Mixed anxiety disorders and depression
INTRODUCTION
Anxiety is a condition characterized by feelings of fear accompanied by physical symptoms that indicate an autonomic nervous system activity berlebihandari (SSA). Anxiety is a common symptom of non-specific, but often is a function of emotion. While depression is a function of human disturbance associated with the natural feeling of sadness and penyertanya symptoms include changes in sleep patterns and appetite, psychomotor performance, concentration, fatigue, despair and helplessness, and suicidal thinking.
Etiology
The cause of this disorder is less clear. Symptoms usually appear from the interaction of these aspects, including genetic biopsikososial some situations, stress or trauma is a stressor that the emergence of this phenomenon. In the central nervous system of several key mediators of this phenomenon. norepinephrine and serotonin. In fact, anxiety is mediated by a complex system involving the limbic system, thalamus, frontal cortex is anatomically and norepinephrine, serotonin and GABA in neurochemical systems, which until now has not known clearly how to work these parts cause anxiety . Similarly, although the cause of depression can not be determined, but generally is in a relatively defisensi or several aminergic neurotransmitters (noeadranaline, serotonin, dopamine) in synapses of neurons in the central nervous system, especially the limbic system
DIAGNOSISBerdasarkan PPDGJ-III criteria for diagnosis of disorders of mixed anxiety and depression are:
• No symptoms of anxiety or depression, in which each set of symptoms was not severe enough to impose its own diagnosis. For anxiety, some autonomic symptoms must be found, although not continuously, as well as anxiety or excessive worry.
• If you are accompanied by severe anxiety, depression, which is lighter, consider another category of anxiety disorders or anxiety disorders FOBIK.
• If you are depression and anxiety syndrome are severe enough to establish each diagnosis, both diagnoses should be filed, and the diagnosis of joint disorders can not be used. If for any reason you can move only a diagnosis of depressive disorder should be a priority.
• If symptoms are closely related to the stress of life is clear, then the category should be used F43.2 adjustment disorders.
CLINICAL
Anxiety and its disorders can occur in a variety of signs and physical and psychological symptoms such as tremor, renjatan, feeling tremors, back pain, headaches, muscle tension, shortness of breath, tires easily, often shock , autonomik hyperactivity, such as red and white face, tachycardia, palpitations, sweating, cold hands, diarrhea, dry mouth, frequent urination. The fear, difficulty concentrating, insomnia, libido down, feeling stuck in the throat, nausea and stomach sebagainya.Gejala of depression is major depressive affect, loss of interest and enthusiasm and energy that leads to reduced higher state of fatigue (real fatigue after a little work) and decreased activity. Some other symptoms of depression are:
• reduced concentration and attention;
• self-esteem and confidence declines;
• Ideas on guilt and not useful;
• Future outlook gloomy, pessimistic;
• ideas or acts dangerous to themselves or commit suicide;
• sleep disturbances;
• decreased appetite.
To a mixture of anxiety disorders and depression, symptoms of anxiety symptoms and depressive symptoms remained, but neither showed symptoms severe enough or is more prominent with each other. 3,4,6,7
DIAGNOSIS OF BANDING
Differential diagnosis of mixed anxiety disorders and depression, almost all medical conditions that cause anxiety. Given the state of anxiety is usually accompanied and followed by symptoms of depression. The determination required for the diagnosis of the exact criteria of the severity of the symptoms, causes and symptoms of perlangsungan either temporarily or permanently. In anxiety disorders is a form of depression usually end when the patient is not able to solve problems. In the anxiety of depression is usually temporary and milder symptoms of anxiety, adjustment disorders have obvious symptoms related to stress of life.
THERAPY
The most effective treatment for patients with anxiety disorders and depression is mixed psikoterapetik the possibility of combining treatment farmakoterapetik, and supportive approach. Treatment may require considerable time for the doctors involved, regardless of whether the clinician is a psychiatrist, a family physician or other specialist.
