Printer Friendly

Normal and pathological anxiety/Anxietatea normala si patologica.

INTRODUCTION

In everyday language, the term anxiety is rarely used, as it is replaced by words such as restlessness, fear, psychic tension, excitement, and it connotes mostly the subjective psychological aspects, an embarrassing emotional experience that is difficult to describe, consisting of the combination of intellectual affective disorders and diffuse disturbing activity impairment. At this level, anxiety occurs as painful and uncertain waiting of a virtual threat accompanied by feelings of insecurity and uncertainty.

In psychiatric language, the term anxiety is less syncretic. It designates both subjective distressing experience and symptomatic autonomic phenomena, such as: tremor, tachycardia, dyspnea, pallor, sweating, dizziness or headache, fainting or loss of control, etc. Disorders "located" in the human body (and not in the mental universe) express the somatic dimension of anxiety, the autonomic expression of the unity of psyche and body in normal and pathological situations.

Anxiety disorders also include features of other disorders: panic disorders (panic attacks), discomfort, fear and embarrassment of a person when present in public places or interacting with others (social phobia), fear or excessive worry not to get sick (obsessive compulsive disorder), fear of being separated from the loved ones (separation anxiety), fear of gaining weight (anorexia nervosa), complaint of various symptoms of physical illness triggered by psychological mechanisms (somatization disorders) or even by serious diseases (hypochondriasis) and posttraumatic stress disorders.

Traditionally, the term anxiety is used in denoting the psychic feature of the disorder, while the somatic side is labelled as anguish.

Anxiety is a generalized diffuse emotional state, characterized by feelings of discomfort, insecurity, fear, that the individual cannot explain and relate to an object.

Unlike object related emotions, anxiety does not usually cause physiological changes. What underlies such features of the affective structure still remains an unresolved issue. Various doctrinal guidelines suggest different origins. For instance, exponents of learning theory regard anxiety as the result of the conditioned perpetuation of the fear reaction, which is directly determined by the subunit ratio between successes and failures. On the contrary, psychoanalysis regards anxiety as an effect of repeated frustration, of libido tendencies and urges, as well as prohibitions imposed by the superego. Anxiety is considered a warning addressed to the ego, to the self-awareness of personality, that are able to take recovery actions or to mobilize specific defence mechanisms. The anxious person always shows restraint and fear about the future, about activities that will be performed or about situations to deal with.

Anguish could be defined as aggravation and intensification of anxiety, as it is characterized by uneasiness taken to the extreme and by exacerbated irrational fear. It is a feeling of undefined but impending danger that makes one feel totally vulnerable and defenceless.

One could become anxious without being aware of the cause of anxiety. Such "undetermined" anxiety affects attention. Instead of forcing the individual to focus on a certain idea, it disrupts thoughts, making the individual concentrate on the world around him. If an anxious person walks on a dark street, late at night, anxiety makes him scan the surrounding shadows, in order to detect any movement. In this situation, anxiety is really useful. A person with anxiety symptoms watches out for possible threats, being able to respond quickly to any unfortunate events.

If someone wants to give a good speech at the best friend's wedding, the biggest threat might be to stutter. Anxiety makes the individual pay attention to the slightest sign of hesitation. The anxiety increases when such hesitation is noticed and the stutter gets even worse. On such occasions, anxiety becomes harmful.

Besides cognitive and somatic anxiety, in modern psychiatry, there is also a third dimension of anxiety disorders, namely, the behavioral dimension.

Clinical and common observation have shown that the individuals who have experienced an acute anxiety crisis in crowded places, in the elevator, while crossing the street or speaking in public definitely change their behavior by systematically avoiding places or situations of which they were afraid. These individuals not only develop avoidance behaviors and severe disturbances if forced to respond to an anxiogenic situation, but also anticipatory anxiety (fear that panic attacks might occur once more in similar circumstances).

The three aspects of anxiety as mental illness are not equally and simultaneously present in all individuals. Some patients permanently show diffuse uneasiness and fear without being aware of changes in heart rate, breathing rate, etc. Other patients have anxiety disorders, especially acute crises that occur "out of nowhere". These crises intensify the multiple neurovegetative disorders only in minutes, inducing lipothymia symptoms and the frightening sensation of imminent death.

There are individuals who may manifest anxiety as a personality trait and although they are described by their entourage as being always "tense, nervous, fearful", they develop a high degree of tolerance to this phenomenon and keep their life and work free from serious problems caused by anxiety.

As an universal human experience, anxiety is characterized by anticipatory fear of an unpleasant or traumatic future event, imaginary danger or virtual threat.

