Understanding the Pathophysiology and Management of the Anxiety Disorders
Anxiety is a general psychiatric state characterized by fear, worry, unnecessary violent behavior, poor quality of life, avoidance and the compulsive rituals that are related with the significant suffering. Current epidemiological studies of the anxiety disorders provided facts of their elevated incidences in the general population worldwide. Anxiety disorders are extremely widespread in adults especially females show higher preponderance of 2:1 over the males. Anxiety disorders can be measured as intact| situation, which completely upsets everyday life of the individual. It creates a state of mysterious anticipatory fear and apprehension concerning the incidence of even usual things in life. Drug treatment for the anxiety disorders includes use of latest pharmacological agents acting at definite neurotransmitters and neuropeptides, their reuptake and metabolism. Anxiety disorders are frequent psychiatric conditions that result in poor quality of life, significant disability, and influences enormous social cost. Even though treatments with confirmable efficiency are existing, a large number of patients fail to respond or remain with clinically significant residual symptoms even after management. The treatment resistance involved in anxiety disorders remains a challenge to the clinical practice going from non uniform concepts of response and the resistance to a paucity of controlled studies relating to remedial strategies. This clinical review focuses on the pathophysiologic basis for anxiety disorders, brief overviews of different anxiety disorders, clinical features, diagnosis and the management options for the patients suffering. Shivani Soodan and Ashwani Arya* Department of Pharmaceutical Education and Research, BPS Women University, South Campus, Bhainswal Kalan, Sonipat (Haryana) India. Submission: 7 October 2015 Accepted: 14 October 2015 Published: 25 October 2015 www.ijppr.humanjournals.com Citation: Ashwani Arya et al. Ijppr.Human, 2015; Vol. 4 (3) 251 278. 252 INTRODUCTION Anxiety disorders are among the most prevalent categories of mental illnesses [1,2] Anxiety disorders are characterized by excessive and unrealistic worry about everyday tasks or events, or may be specific to certain objects or rituals. Recent epidemiological studies of anxiety disorders provided evidence of their high frequency in the general population worldwide. Anxiety disorders afflict an estimated 15.7 million people in the United States each year [3] Anxiety disorders are highly prevalent in adults especially females show higher preponderance of 2:1 as compared to males [4] Anxiety is associated with substantial negative effects on children's social, emotional and academic success [5] When left untreated, anxiety symptoms persist and are associated with significant impairments in functioning, poor quality of life, and a huge economic burden. Anxiety disorders are of particular importance in the context of recent and ongoing world conflicts, as environmental factors can have a strong impact on anxiety disorder development [6] Although anxiety disorders have been extensively studied, the literature examining underlying neural mechanisms remains scarce, with relatively little evidence identifying specific deficits for various anxiety disorders. Despite the lack of concrete knowledge regarding the specific mechanisms underlying anxiety, both pharmacologic and psychotherapeutic treatments for anxiety management have been developed. These treatments are effective for many patients suffering from anxiety, but the exact mechanisms of action are not well known. Moreover, many patients do not have access to or do not experience complete symptom relief with the existing evidence based treatments. Alternatively, anxiety is often defined by a more prolonged state of tension, worry, and apprehension regarding uncertain, and potentially negative, future events [7] Perhaps it is not surprising that nearly one in four of us will experience a clinical level of anxiety within our lifetimes [8] Anxiety crucially involves uncertainty as to the expectancy of threat, is triggered by less explicit or more generalized causes, and is characterized by a more diffuse state of distress, with symptoms of hyperarousal and worry [9] It has been suggested that these cognitive biases are implicated in the maintenance, and possibly even the etiology, of anxiety [8] Anxiety disorders are among the most common mental, emotional, and behavioral problems [1,10,11] .These affect one eighth of the total population worldwide [12,13] In addition to the high prevalence, anxiety disorders account for major expenditure for their management and www.ijppr.humanjournals.com Citation: Ashwani Arya et al. Ijppr.Human, 2015; Vol. 4 (3) 251 278. 