Psychotherapy
Main Focus psikoterapetik for general anxiety disorder is cognitive-behavioral, supportive, and oriented tilikan. The data are still limited about the relative merits of these approaches, even the most sophisticated research has been done with cognitive behavioral techniques, it seems that the long-term and short term. Cognitive approach to directly address the cognitive distortions assumptions of patients, and behavioral approaches to respond directly somatic complaints. The main technique used in cognitive and behavioral approaches are most effective when using these techniques separately. But support offers peace and comfort for patients, although long-term benefits are questionable. Psychotherapy Tilikan oriented approach to reveal the unconscious conflicts and recognize the power of ego. Benefit-oriented psychotherapy for anxiety disorders often tilikan often anecdotal, but there are no large controlled studies.
Most patients have a clear weakness keeemasan if given the opportunity to discuss difficulties with the doctor concerned and sympathetic. If doctors are external situations that cause anxiety, doctors may be able – alone or with help from the patient or his family – to change the environment and thus reduce the pressure of stress. Memungkinankan often decrease the symptoms of the patient to function effectively in work and everyday relationships, to give pleasure and gratification yagna again that in itself is therapeutic.
Psychoanalytic view is that in certain cases of anxiety is a sign of unconscious chaos that require consideration. The anxiety may be normal, adaptive, maladaptif, too strong or too IIng, depending on circumstances. Anxiety appears in several situations during the life cycle peijalanan, in many cases, reduction of symptoms is not the focus of the most appropriate action.
For patients who are middle and psychologically motivated to understand the source of anxiety, psychotherapy may be the treatment chosen. But psikodinamika work with the assumption that increases in keeemasan effective treatment possible. Purpose of the dynamic approach is to increase the tolerance of patients with anxiety (defined as the capacity to experience anxiety without rabbits it out), rather than relieve anxiety. Empirical research says many patients who undergo successful psikoterapetik can continue the experience of anxiety after the termination of psychotherapy. However, increased mastery of self allows them to use anxiety symptoms as a sign to reflect the struggle of life and to expand their tilikan and understanding. Psikodinamika approach in patients with general anxiety disorder involves the fear of a patient search for the base.
Farmakoterapi
The decision to prescribe a drug in patients with anxiety disorders and depression, mixed anxiety rarely be done in the first visit. Due to the nature of long-standing problems, a treatment plan carefully explained hares. Two main types of drugs used to treat anxiety disorders are benzodiazepines and benzodiazepines, with benzodiazepines, as the main option. For depression group used tricyclic Tetrasiklik, reversible MAOIs, SSRIs, and the fight against atypical depression. When SSRIs become the primary election.
Benzodiazepines (diazepam). Benzodiazepines have chosen a drug for general anxiety disorder. Benzodiazepines may be prescribed at the base if necessary, so that patients using benzodiazepines work quickly if you feel some anxiety. An alternative approach is to prescribe benzodiazepines for a limited period during Mans psychosocial treatment approach is applied.
Several problems are associated with benzadiazepin use in anxiety disorders. Approximately 25 to 30 percent of all patients do not respond, and can produce tolerance and dependence. Some patients also have problems using the knowledge of drugs and therefore run the risk of motor vehicle accident or engine.
Decisions to start treatment with benzodiazepines are considered specific and hares. Diagonosis patients, specific symptoms, and duration of treatment – all hares are determined, and should disclose to the patient. The treatment for anxiety most cases berlangksung two to six weeks followed by one or two weeks by the drug gradually (decreasing) before the drug was stopped. The mistake is often in clinical therapy is passively decide benzodiazepines for the treatment of melanjutklan unlimited basis.