Unlike anxiety, normal fear is a comprehensible reaction to a real and present danger to the individual's life or health. Its intensity and duration is proportional to the extent of objective danger in a given situation, to the closeness in time and space between the individual and the source of danger, to a previous experience that has proven possible harmful consequences.

Depending on the consequences negatively anticipated by the anxious person, subjective anxiety can take different forms. For instance, the anticipatory fear of losing a loved one defines separation anxiety, which is dramatically intensified in case of separation, incurable physical disease, accident etc. Anger, rage, aggressive impulses and fear that this will lead to loss of control and to irrational aggressive and reprehensible behavior generates a particular form of anxiety ("emotional storm", a characteristic of these moods that is not always referred to as anxiety).

A form of anxiety that no one can pretend not to have experienced (at least in childhood) is a vague and irrational sense of having committed an act that was not agreed by the loved ones and will entail disapproval, reproach, criticism, loss of affection.

Anxiety becomes pathological when present in excess, either in duration and frequency, or in intensity. Pathological anxiety is the fear with no actual or defined grounds, when the experience of terror is basically fuelled by imaginary more or less ineffable representations. The unfortunate or frightening experience is generally expressed at a mental, somatic and behavioral level.

Anxiety reaches clinical intensity when the performance and resilience decrease (in neuroses) or it disrupts the conduct constituting the appropriate background for the development of psychic elements. In the context of normal and pathological hypotheses, where anxiety is not considered as one of the most common experiences of existence, Tyrer (1984) developed "a pyramid of clinical anxiety" in order to classify pathological anxiety.

Family doctors identify different degrees of severity of anxiety in their patients.

Anxiety is the dynamic centre of neuroses. Fear is a proportional response to the danger to be faced, whereas anxiety is a disproportionate response to threat or even a reaction to an imaginary danger. In the case of fear, danger is transparent and objective, whereas in the case of anxiety, the danger is hidden and subjective.

The attempt to help a neurotic get rid of anxiety by methods of persuasion is useless. Anxiety refers not to the situation as it really is, but the situation as it appears to him. Therefore, the therapeutic task is to find the meaning that certain situations have for the neurotic person.

The elements of anxiety are: inability (on the verge of despair), irrationality, as a warning sign of mental disorder.

The effective measures to combat anxiety are:

1. to rationalize it (a mother realizes that her absurd concern about children is not quite irrational);

2. to deny it (a soldier driven by the impulse to overcome fear does heroic deeds);

3. to narcotize it (with alcohol and drugs, through social activity and immersion in work, through sleep or sexual relationships);

4. to avoid all situations, thoughts or feelings that might induce anxiety (when avoidance is automatic, it is about a phenomenon of inhibition with a defensive role).

Fear and anxiety (uneasiness)

Cavemen attacked by beasts experienced real fear. They had no time to ask questions or to ponder. They had a minute, maybe two to choose between life and death. The adrenaline was flowing quickly through the body, giving them speed, energy and power. Veins and arteries contracted simultaneously to slow bleeding if they were hurt quicken. The pulse grew faster. Fear saved lives.

Nowadays, "fear" is called anxiety. It is not a response to the threat itself, it is a response to a potential danger. When the car's brakes fail on a hill, what we feel is called fear. If we are worried about what we are going to say at a meeting next Tuesday, it is called anxiety. And anxiety is more terrible than fear. Fear ends with the event: the car stops, the fear disappears. Anxiety can be endless. Fear manifests itself by sweaty hands, dry throat, a feeling of being paralyzed. Anxiety is frustrating, as it brings a lot of energy that is useless. We cannot run and we cannot fight, because there is nothing to run from and nothing to fight for. We sit crouched, with a knot in the stomach, anticipating danger. Symptoms may vary from transient uneasiness to psychological and physical mutilation or even death.

On the other hand, anxiety, as a real source of energy, can help us live better, if properly directed. All famous people (scholars, writers, physicians) worry, but they worry in a positive way.

Alleviating anxiety

Worry lies at the core of anxiety. The worried mind thinks through endlessly in a vicious circle of poor melodrama, going from one worry to another. Worry is a preparation for problems that might happen and for ways of addressing them. The purpose of worry is to find positive solutions for coming hazards and to anticipate dangers.

There is a problem only when it comes to chronic repetitive worries that appear again and again and never come close to a positive solution. Chronic worry has all the attributes of an emotional blockage, as it locks the person into an inflexible perspective, namely, the worry-generating topic. When this phenomenon intensifies and persists, it turns into a real natural blockage, leading to anxiety disorders, such as phobias, obsessions or panic attacks.

