Trait anxiety - An individuals tendency to experience anxiety in response to stressors
State anxiety - simply the state of feeling anxious
Anxiety disorder
A combination of high trait anxiety and a critical mass of psychosocial stressors can tip someone into excessive and persistent anxiety. Several thought processes drive this spiral:
- Avoidance - need to expose to stimulus to uncouple anxiety from it
- Attentional and cognitive bias - anxiety makes people pay attention to things and perceive threats more easily
- Anxious rumination - snowballing events
- Low self worth - frequently comorbid with Depression
- Poor sleep - essential functions relating to cognition, emotional processing and memory
ICD-10 diagnostic criteria for all anxiety disorders
- Persistent for several months, on more days than not
- Result in significant impairment (personal, family, social, educational, occupational or other important areas)
- Not be a manifestation of another health condition or effects of substance/medication
Generalised anxiety disorder
Persistent “free-floating” not restricted to any circumstance or excessive worrying focused on multiple everyday events
Common features of generalised anxiety disorder include:
- Subjective experience of nervousness
- Difficulty maintaining concentration
- Muscular tension or motor restlessness
- Sympathetic autonomic over-activity
- Irritability
- Sleep disturbance.
Management
Psychological therapies to address the problem - breaking the positive feedback loops.
- Sleep hygiene
- Psychoeducation
- Self guided CBT/mindfullness
- CBT ± exposure therapy
Medications to reduce the intensity of the state of anxiety
- SSRI (escitalopram or sertraline)
- SNRI (duloxetine or venlafaxine)
- Or atypical antidepressant dependant on side effect profile
Benzodiazepines
- Avoid benzodiazepines in chronic anxiety
- Tolerance develops after 1/2 months and anxiety returns
- Can be used for transient causes only (eg fear of flying) or in crisis.
- Maximum 2 week prescription