For the treatment of anxiety, which usually begins with terapetiknya drugs in low range and increase the dose to achieve a therapeutic response. The use of benzodiazepines with half-lives are (from 8 to 15 hours) may avoid some adverse effects associated with use of benzodiazepines with half a life time. Consumption divided doses prevent the development of adverse effects associated with peak plasma levels are high. Improvement obtained with benzodiazepines may be more and more that antikecemasan effects. For example, the drug causes the patient’s vision of events in a positive perspective. The drugs can also have a job disinhibisi ringah, similar to that seen after a small amount of alcohol. For tab dose diazepam. Blisters of 2-5 mg, 10 mg/2cc l0-30mg/hari recommended dose 2-3xsehari, IV / IM 2-10mg / 3-4 hours.
No benzodiazepines (buspirone). Buspirone likely effective in 60 to 80 percent of patients with anxiety disorders. Data from states that buspirone is more effective in reducing cognitive symptoms of general anxiety disorder, compared with less somatic symptoms. Evidence also suggests that patients who had previously been treated with benzodiazepines may not respond to buspirone medication. The lack of response is probably caused by the lack of effect of benzodiazepines nonansiolitik (such as muscle relaxation and a feeling of additional health), what happens to buspirone therapy. However, the risk-benefit ratio is more reluctant, the absence of cognitive and psychomotor effects and the absence of buspirone withdrawal symptoms that causes the first line drug in treating general anxiety disorder. The main disadvantage of buspirone is that the effect requires two to three weeks before the visible, in contrast to the effects of benzodiazepines ansiolitik almost immediately visible. Buspirone is an effective treatment for end benzodiazepines. Dose Tab. 10 mg dose of 3 × 25 mg / h.
Anti-Depression. mechanism anti-depression drug, adalahmenghambat “aminergic neurotransmitter reuptake, inhibits the destruction ensirn” MAO “So there is an increase jurnlah” arninergic neurotransmitter “at the synapse of neurons in the CNS. Obal side effects of the fight against depression include:
• Sedation (sleepiness, decreased clarity, decreased psychomotor performance, cognitive ability rnenurun, D11)
• Anticholinergic effects (enter the mouth, urinary retention, blurred vision., Constipation, sinus tachycardia, etc.)
• Anti-alpha adrenergic effects (ECG changes, hypotension)
• Values Nourotoksis (tremors, restlessness, agitation, insomnia)
The serious side effects are usually reduced after 2-3 weeks. The SSRIs have been selected taking into account the side effects from this drug ringan.namun relatively high price has therefore still used antidepressants. Examples of such drugs are fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine. 2.4.6,7,8
TRAVEL disease and prognosis
Clinical features and prognosis of travel disruption is difficult to predict. However, some events of the associated data with the emergence of life from this disorder. The emergence of some negative life events are clearly increasing possibility of interference. This is also related to the strong interference of light.
CONCLUSION
Mix of mental disorders of anxiety disorders and depression are common place in the community. In anxiety disorders there is a mix of distribution problems and depression (F41.2) as one of anxiety disorders and anxiety is a normal response to the threat of individuals or stress. When anxiety becomes so severe or occur without induced by a non-hazardous, then the situation becomes anxiety disorders
The cause of this disorder is unclear. mediated by a complex system involving the limbic system, thalamus, frontal cortex is anatomically and norepinephrine, serotonin and GABA in neurochemical systems, so far a man is not clear how these parts work
Diagnosis of anxiety disorders and depression are mixed symptoms are anxiety and depression, in which each set of symptoms was not severe enough to impose its own diagnosis. For anxiety, some autonomic symptoms must be found, although not continuously, as well as anxiety or excessive worry.
The determination required for the diagnosis of the exact criteria of the severity of the symptoms, causes and symptoms canal and whether temporarily or permanently.
The most effective treatment for patients with anxiety disorders and depression is mixed psikoterapetik the possibility of combining treatment farmakoterapetik, and supportive approach.
Travel Clinic and prognosis difficult to predict conditions associated also with a strong interference of light.
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Posted: December 12th, 2009 under medical clinic.
Tags: clinic, depression, disease, Mixed anxiety disorders, psikoterpy