For the phobic, anxieties bring fears into focus, for the obsessive, the prevention of feared calamity is the most important, for panic prone individuals, the fear of dying or even the idea that they might suffer a panic attack. In all these cases, the common denominator is worry taken to the extreme.

Anxiety occurs in two forms:

--cognitive--or disturbing thoughts,

--somatic--as physiological symptoms: sweating, rapid heartbeat, muscle pain.

Anxiety and somatic diseases

The association of anxiety and fear with somatic diseases is a known clinical fact.

On one hand, some psychiatric patients receiving outpatient and inpatient services simultaneously suffer from a somatic disorder accompanied by anxiety symptoms. On the other hand, symptoms of anxiety are the first signs or complaints of the patient at the onset of many psychosomatic diseases (arterial hypertension, ischaemic heart disease, etc.).

The most striking association between anxiety symptoms and somatic symptoms occurs in cardiovascular and respiratory diseases that arouse an understandable state of fear, uneasiness and anxious waiting. Fear associated with the awareness of severe disease is often exacerbated by the awareness of cardiac dysfunction (tachycardia, extrasystoles, dysrhythmia), by precordial pain, breathing difficulties or feelings of physical exhaustion.

The difference between fear and anxiety: fear is induced by an immediate threat and requires a reaction. When someone is pursued by a bear, he runs. Fear sharpens the senses, anxiety paralyzes them.

The characteristic feature of anxiety is the lack of an object of fear. It passes through the body in shapeless successive waves, it abases you until pressure and coercion become tangible and panic keeps growing: "it is dense, I dive deep, I will drown". It brings a diffuse sense of insecurity, of being helpless in the face of threat [1].

These clinical facts justify the use of combination therapy with specific drugs and mild sedatives recommended in psychiatric clinics to patients with primary anxiety disorders (unrelated to a somatic disorder or to other mental illness).

Many endocrine diseases or merely disorders of this system (hyperthyroidism, hypoglycemia, symptoms of menopause, premenstrual syndrome) have symptom profiles similar to those of anxiety disorders. There symptoms are generated by the hypermetabolic state characteristic to these conditions, by the growth of autonomic adrenergic activity. The characteristic difference between anxiety states with endocrine etiology and psychological etiology is the presence, in the foreground, of symptoms of somatic anxiety in endocrine patients who often do not show symptoms of subjective psychic anxiety.

Anxiety and drugs

Less well known and often ignored is that prolonged administration of drugs or toxic substances and their abrupt withdrawal are likely to generate anxiety disorders of clinical severity.

One category of substances is represented by steroids, anticholinergic agents, hallucinogens and even aspirin. Tobacco and caffeine withdrawal may also induce anxiety. All of these can generate temporary anxiety disorders of subclinical severity in normal individuals, but they can also aggravate anxiety symptoms in persons who have already had such disorders.

The second category of substances that induces anxiety disorders as withdrawal phenomena is represented by alcohol and sedativehypnotics drugs.

In both cases, there is not only an increase in anxiety state, psychological distress and autonomic phenomena, but also a hyperreactivity to minor stressful situations which would otherwise have been easily overcome by those individuals.

Given the diversity of acute and chronic manifestations, the predominance of subjective psychological or somatic autonomic phenomena in the clinical picture and the differences in therapeutic response of various forms of pathological anxiety, current treatment of symptoms includes two methods: behavioral therapy of phobic disorders and antidepressant drugs used for treating panic attacks.

Behavioral therapy is based on the observation that repeated exposure to stimuli that generate fear helps patients gradually tolerate them and leads to an "unlearning" of fear. Although, theoretically, it is still unclear why exposure to

CONCLUSIONS

Certain stimuli sometimes generates fear and sometimes leads to the disappearance of fear, in practice, behavioral therapies were the treatment of choice for most phobias and anxieties related to certain stimulus-situations.

The more rational control in a culture, the more anxiety generating situations, because there is more fear of losing control.

Accept your anxiety as a sign of your sensitivity to the world and as a call to action. Real courage means mastering your fear and not necessarily being imprudent. Being able to do a thing that scares you can make you proud and you may realize what a wonderful thing you have done. Think of your strong points that might also include the image of "the scared child".

