Anxiety
CONTENTS
1. Anxiety
2. Initial Assessment
3. Treatment
4. Medicines
5. Psychological Intervention
6. Other Associated Conditions
7. Long Term Treatment
Available on the HPB website: www.hpb.gov.sg
This Patient Education Booklet has been prepared based on the Clinical Practice Guidelines on Anxiety Disorders. It is written for patients with anxiety disorders, their family members and caregivers, and aims to help them understand their conditions and treatments. It is hoped that patients, their family and caregivers would be able to use this booklet as a basis to discuss with their doctors the treatment options available to them.
Clinical Practice Guidelines are guidelines, based on the best scientific evidence currently available, to help doctors make appropriate choices about treatment of their patients’ illnesses. The guidelines do not replace the judgment of the doctor. It is important it remember that each person is different, and the Clinical Practice Guidelines may not always apply to everyone.
Anxiety is a normal emotion that everyone experiences as part of everyday life. Normally, anxiety can be useful in helping us avoid dangerous situations, making us alert and giving us the motivation to deal with problem. However, when such feelings are too strong or exaggerated, it can lead to an anxiety disorder which can interfere with our day-to-day living. The impact can be devastating and disruptive to that person’s personal, emotional, social, physical and occupational life.
There are several types of anxiety disorders. It is important that a correct diagnosis is made so that the appropriate treatment can be prescribed.
TYPES OF ANXIETY DISORDERS:
1. Panic Disorder
Panic attacks which occur repeatedly may make the person feel like having a heart attack, or is going crazy. The panic attack appears for no apparent reason. The person may complain of experiencing a fast heartbeat, chest pain or discomfort, sweating, trembling, tingling sensations in the body, feeling of choking, fear of dying, fear of losing control, and feelings or unreality. Panic disorder often occurs with agoraphobia (fear of crowded places).
2. Social Phobia/Social Anxiety Disorder
People with this condition have severe anxiety and excessive self-consciousness. They fear and avoid public speaking, meeting new people and eating or drinking in front of others. In addition, they may experience a fast heartbeat, fainting, blushing and profuse sweating.
3. Specific Phobia
People with specific phobias suffer from an intense, irrational fear reaction to a specific object or situation (such as spiders, snakes or heights). This can lead to the avoidance of common, everyday situations.
4. Generalized Anxiety Disorder (GAD)
People with GAD have excessive and persistent worry lasting more than six months. The anxiety may focus on issues such as health, finances, career or family. They also have fatigue, trembling, muscular tension, sleeping difficulties, abdominal upsets, dizziness, and irritability.
5. Obsessive Compulsive Disorder (OCD)
People with OCD have recurring obsession (unpleasant thoughts, images or urges) compulsion or both. The obsessions may lead them to perform rituals or compulsions – such as excessive hand washing, cleaning, checking, repeating phrases or hoarding – to relieve the anxiety caused by the obsession.
6. Post Traumatic Stress Disorder
PTSD can follow experiencing or witnessing a life-threatening or extremely distressing situation that causes feelings of intense fear, horror or a sense of helplessness. They can experience “flashbacks” and nightmares, avoid places related to the trauma and have difficulty in sleeping, become easily irritated or have poor concentration.
Anxiety disorders are the most common of all the mental disorders. In Singapore, about 10% of people are affected by some form of anxiety disorder.
2 INITIAL ASSESSMENT
The family doctor can do a thorough medical check-up, which may include blood and urine tests to rule out any underlying disease or drug/substance-induced conditions that can cause excessive anxiety. Although most anxiety disorders can be treated in the general outpatient clinic, your family doctor may refer you to the specialist psychiatrist for an expert opinion and treatment if necessary.
3 TREATMENT
There are basically two types of treatment, medicines and counseling therapy. They are often used together. Each person is treated differently, as treatment is tailored according to the type of anxiety disorder.
4 MEDICINES
Anti-depressants and anti-anxiety medicines can be very useful in treating anxiety disorders. Medicines may be prescribed for a short term, or it may be required for a longer period of time. Medicines for anxiety generally belong to the following types:
Benzodiazepines include drugs such as Xanax and Valium which reduce tension and have a strong calming effect. They can, however, cause addiction so careful use is required. These drugs must be reduced gradually to avoid withdrawal symptoms. People who have had problems with drug and alcohol abuse in the past are usually not suitable for benzodiazepines, because they may become dependent on them.
