Acute and Chronic Anxiety States

Introduction

A highly unpleasant, many times vague feeling of apprehension is always complained of. The commonest presenting complaints are: 1. Inability to concentrate 2. Forgetfulness 3. Excessive worry 4. Difficulty to get to sleep 5. Nightmares 6. Difficulty to work 7. Weakness

A more detailed enquiry will reveal palpitation, sweating, trembling, funny sensation in the abdomen, dizziness, paraesthesis in the extremities, frequency of micturition and sometimes diarrhoea. On examination, the following features are elicited: tachycardia, increased respiratory rate, elevated blood pressure, sweating and hyperreflexia. These features can present either in attacks called panic attacks or continuously

Management

• Benzodiazepines: Diazepam (5 mg TDS)
• Lorazepam which has shorter duration of action is also found to be useful (Dose: 1-4 mg daily)
• In view of the fact that benzodiazepines are known to produce dependence, the introduction of Buspirone is welcome. It is non-sedative and does not produce dependance (Dose: 5 mg 2-4 times a day).
• If the peripheral symptoms are more, propranolol may be useful
• Psychotherapy of individual and family need to be resorted to in such cases
• In chronic anxiety many will be helped by relaxation techniques or meditation or yoga.