Isabella Cristina Brujbu--M. D., Ph. D., Assistant Professor, Department of Anatomy, "Apollonia" University, Iasi; Senior Family Physician, Medicine--Private Practice, Iasi, Romania

Luana Macovei--M. D., Ph. D., Assistant Professor, Department of Internal Medicine, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi; Physician, Department of Rheumatology, Rheumatology, Clinical Rehabilitation Hospital, Iasi, Romania

Iulian Eduard Dobos--Master student, Faculty of Economics and Business Administration, Management, "Alexandru Ioan Cuza" University, Iasi, Romania

Isabella Cristina Brujbu--M. D., Ph. D., Sef de Lucrari, Departamentul de Anatomie, Universitatea "Apollonia", Iasi; Medic Primar, Medicina de Familie, Practica Privata, Iasi, Romania

Luana Macovei--M. D., Ph. D., Asistent universitar, Departamentul Medicale I, Universitatea de Medicina si Farmacie "Gr. T. Popa", Iasi; Medic Primar, Clinica de Reumatologie, Spitalul Clinic de Recuperare, Iasi, Romania

Iulian Eduard Dobos--Masterand, Facultatea de Economie si Managementul Afacerilor, Universitatea "Alexandru Ioan Cuza", Iasi, Romania

ACKNOWLEDGMENTS AND DISCLOSURE

The authors declare that they have no potential conflicts of interest to disclose.

REFERENCES

(1.) Tudose, Fl. O abordare moderna a psihologiei medicale, Ed. InfoMedica, Bucuresti, 2000

(2.) Berkow, R. The Merck Manual of Diagnosis and Therapy, Ed. Merck and Co. Ind., 2006

(3.) Octavian, Ioan. Marginalizare versus boala psihica si stigmatizare. Dileme bioetice, "Revista Romana de Bioetica", Iasi, 2008

(4.) Branea, I. Medicina de familie, Ed. Universitas Company, Bucuresti, 2000

(5.) Kumar, P. J., Clark, M. I. Clinical Medicine, Ed. Balliere Tindall, 2002

(6.) Burns, J., Hickie, I. Depression in young people: a national schoolbased initiative for prevention, early intervention and pathways for care. Australas Psychiatry, 2002

INTRODUCERE

In limbajul curent, termenul de anxietate este rareori folosit, acesta fiind inlocuit cu neliniste, teama, tensiune psihica, emotie, si conotand, cu predilectie, dimensiunea psihica subiectiva, acea traire emotionala penibila, dificil de descris, constituita din asocierea unor tulburari afective intelectuale si de activitate difuze si perturbatoare. La acest nivel, anxietatea capata forma asteptarii dureroase si nelamurite a unui pericol virtual, insotita de sentimente de insecuritate si incertitudine.

In limbajul psihiatric, termenul de anxietate este mai putin sincretic, el desemnand atat trairea subiectiva, neplacuta, cat si fenomenele neurovegetative simptomatice ca: tremorul, tahicardia, dispneea, paloarea, transpiratia, senzatia de ameteala sau cefaleea, senzatia de lesin sau de pierdere a controlului etc. Tulburarile a caror "localizare" este corpul uman (si nu universul sau psihic) reprezinta dimensiunea somatica a anxietatii, expresia neurovegetativa a unitatii dintre psihic si corp, in situatii normale si patologice.

Tulburarile de anxietate includ si caracteristici ale altor afectiuni: tulburarile de panica (atacul de panica), disconfortul, teama si jena unei persoane care este prezenta in public sau in momentul interactiunii cu ceilalti (fobia sociala), teama sau grija excesiva de a nu se imbolnavi (tulburarea obsesiv-compulsiva), teama de a nu fi despartit de cei apropiati (anxietatea de separare), frica de ingrasare (anorexia nervoasa), lamentarile privind manifestarea unor diverse simptome ale unor boli fizice declansate de mecanisme psihice (tulburarile de somatizare) sau chiar boli grave (hipocondria) si tulburarile de stres posttraumatic.

Clasic, termenul de anxietate este dat laturii psihice a tulburarii, in timp ce laturii somatice i se rezerva termenul de angoasa.

Anxietatea este o stare afectiva generalizata, difuza, caracterizata prin trairi de tulburare, de insecuritate, de teama, pe care subiectul nu le poate explica si relationa obiectual.

Spre deosebire de emotiile obiectuale, anxietatea nu antreneaza, de regula, modificari fiziologice. Ce sta la originea unei asemenea trasaturi a structurii afective ramane o chestiune inca neelucidata. Diferitele orientari doctrinare ii gasesc origini diferite. Astfel, pentru reprezentantii teoriei invatarii, anxietatea este rezultatul perpetuarii prin conditionare a unei reactii de teama, fiind nemijlocit determinata de raportul subunitar dintre reusite si esecuri; dimpotriva, pentru psihanalisti, ea este un efect al frustrarii repetate, al pornirilor si tendintelor libidoului si al interdictiilor impuse de Supraeu. Anxietatea este considerata un semnal de alarma adresat Eului--constiintei de sine a personalitatii, singurul in masura sa intreprinda actiuni de redresare sau sa-si mobilizeze mecanismele specifice de aparare. Persoana anxioasa manifesta intotdeauna retinere si teama in raport cu viitorul, cu activitatile pe care urmeaza sa le efectueze sau cu situatiile cu care urmeaza sa se confrunte.