Selective serotonin re-uptake inhibitors (SSRIs) help to control anxiety by acting on the parts of the brain that control fear and anxiety. SSRIs are safe and effective for long term use. They are more widely used, due to their fewer side effects, when compared to other anti-depressants. Some people may experience side effects like nausea (feelings of vomiting), difficulty in sleeping and delayed orgasm.
Tricyclic anti-depressants (TCAs) have specific anti-panic and anti-anxiety qualities and are not addictive. However they can cause side effects like “dry” mouth, dizziness and nausea. The major disadvantage of TCAs is that they are potentially fatal in an overdose situation.
Side effects may occur at the beginning of treatment or after an increase in dose. They then usually subside as treatment progresses.
As each individual reacts differently to different types of medicines, not all types of anti-anxiety medicines are suitable for everyone. Medicines do not “cure” anxiety. They will help decrease the anxiety feelings. Therefore, it is always recommended that you receive treatment that will help you change the way you view things and situations as well.
5 PSYCHOLOGICAL INTERVENTION
Psychological treatment can be combined with routine treatment; these include being educated about the condition, overcoming avoidance and controlled breathing and relaxation techniques. It may also involve making lifestyle changes that reduce stress, enhance problem solving skills and ongoing supportive counseling.
Cognitive behavior therapy (CBT) is recommended as an effective treatment for most anxiety disorders. CBT aims to reduce anxiety by changing “faulty” beliefs or behaviors that contribute to the anxiety disorder.
6 OTHER ASSOCIATED CONDITIONS
Although anxiety disorders can exist on their own, many with anxiety disorders may have other conditions as well. These can include another anxiety disorder, depression, or alcohol/drug dependence. It is necessary to receive treatment for these conditions since they affect the result of treatment.
7 LONG TERM TREATMENT
Some people may respond to treatment after a few months while others may take longer. After improvement with medicines, antidepressant treatment should be continued for at least 6 months. Some anxiety disorders remain chronic with remissions and relapses over several years. Long term medication is recommended for some individuals even when they no longer experience symptoms. This is because there is a danger of recurrence of symptoms.
It is important not to stop medications suddenly as some medicines may produce recurrence of symptoms. These medicines should be reduced gradually by the doctor. CBT may facilitate the reduction of medicines. For psychological treatments, continuation of therapy sessions during long term follow-up can lead to improvement and reduced relapse.
A Way Out of Anxiety
®Copyright MediaCorp
Are you prone to mild panic attacks?
Anxiety, intense worrying....even fear?
It feels like you just cant stop these feelings.
In fact you can, says this new book from the Institute of Mental Health.
Doctors are saying that anxiety disorders are still not well understood in Singapore.
While mental illness is no longer a taboo topic, it remains something of a mystery to most Singaporeans.
Dr Alex Su is a Senior Consultant Psychiatrist at the Institute of Mental health,
"Over the last three years we have seen more and more cases of anxiety disorder coming to our hospital to seek earlier assessment and treatment so thats a good sign. However really we still Know that because we give public talks and all that and we get feedback from the public, that a lot of people are still suffering quietly at home fearful of coming forward for treatment. I think a lot of people suffering from anxiety disorder basically suffers it very quietly for many years before seeking treatment. A lot of people, even in Singapore assumes that anxiety is normal, its just a passing phase and a lot of people will try to bear with it or try to find other ways of overcoming it but actually anxiety disorder is easily diagnosed.,easily treated."
And this is why his Institute decided to come up with a new book.
Its called A Way Out of Anxiety.
"Its really a collective experience, clinical experience, from all our psychiatrists, and collectively I think we have really a lot of experience. Case studies and treatment options that we have provided in the book are all locally based. I think a lot of books and even Internet available websites are sort of Western based so I think this book is very relevant to Singapore. Treatment options in terms of medication, psychological options as well as social problem solving are all locally based."
The problem is people are unaware of the many treatment options.
For those who fear taking anxiety medication there may be alternative options,
"Well...they can still go for some psychological treatment first for example teaching them relaxation therapy, and using some other cognitive behavioral therapy, psycho therapy methods to help them to try for another period of time. If they find that that helps them alleviate most of their anxiety then they may not go onto an anti depressant."
But in fact he says there is no reason to fear today's anti depressants.
"There are different groups of anti depressants available in Singapore and under each group again there are even many different types of anti depressants available so if one anti depressant is not suitable for the patient, it can easily be switched to another type and sometimes for patients who are more sensitive we can actually start at a lower dose and then slowly try and treat it upwards according to the clinical improvement and also the side effects experienced by the patients but most of our patients actually may only experience some side effects in the initial phase, maybe the first week of starting any medication. Usually these side effects are very mild, for example like dry eyes, dry mouth or some wind in the stomach. Usually the body will get used to it because our body adjusts to any types of medication within a week or two."
