating, trembling, dizziness, shortness of breath, and gastrointestinal issues. 3. Avoidance Behavior : Avoiding situations or activities that might provoke anxiety, even when they are part of daily life. 4. Restlessness: A constant feeling of being "on edge" or unable to relax.

8. Anxiety Disorders  1. Generalized Anxiety Disorder (GAD): Persistent, excessive worry about various aspects of life. 2. Panic Disorder: Recurrent, unexpected panic attacks, involving intense fear or discomfort. 3. Social Anxiety Disorder (Social Phobia): Intense fear of social situations due to fear of being judged or embarrassed. 4. Specific Phobias: Irrational fear of specific objects or situations. 5. Agoraphobia: Fear of situations where escape might be difficult, often leading to avoidance of public places.

9. 6. Separation Anxiety Disorder: Excessive fear of being separated from attachment figures. 7. Selective Mutism: Consistent failure to speak in specific social situations despite speaking in others. 8. Substance/Medication-Induced Anxiety Disorder: Anxiety caused by substance use or withdrawal. 9. Anxiety Disorder Due to Another Medical Condition: Anxiety symptoms directly resulting from a medical condition.

10. Characteristic Symptoms Pathological Anxiety Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep due to racing thoughts or anxiety. Concentration Problems: Difficulty concentrating or having your mind go blank, often due to intrusive worries. Irritability: Increased irritability or quick temper, often as a result of ongoing stress and worry. Muscle Tension: Chronic muscle tension, often leading to headaches or other forms of discomfort. Catastrophic Thinking: Always expecting the worst possible outcome in any given situation. These symptoms can significantly impair daily functioning and quality of life, requiring professional intervention for management.

11. Evaluation of Anxiety

12. Treatment / Management