Angoasa s-ar putea defini ca o agravare si intensificare a anxietatii, caracterizandu-se printro neliniste dusa la extrem, printr-o frica irationala acutizata, presimtirea unui pericol nedefinit, dar iminent, in fata caruia ramai total descoperit, dezarmat.

Am putea deveni anxiosi fara sa fim constienti de cauza anxietatii noastre. O astfel de anxietate "fara obiect" ne afecteaza atentia. In loc sa ne oblige sa ne concentram asupra unei anumite idei, ea sterge celelalte ganduri, facandu-ne sa acordam atentie lumii din jur. Daca trecem seara tarziu pe o alee intunecata, starea de anxietate ne determina sa scanam umbrele din jur ca sa depistam orice miscare.

In aceasta situatie, anxietatea este, in mod clar, un lucru bun. O persoana aflata intr-o stare de anxietate urmareste posibilele amenintari, fiind capabila sa reactioneze mai rapid intr-un incident nefericit.

Daca obiectivul dumneavoastra este sa tineti un discurs admirabil la nunta celui mai bun prieten, cea mai mare amenintare ar fi tendinta de balbaire. Anxietatea va streseaza sa fiti atent la cel mai mic semn de ezitare. Sesizarea vreunei nereguli v-ar face si mai anxios, ducandu-va sigur la balbaire. In asemenea ocazii, anxietatea devine nociva.

Alaturi de anxietatea psihica si de cea somatica, psihiatria actuala a delimitat si a descris si o a treia dimensiune a tulburarilor anxioase, dimensiunea comportamentala.

Observatia clinica, dar si cea comuna pot constata faptul ca persoanele care au trait o criza acuta de anxietate, in aglomeratie, in lift sau in timp ce traversau o strada sau vorbeau in public, isi modifica evident comportamentul, evitand, in mod sistematic, locurile sau situatiile in care le-a fost frica. Astfel de persoane dezvolta nu numai conduite de evitare si tulburari ample, daca sunt obligate sa se confrunte cu situatia anxiogena, dar si o anxietate anticipatorie, respectiv teama ca nu cumva, in situatii similare, sa se repete criza de panica.

Cele trei aspecte ale anxietatii ca boala psihica nu se manifesta in mod egal si paralel la toate persoanele, unii pacienti prezentand, in mod cronic, o stare de neliniste si teama difuza, fara sa fie constienti de modificarile de ritm cardiac, respirator etc.

Alti subiecti prezinta tulburari anxioase, mai ales sub forma crizelor acute, survenite "din senin", in timpul carora tulburarile neurovegetative multiple se intensifica in cateva minute, generand stari lipotimice si senzatia inspaimantatoare de moarte iminenta.

O alta categorie de persoane poate prezenta anxietate, ca trasatura caracteristica de personalitate, si, desi descrise de anturaj ca permanent "tensionate, nervoase, prapastioase", acestea dezvolta un grad crescut de toleranta la acest fenomen si isi desfasoara viata si activitatea fara perturbari severe induse de anxietate.

Ca traire emotionala universal-umana, anxietatea se caracterizeaza prin teama anticipatorie de un viitor eveniment neplacut sau traumatizant, de un pericol imaginar sau de o virtuala amenintare.

Spre deosebire de anxietate, frica normala este o reactie comprehensibila fata de un pericol prezent si real pentru viata sau sanatatea persoanei, intensitatea si durata ei fiind proportionale cu periculozitatea obiectiva a situatiei, cu gradul de apropiere in timp si spatiu dintre persoana si sursa pericolului, cu experienta anterioara confirmata a consecintelor daunatoare ce ar putea rezulta.

In functie de natura consecintelor pe care persoana anxioasa le anticipeaza negativ, anxietatea subiectiva poate lua forme diferite. Astfel, teama anticipatorie de pierdere a unei persoane iubite ia forma anxietatii de separare intensificata dramatic in situatii de despartire, de boala somatica incurabila, accident etc.

Enervarea, furia, impulsurile agresive si teama ca acestea vor duce la pierderea controlului si la manifestarea unor conduite agresive irationale si reprobabile genereaza o forma particulara de anxietate ("furtuna emotionala"), aceste stari nefiind, de cele mai multe ori, identificate ca anxietate.