253 anxiety disorders have a substantial negative impact on quality of life [10] Drug development in this direction also aims to generate new pharmacological agents with action at specific neurotransmitters and neuropeptides, their reuptake and metabolism. This search has led to development of unconventional agents [14] The neurobiological approach to delineate the pathophysiology of anxiety also come across the fact anxiety disorders are highly co morbid with each other and respond to the single or same spectrum of treatments. Different types of anxiety disorders are characterized by the presence of chronic anxiety symptoms that are clinically significant and are part of most prevalent group of psychiatric disorders [1,15] Patients with anxiety disorders exhibit a significant reduction in their quality of life, less productivity, higher morbidity and mortality, and higher rates of comorbidity [16,17] Although there are several therapeutic strategies available for the treatment of anxiety disorders, the management of patients who do not respond adequately to the treatment remains a challenge in the clinical practice [15] Anxiety disorders are responsible for a significant social cost due to individual suffering, as well as indirect social costs [15] There is huge impact on the health system not only because of the expenses with the treatment, but also because of the more frequent search for medical care caused by anxiety [16,17,18] SYMPTOMS OF ANXIETY DISORDER Subjective incident of anxiety characteristically has two components the physical and the emotional which influence the cognitive processes of the person [19,20,21,22,23] These features have been summarized in the Figure1.The clinical sign and symptoms differ depending on the form of anxiety disorder, but general sign and symptoms include the heart palpitations, feelings of panic, fear, and uneasiness, insommnia, cold or sweaty hands and/or feet, shortness of breath, an incapability to be steady and calm, dry mouth, numbness or tingling in the hands or feet, nausea, muscle tension and dizziness [21,22,23] www.ijppr.humanjournals.com Citation: Ashwani Arya et al. Ijppr.Human, 2015; Vol. 4 (3) 251 278. 254 Figure 1: Clinical symptoms of Anxiety Disorders CAUSES OF ANXIETY DISORDERS About 500 million people, worldwide, suffer from mental and behavioral disorders [24] Anxiety disorders, like depression, are among the most prevalent psychiatric disorders. Most anxiety disorders first appear during childhood and adolescence. Evidence shows that a high proportion of children do not grow' out of their anxiety disorders during adolescence and adulthood [25] Different surveys suggest that anxiety affects one eighth of the total population of the world. The overall lifetime prevalence rate for anxiety disorders is 24.9% This data suggests anxiety disorders are more chronic than affective or substance abuse disorders [26] Prevalence of anxiety SYMPTOMS OF ANXIETY DISORDERS EMOTIONAL SENSATIONS Headache, Nausea Vomiting, Sweating, Trembling stomach Pain, ulcers, Diarrhea, Weakness, Body ache, Feeling shortness of breath, Hot flashes or chills, Increased blood pressure Heart rate, etc. PHYSICAL SENSATIONS Nervousness, Worry, Fear, Irritability, Insecurity, Isolation From others Self consciousness, Desire to escape, Feeling that one is going to die, etc. IMPAIRED COGNITIVE PROCESSES Thinking decision making ability, Perceptions of the environment, Learning ability Memory and concentration. www.ijppr.humanjournals.com Citation: Ashwani Arya et al. Ijppr.Human, 2015; Vol. 4 (3) 251 278. 255 disorders is difficult to pinpoint since even small changes in diagnostic criteria, interview tools, or study methodology affect results [26] Anxiety disorders are among the most frequent mental disorders encountered in clinical practice [27] As scientists continue their research on mental illness, it is becoming clear that many of these disorders are caused by a combination of factors, including changes in the brain and environmental stress. Like other brain illnesses, anxiety disorders may be caused by problems in the functioning of brain circuits that regulate fear and other emotions. Studies have shown that severe or long lasting stress can change the way nerve cells within these circuits transmit information from one region of the brain to another. Other studies have shown that people with certain anxiety disorders have changes in certain brain structures that control memories linked with strong emotions. In addition, studies have shown that anxiety disorders run in families, which means that they can at least partly be inherited from one or both parents, like the risk for heart disease or cancer. Moreover, certain environmental factors such as a trauma may trigger an anxiety disorder in people who have an inherited susceptibility to developing the disorder [26] Anxiety disorders represent a heterogeneous group of disorders, probably with no single unifying etiology. Various psychodynamic, psychoanalytic, behavioral, cognitive, genetic and biological theories have been proposed to explain the