One common misconception is that tranquillizers, not anti depressants, are a long term solution.
"Anti depressant basically treats the specific bio chemical imbalance in the brain, tranquillizers basically just help them to calm down. Tranquillizers has more immediate effect because the patients will feel calmer but it shouldn't be used in the longer term because it also can lead to dependence on tranquillizers so some patients without tranquillizers feel even more anxious. Tranquillizers is only used in the initial phase and also for a short term whereas anti depressant their effects will have a more long lasting...longer lasting effect. "
Not seeking any appropriate treatment-psychological or medical, Dr Su warns will have a very serious long term impact,
"If untreated they will probably continue to disrupt a person's life and causes more disfunction, affect the person's confidence, and a lot of patients when they come to us after years of suffering actually thought that they were going crazy. A lot of untreated anxiety disorder also goes into depression and more severe complications."
The book is available at the Institute of Mental Health's pharmacy and at the Mental Health Education office.
-By Devika Misra
Anxiety, intense worrying....even fear?
It feels like you just cant stop these feelings.
In fact you can, says this new book from the Institute of Mental Health.
Doctors are saying that anxiety disorders are still not well understood in Singapore.
While mental illness is no longer a taboo topic, it remains something of a mystery to most Singaporeans.
Dr Alex Su is a Senior Consultant Psychiatrist at the Institute of Mental health,
"Over the last three years we have seen more and more cases of anxiety disorder coming to our hospital to seek earlier assessment and treatment so thats a good sign. However really we still Know that because we give public talks and all that and we get feedback from the public, that a lot of people are still suffering quietly at home fearful of coming forward for treatment. I think a lot of people suffering from anxiety disorder basically suffers it very quietly for many years before seeking treatment. A lot of people, even in Singapore assumes that anxiety is normal, its just a passing phase and a lot of people will try to bear with it or try to find other ways of overcoming it but actually anxiety disorder is easily diagnosed.,easily treated."
And this is why his Institute decided to come up with a new book.
Its called A Way Out of Anxiety.
"Its really a collective experience, clinical experience, from all our psychiatrists, and collectively I think we have really a lot of experience. Case studies and treatment options that we have provided in the book are all locally based. I think a lot of books and even Internet available websites are sort of Western based so I think this book is very relevant to Singapore. Treatment options in terms of medication, psychological options as well as social problem solving are all locally based."
The problem is people are unaware of the many treatment options.
For those who fear taking anxiety medication there may be alternative options,
"Well...they can still go for some psychological treatment first for example teaching them relaxation therapy, and using some other cognitive behavioral therapy, psycho therapy methods to help them to try for another period of time. If they find that that helps them alleviate most of their anxiety then they may not go onto an anti depressant."
But in fact he says there is no reason to fear today's anti depressants.
"There are different groups of anti depressants available in Singapore and under each group again there are even many different types of anti depressants available so if one anti depressant is not suitable for the patient, it can easily be switched to another type and sometimes for patients who are more sensitive we can actually start at a lower dose and then slowly try and treat it upwards according to the clinical improvement and also the side effects experienced by the patients but most of our patients actually may only experience some side effects in the initial phase, maybe the first week of starting any medication. Usually these side effects are very mild, for example like dry eyes, dry mouth or some wind in the stomach. Usually the body will get used to it because our body adjusts to any types of medication within a week or two."
One common misconception is that tranquillizers, not anti depressants, are a long term solution.
"Anti depressant basically treats the specific bio chemical imbalance in the brain, tranquillizers basically just help them to calm down. Tranquillizers has more immediate effect because the patients will feel calmer but it shouldn't be used in the longer term because it also can lead to dependence on tranquillizers so some patients without tranquillizers feel even more anxious. Tranquillizers is only used in the initial phase and also for a short term whereas anti depressant their effects will have a more long lasting...longer lasting effect. "
Not seeking any appropriate treatment-psychological or medical, Dr Su warns will have a very serious long term impact,
"If untreated they will probably continue to disrupt a person's life and causes more disfunction, affect the person's confidence, and a lot of patients when they come to us after years of suffering actually thought that they were going crazy. A lot of untreated anxiety disorder also goes into depression and more severe complications."
The book is available at the Institute of Mental Health's pharmacy and at the Mental Health Education office.
-By Devika Misra