O forma de anxietate, pe care nimeni nu poate sustine ca nu a trait-o vreodata in viata (cel putin in copilarie), este sentimentul vag si irational de a fi comis un act care nu este pe placul celor apropiati si ca aceasta va atrage dupa sine dezaprobarea, blamarea, critica sau pierderea afectiunii.

Anxietatea devine patologica atunci cand se prezinta in exces fie ca durata si frecventa, fie ca intensitate. Anxietatea patologica reprezinta frica fara obiectul actual sau definit, experienta de teroare, in mod esential, alimentata de reprezentari imaginare, mai mult sau mai putin inefabile, experienta nefasta sau paralizanta exprimandu-se, in general, sub forma psihica, somatica si comportamentala.

Anxietatea atinge intensitatea clinica atunci cand scade randamentul si capacitatea de adaptare (in nevroze) sau cand dezorganizeaza conduita, constituind fundalul propice pentru dezvoltarea unor elemente psihice. In evantaiul de ipoteze normale si patologice in care anxietatea nu apare ca una dintre trairile cele mai frecvente ale existentei, pentru sistematizarea anxietatii patologice, Tyrer (1984) a propus "piramida anxietatii clinice".

Medicul de familie recunoaste variate grade de severitate ale anxietatii la pacientii sai.

Anxietatea este centrul dinamic al nevrozelor. Frica este reactia proportionala cu pericolul pe care il are cineva de infruntat, pe cand anxietatea este o reactie disproportionata la pericol, chiar o reactie la un pericol imaginar. In cazul fricii, pericolul este transparent obiectiv, pe cand in cazul anxietatii, pericolul este ascuns si subiectiv.

Incercarea de a-i scoate nevroticului din cap anxietatea prin metoda persuasiunii este zadarnica. Anxietatea sa se refera nu la situatie, asa cum este ea in realitate, ci asa cum ii apare lui. Sarcina terapeutica, asadar, consta in a descoperi sensul pe care anumite situatii il au pentru nevrotic.

Elementele principale ale anxietatii sunt: neputinta (dusa pana la disperare), irationalitatea, avertisment al dereglarii psihice.

Modalitatile principale de a scapa de anxietate sunt:

1. rationalizarea (de exemplu: o mama demonstrand ca temerile ei absurde in legatura cu copiii nu sunt tocmai irationale);

2. negarea (de exemplu: soldatul care, stapanit de impulsul de a-si birui frica, savarseste fapte eroice);

3. narcotizarea (drogarea) (prin alcool si droguri, printr-o activitate sociala, prin cufundarea in munca, prin somn, relatii sexuale);

4. evitarea: situatiilor, gandurilor sau sentimentelor care ar putea sa genereze anxietate (cand evitarile au loc in mod automat, avem de a face cu fenomenul inhibitiei, al carei rol este de aparare).

Frica si anxietate (neliniste)

Omul cavernelor, atacat de fiare, traia frica adevarata. El nu avea timp sa-si puna intrebari sau sa chibzuiasca. Avea un minut, poate doua, ca sa aleaga intre viata si moarte. Adrenalina ii curgea repede prin corp, dandu-i viteza, energie si putere. Venele si arterele se contractau simultan pentru a incetini sangerarea, daca era ranit. I se accelera pulsul. Frica ii salva viata.

Astazi, "frica" se numeste neliniste, un raspuns nu la pericolul in sine, ci la un potential pericol. Cand ne cedeaza franele de la masina pe un deal, ceea ce simtim se numeste frica. Daca suntem ingrijorati in legatura cu ceea ce o sa spunem la intrunirea de martea viitoare, asta se numeste neliniste. Si nelinistea este mult mai cumplita decat frica. Frica inceteaza de indata ce se incheie evenimentul: masina se opreste, frica dipare. Nelinistea poate fi infinita. Frica se manifesta prin transpiratia palmelor, gat uscat, "taierea" picioarelor. Nelinistea este frustranta, o invazie de energie care nu ne foloseste la nimic. Nu putem fugi, nu ne putem lupta, pentru ca nu avem de ce sau cu cine. Stam chirciti, cu un nod in stomac, anticipand pericolul. Simptomele pot varia de la o neliniste trecatoare la mutilare psihologica si fizica sau chiar moarte.

Culmea este ca nelinistea, ca o sursa adevarata de energie, ne poate ajuta sa traim mai bine, daca este directionata corect. Marii oameni (savanti, scriitori, medici) isi fac griji. Dar ei isi fac griji pozitive.

