MED-NERD
Psychiatric disorders
Outline:
• Overview
• Incidence
• Anxiety disorders
• Risk factors
• Symptoms
• Differential diagnosis
• Treatment
• Conclusion
• References
Overview:
The number of psychiatrists has increased markedly over the recent years. There are many mental disorders that millions of people suffer from worldwide including depression, bipolar disorder, dementia, schizophrenia and other psychoses, and developmental disorders including autism. These disorders are characterized by abnormal thoughts, emotions, perceptions and behaviour.
Keywords: Psychiatric disorders, Anxiety disorders, phobia, cognitive behavioural therapy.
Incidence:
The most common psychiatric disorders are anxiety disorders. According to WHO, 264 million people are affected by depression, bipolar disorder affects about 45 million people, and Schizophrenia affects almost 20 million people and approximately 50 million people have dementia worldwide.
Anxiety disorders:
The normal feeling of anxiousness or nervousness is not considered an anxiety disorder. Anxiety disorders mean feeling severe fear or anxiety affecting nearly 30% of adults whose lives are improved by proper treatment and management.
Various anxiety disorders in the U.S according to The American Psychiatric Association (APA) :
• Specific phobia: 8% - 12%
• Social anxiety disorder: 7%
• Panic disorder: 2% - 3%
• Agoraphobia: 1-2.9% in adolescents and adults
• Generalized anxiety disorder: 2%
• Separation anxiety disorder: 0.9% - 1.9%
Age prevalence:
Age prevalence varies according to the type of disorder as follows:
• Separation anxiety disorder >> average ( 13 years)
• Specific phobia >> average ( 7 years )
• Agoraphobia without panic attacks >> (20 years)
• Panic disorder >> (24 years)
• Generalized anxiety disorder (GAD) >> may start later in life.
-Symptoms are fluctuating and turn into a chronic course.
-Studies have shown a decrease in the prevalence of anxiety disorders after the age of 50.
Risk factors:
Researchers have found that both genetic and environmental factors contribute to developing an anxiety disorder. Here are some of the general risk factors:
• Feeling distressed or shy excessively in childhood.
• Stressful negative life events.
• Family history of anxiety or mental disorder.
• Physical conditions such as thyroid diseases or cardiac arrhythmia.
• Substances like caffeine and some medications.
• Social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.
• Nutrition and perinatal infections.
Genetics:
Anxiety disorders are characterized by uncertainty and high rate of treatment resistance, this in turn has attracted psychiatric geneticists in orders to identify the risk of the disease, biomarkers and treatment response.
A population-based family study of Generalized Anxiety Disorders (GAD) showed noticeable odd ratio (OR) ( between 2.1 and 2.6) in children of parents diagnosed as having GAD, with exclusion of offspring with non-GAD anxiety disorder diagnoses or major depressive disorder (MDD).
Meta-analytic studies of family and twins showed a genetic heritability of 31.6% and a recurrent OR (6.1), with small effect on females by common familial environment, variables because of individual-specific environment, and the same genetics predisposing to the disorders across sexes.
A general community twin study discussing the genetic and environmental structure of anxiety spectrum disorders concluded that there are two independent genetic factors for GAD:
-The first factor is mainly associated with social anxiety disorder, panic disorder, and agoraphobia.
-The other factor is mainly predisposing to specific phobias.
Both genetic factors represent about 23% of the genetic variabilities predisposing to GAD, other risk factors are caused by certain conditions in the environment.
Symptoms:
Here are symptoms of some anxiety disorders:
1-Generalized anxiety disorder ( GAD):
• Restlessness, wound-up, or on-edge
• Being easily fatigued
• Difficulty in concentration
• Irritability
• Headaches, muscle aches, stomach-aches, or unexplained pains
• Difficulty controlling feelings of worry
• Sleep problems
2-Panic disorders:
During a panic attack, a person may experience:
• Tachycardia
• Sweating
• Trembling or tingling
• Chest pain
• Feelings of impending doom
• Feelings of being out of control
NB: Experiencing a panic attack does not necessarily develop panic disorder.
3-Social Anxiety Disorder:
Social anxiety disorder is defined as severe, permanent fear of being in front of other people watched and judged.
Symptoms :
• Shivering, blushing, sweating
• Stomach-aches
• Tachycardia
• Inability of making eye contact with others easily
• Stiffness of body or rigid body posture or involuntary change of the tone of voice (e.g., speaking with an overly soft voice)
• Fear of being judged in a negative way, known as (self-consciousness)
4-Phobia-related disorders:
Phobia is defined as severe fear of certain subject or situation which is usually not really dangerous.
Symptoms:
• Extreme worry about the situation or subject
• Taking action in order to avoid that subject or situation
• Extreme anxiety on exposure to the feared object
• Dealing with the condition with severe anxiety and fear if it can not be avoidable
Differential diagnosis:
Mental disorders include wide range of diseases. Other mental disorders are for instance : major depression, somatic symptom disorders, other anxiety disorders.
Moreover, some physical disorders have symptoms that resemble mental disorders, including: hyperthyroidism, lung diseases, coronary heart disease.
Anxiety disorders usually do not occur alone , but occur in association with other mental disorders such as major depression, personality disorders, somatic symptom disorders, and substance abuse disorders.
Treatment:
Treatment usually includes psychotherapy, medication, or both.
-Cognitive behavioural therapy: is an example of psychotherapy that teaches people different ways of thinking about anxious situations properly. It is the gold standard method of psychotherapy.
-Acceptance and Commitment Therapy: it is considered a new form of psychotherapy. It uses values like mindfulness and goal setting to reduce anxiety.
- Medications: the most common medications used to relieve symptoms of anxiety disorders are antidepressants, beta blockers and antianxiety medications such as benzodiazepines.
Conclusion:
Anxiety disorders are the most common psychiatric disorders worldwide. Different types of anxiety disorders can affect different ages. Studies have shown that genetic and environmental factors are relevant symptoms of anxiety including tachycardia, sweating, irritability and aches in different parts of the body. Choosing the right medication and treatment plan under expert's care can help improve anxiety disorders.
See: Adverse Childhood Experiences (ACEs)
References:
(1)Mental disorders, the World Health Organization (WHO)
https://www.who.int/news-room/fact-sheets/detail/mental-disorders
(2)Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017 Jun;19(2):93-107.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
(3)Gottschalk MG, Domschke K. Genetics of generalized anxiety disorder and related traits. Dialogues Clin Neurosci. 2017 Jun;19(2):159-168.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/
(4)National Institute of Mental Health Office of Science Policy, Planning, and Communications
https://www.nimh.nih.gov/health/topics/anxiety-disorders
(5)The American Psychiatric Association (APA)
Physician Review By: Philip R. Muskin, M.D., M.A.
https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
(6)Thibaut F. Anxiety disorders: a review of current literature. Dialogues Clin Neurosci. 2017 Jun;19(2):87-88.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573565/
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