Calmarea nelinistii

Miezul nelinistii este ingrijorarea. Mintea ingrijorata se roteste la nesfarsit in cercul vicios al unei melodrame de slaba calitate, mergand dintr-o ingrijorare in alta. Ingrijorarea este o repetitie in vederea a ceea ce s-ar putea intampla rau si a felului in care trebuie abordata situatia; misiunea ingrijorarii este sa gaseasca solutii pozitive in cazul pericolelor ce apar, anticipand primejdiile.

Dificultatea intervine atunci cand este vorba despre ingrijorari cronice repetitive, cele care apar iar si iar si nici macar nu se apropie vreodata de o solutie pozitiva. Ingrijorarea cronica are toate atributele unui blocaj emotional, tintuind persoana intr-un punct de vedere inflexibil, subiectul generator de ingrijorare. Cand fenomenul se intensifica si persista se transforma intr-un adevarat blocaj natural, ajungandu-se la tulburari de anxietate, cum ar fi fobiile, obsesiile sau crizele de panica.

Pentru fobic, nelinistile se axeaza pe temeri; pentru obsedat, pe prevenirea unei calamitati care il sperie; pentru panicarzi, pe frica de moarte sau chiar pe ideea ca ar putea suferi o asemenea criza.

In toate aceste situatii, numitorul comun este ingrijorarea scapata de sub control.

Anxietatea apare sub doua forme:

--cognitiva sau ganduri ingrijoratoare si

--somatica, prin simptome fiziologice: transpiratii, tahicardie, febra musculara.

Anxietatea si bolile somatice

Asocierea starilor de anxietate si frica cu bolile somatice este un fapt clinic cunoscut.

Pe de o parte, o parte dintre pacientii psihiatrici, in ambulatoriu sau spitalizati, sufera simultan de o afectiune somatica ce este insotita de simptome anxioase. Pe de alta parte, la debutul multora dintre afectiunile psihosomatice (hipertensiune arteriala, cardiopatie ischemica etc.), primele semne si acuze ale bolnavului au forma unor simptome anxioase.

Cea mai frapanta asociere dintre simptomele anxioase si cele somatice apare in bolile cardiovasculare si respiratorii, care determina, in mod comprehensibil, stari de frica, neliniste si asteptare anxioasa. Frica, asociata constiintei unei boli severe, este, deseori, exacerbata de constientizarea disfunctiilor cardiace (tahicardie, extrasistole, aritmii), de aparitia durerilor precordiale, de dificultatile in respiratie sau senzatiile de epuizare fizica.

Diferenta dintre frica si anxietate poate fi ilustrata dupa cum urmeaza: frica este invocata de o amenintare imediata si cere o reactie. Te urmareste un urs: fugi. Frica ascute simturile, insa anxietatea le paralizeaza.

Trasatura caracteristica a anxietatii este lipsa unui obiect al fricii. Te strabate in valuri informe, succesive, te trage in jos, pana ce presiunea si constrangerea devin tangibile si panica tot creste: "e groasa, ma scufund in adanc, o sa ma inec". Ai un sentiment difuz de nesiguranta, de a fi neajutorat in fata amenintarii [1].

Aceste fapte clinice justifica asocierea terapeutica a medicatiei specifice cu sedativele usoare, recomandate in clinica psihiatrica pacientilor cu tulburari anxioase primare (nelegate de o afectiune somatica sau de alta boala psihica). Numeroase boli endocrine sau simple disfunctii ale acestui sistem (hipertiroidismul, hipoglicemia, simptomele de menopauza, sindromul premenstrual) prezinta profile simptomatice similare cu cele ale tulburarilor anxioase, simptome generate de starea hipermetabolica caracteristica acestor conditii, de cresterea activitatii autonome adrenergice.

Diferenta caracteristica dintre starile anxioase de etiologie endocrina si cele de etiologie psihica este prezenta, in prim-planul simptomatologiei, a anxietatii somatice la pacientii endocrini, care, de multe ori, nu acuza simptome de anxietate psihica, subiectiva.

Anxietatea si medicamentele

Mai putin cunoscut, si adesea ignorat, este faptul ca administrarea prelungita a unor substante medicamentoase sau toxice, precum si intreruperea brusca a administrarii lor (sevrajul) sunt susceptibile de a genera tulburari anxioase de intensitate clinica. Fac parte din prima categorie steroizii, substantele cu efect anticolinergic, halucinogenele si chiar banala aspirina, la care se adauga tutunul si cafeaua.

Toate acestea pot produce tulburari anxioase de intensitate subclinica, tranzitorii, la persoanele normale, dar pot agrava simptomatologia anxioasa la persoane care au avut deja astfel de tulburari. Din a doua categorie, a substantelor ce determina tulburari anxioase ca fenomene de sevraj, fac parte alcoolul si medicamentele sedativ-hipnotice.

In ambele situatii, se constata nu numai o intensificare a starii de neliniste, disconfort psihic si fenomene neurovegetative, ci si o hiperreactivitate la situatii stresante minore, care, in alte conditii, ar fi fost, cu usurinta, depasite de persoanele respective.

In conditiile diversitatii formelor de manifestare (acute si cronice) ale predominantei in tabloul clinic al fenomenelor subiective, psihice sau somatice-neurovegetative si ale diferentelor de raspuns terapeutic ale variatelor forme de anxietate patologica, tratamentul simptomatic actual a inregistrat doua metode: terapia comportamentala a tulburarilor fobice si posibilitatea combaterii crizelor de panica prin medicatie antidepresiva.

Terapia comportamentala se bazeaza pe observatia ca, prin expunere repetata la stimuli care genereaza frica, pacientii ajung, in mod gradat, sa le tolereze si are loc o "dezvatare" a fricii. Desi, din punct de vedere teoretic, nu se stie inca de ce expunerea la anumiti stimuli produce uneori frica, iar alteori, duce la disparitia fricii, din punct de vedere practic, terapiile comportamentale s-au dovedit tratamente de electie pentru majoritatea fobiilor si anxietatilor legate de anumite situatii-stimuli.

Cu cat o cultura insista mai mult asupra controlului rational, cu atat tinde sa genereze mai multa anxietate, deoarece cu atat mai mult se teme de pierderea controlului.

CONCLUZII

Acceptati-va anxietatea ca pe un semn al sensibilitatii voastre fata de lume si ca pe un indemn la actiune. Adevarul curaj este sa-ti stapanesti frica, nu sa fii imprudent. Cand reusiti sa faceti un lucru care va inspaimanta, fiti mandri si recunoasteti ce lucru minunat ati realizat. Ganditi-va la partea puternica din voi, care poate antrena dupa sine si partea de "copil speriat".

MULTUMIRI SI DEVOALARI

Autorii nu declara existenta vreunui conflict de interese legat de acest articol.

BIBLIOGRAFIE

(1.) Tudose, Fl. O abordare moderna a psihologiei medicale, Ed. InfoMedica, Bucuresti, 2000

(2.) Berkow, R. The Merck Manual of Diagnosis and Therapy, Ed. Merck and Co. Ind., 2006

(3.) Octavian, Ioan. Marginalizare versus boala psihica si stigmatizare. Dileme bioetice, "Revista Romana de Bioetica", Iasi, 2008

(4.) Branea, I. Medicina de familie, Ed. Universitas Company, Bucuresti, 2000

(5.) Kumar, P. J., Clark, M. I. Clinical Medicine, Ed. Balliere Tindall, 2002

(6.) Burns, J., Hickie, I. Depression in young people: a national schoolbased initiative for prevention, early intervention and pathways for care. Australas Psychiatry, 2002

Correspondence:

ISABELLA CRISTINA BRUJBU

"Apollonia" University No. 2 Str. Muzicii, code 700399, Iasi, Romania

Phone: +40 744 633 927

E-mail: isabellabrjbu@yahoo.com

Date of Submission: November, 18, 2013

Acceptance: January, 27, 2014

Corespondenta:

ISABELLA CRISTINA BRUJBU

Universitatea "Apollonia" Str. Muzicii nr. 2, cod 700399, Iasi, Romania

Tel.: + 40 744 633 927

E-mail: isabellabrjbu@yahoo.com

Primire: Noiembrie, 18, 2013

Acceptare: ianuarie, 27, 2014

[1] The painter Edvard Munch was haunted all his life by anxiety and he captured the horror on canvas as a moth in an insectarium in his famous painting "The Scream".

[1] Pictorul Edvard Munch a fost bantuit de anxietate toata viata si a imortalizat groaza pe panza asa cum tintuiesti o molie in insectar in celebrul tablou "Strigatul".
COPYRIGHT 2014 Institute of Psychiatry Socola, Iasi
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

 
Article Details
Printer friendly Cite/link Email Feedback
Author:Brujbu, Isabella Cristina; Macovei, Luana; Dobos, Iulian Eduard
Publication:Bulletin of Integrative Psychiatry
Article Type:Report
Date:Jun 1, 2014
Words:5481
Previous Article:The study of the metabolic syndrome in geriatrics, in the context of cardiovascular, psychosocial and spiritual rehabilitation/Studiul sindromului...
Next Article:Orthorexia nervosa: cultural product or mental illness/Ortorexia nervoasa: produs cultural sau boala psihica?
Topics:

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters