Biopsychology of Anxiety Disorders with Treatment Approach Using Medication and Therapy - Coursework Example

Biopsychology of Anxiety Disorders with treatment approach using medication and therapy Introduction According to Reber (1985), fear is:- An emotional state in the presence or anticipation of a dangerous or noxious stimulus, and is usually characterized by an internal, subjective experience of extreme agitation, a desire to flee or to attack and by a variety of sympathetic reactions. In anxiety conditions there isn’t necessarily the presence of anything that others might be afraid of , but the results are the same i.e. agitation, a desire to escape and various physical symptoms. In 2004 Grohol declared that all cases of generalized anxiety disorder ( also known as GAD) can have some physical medical component or cause, i.e. they are not to be generally considered as purely psychiatric conditions. He states that before psychological or psychiatric called upon there should be a thorough medical examination. His ideas of possible physical changes causing symptoms has been proved by several studies. The basic the biological or physiological explanation for the presence of generalized anxiety is that there are problems with the functioning of the brain which lead to such disorders. For example, current research indicates that generalized anxiety disorder is caused by excessive neurological activity in the area of the brain that is responsible for emotional arousal, This essay will consider various studies into anxiety disorders and the possible interventions. In 1996 Bruder et al researched brain asymmetries in patients with major depressive illnesses using electro encephalograms. These included individuals with and without accompanying anxiety disorders. They were able to demonstrate definite, measurable differences between members of the two groups and these were also compared with controls. Rubin and Carroll ( 2009) considered not the physiology , but the biochemistry involved when they looked at endocrine differences and the way these affected moods. They describe how the central nervous system (CNS) , together with the limbic system and the forebrain, work together to regulate mood, and at the same time control neuroendocrine functions. They also mention other studies into various other producers of hormones such as the thyroid gland and the gonad, pointing out how, in the case of the thyroid gland at least, correcting deficiencies has a positive effect upon negative moods. So it seems that moods , including anxiety , have complicated, rather than simple, origins, and also are not only dependent upon outside stimuli such as difficult situations. This essay is concerned with extreme anxiety, its biopsychology and possible treatments and therapies. Because there seems to be a complicated causal mechanism for anxiety attacks, there would seem to be a number of possible ways of intervening. Also it should be remembered that anxiety is a normal response to certain situations in life, so it is necessary to distinguish between such episodes and anxiety attacks as a pathological condition. Signs and Symptoms Every person feels anxiety at times, especially in stressful situations. In pathological anxiety the difficulties occur without what would normally be considered to be apparent external triggers. The person suffers from :- Very frequent, almost constant , episodes of worry and tension. Difficulties with work or other responsibilities because of the degree of anxiety. Fears that the person realizes are ill founded and irrational, yet which seem very real and which they cannot get away from . They often have the need to follow certain routines in order to try to avoid difficulties. Feelings of being detached from reality. They may become so anxious that they avoid certain seemingly normal and unthreatening social activities. Sudden dramatic panic attacks during which they experience very rapid heart beats. They may feel that they are constantly about to meet danger. These intense feelings are often accompanied with such physical symptoms as insomnia, muscular tension, stomach upsets, frequency of urination , pounding heart and breathing difficulties. Grohol, 2004, points out how anxiety often goes alongside high stress levels, poor ability to plan and great difficulties in relaxing. These extreme feelings and difficulties can all be summarised as experiencing fear as a result of being in situations that the majority of the population would feel were perfectly normal, everyday occurrences. Possible Interventions Drugs may be prescribed, especially if the condition is judged to be serious enough to be interfering with normal , everyday activities, e.g a person who can no longer drive to work or do basic shopping. The drugs prescribed fall into two main groups –Firstly anti-depressives. These however can take a number of weeks, at least a month , before any positive effect can be perceived. They must be taken in a continuous way and this requires motivation, which can be difficult to achieve if no apparent results are obvious for so long. It is therefore necessary tha the prescriber explains clearly to the patient the likely course of events, but stresses that the anti-depressives are likely to work if the patient persists with the treatment. The other type of medication commonly used acts much more rapidly , and is taken when an attack ensues. These are Benzodiazepines, used from the 1960s onwards, ‘despite a dearth of clinical research that shows this particular class of drugs is any more effective than others ‘ ( Grobal 2004.) These act to relieve symptoms within 30 minutes or so, but even this can seem a long time if someone is panicking. They also have the disadvantage of being addictive and also have withdrawal symptoms. The Royal College of Psychiatrists ( 2011) describe how they have come to replace the barbiturates which were in use previously for this and related conditions. They describe the action of these drugs , which include Diazepam and Lorazepam, as increasing levels in the brain of the neuro transmitter GABA. (Gamma-aminobutyric acid). It works by inhibiting and slowing the action of stimulating messages from other cells and so has a calming effect. For some patients however there are adverse side effects such as memory loss, sleepiness and unsteadiness. In rare extreme examples fits may ensue, as can hallucinations and confusion according to the Royal College of Psychiatrist report ( 2011). If a person stops taking the drug they have a high ( 40% ) chance of developing symptoms similar to those for which they were treated in the first instance. There therefore needs to be a gradual and controlled withdrawal after a few weeks, during which time other interventions such as psychological approaches, take effect. The Royal College of Psychiatrists do point out that in some cases the drugs can be taken long term, but only under expert supervision. Some very short acting Benzodiazepines are used for sleep difficulties, but in cases where anxiety may occur at any time of day then longer acting medication such as Valium or Ativan , which stay in the body longer, would be preferable. Another possible medication would be Buspirone, a new nonbenzodiazepine antianxiety drug. This is non-addictive and does not impair such mechanical acts as driving or operating other machinery, although there is a possibility of such side effects as nausea, dizzy spells and headaches. A positive response can be expected after 2 weeks according to Long ( as quoted by Grobal 2004). Long does point out however that if two weeks, as compared to the benzodiazepines are taken in the first instance then a poor response to the new medication can be expected according to a study by Schwiezer et al ( 1986) . Other possible medications include prescribing the anticonvulsant Pregabalin. In 2003 Pande et al , dissatisfied with the results obtained with the limitations of various drug therapies, conducted a double blind placebo –controlled trial of Pregabalin in cases of patients with generalized anxiety disorder. This was quite a large trial using a total of 276 patients over 6 weeks , including a build-up and tapering off of medication and placebos. Results were measured using the Hamilton Anxiety Rating Scale ( 1959) , a method which considers 14 different parameters an d measures levels of anxiety.. Even in the first week there were obvious measurable differences between those taking Pregabalin and those taking a placebo. Some patients were given lorazepam. In cases of those taking the two drugs there were some side effects i.e. sleepiness and dizziness. There were however no serious negative effects and no withdrawal problems with those who took the Pregabalin. The large team of researchers conclude :- These results indicate that pregabalin is an effective, rapidly acting, and safe treatment for generalized anxiety disorder. In short-term treatment, pregabalin does not appear to have the withdrawal symptoms associated with the benzodiazepines As far back as 1992 a very different approach was studied by Kabat-Zinn et al who looked at the way in which a program of meditation could be used to reduce stress levels and anxiety. The stated aim was to find out how effective a group based stress belief meditation program could be in relieving anxiety. They used weekly assessments, self –ratings and those from the therapists involved, in order to measure the success of the intervention. 22 patients were involved. All had been diagnosed as having a generalized panic or anxiety condition, whether or not this was accompanied by agoraphobia. In 20 cases out of the 22, i.e almost 91 %, there was measurable improvement in anxiety levels and in the degree of depression experienced, improvements which were maintained long term. Panic attacks were also less in number. So what was going on? If the problem is due to physiological differences or to chemical imbalances as described in the research already mentioned, how could a few meditation sessions make such a profound difference? Grohal ( 2004) suggests a possible explanation – that they are able to relax. This will then lower stress levels and so relieve obvious physical symptoms such as racing heart beats and so relieve any feelings of panic. He promotes the idea of teaching relaxation, accompanied or not by bio-feedback i.e. allowing the person to see in some way the changes that occur when relaxation is achieved, although he believes that this isn’t necessary. Grohal claims that if techniques of relaxation are taught effectively then the person is able to go on in life in general without anxiety. However it is necessary that the client follows through with the techniques outside and after therapy sessions. The researchers in the meditation study described the intervention as a self-regulatory strategy and they claim, giving other examples such as relaxation and biofeedback, that these methods offer a ‘unique approach to treating anxiety disorders.’ They describe a number of studies into this or related topics , but admit that most of these studies were uncontrolled i.e. the results were not measured against another group in which this type of intervention had not been used. In this case patients were chosen using quite strict criteria – excluding for instance those who had other major psychiatric conditions or who suffered from substance abuse including alcoholism. There were weekly 2 hour meditation classes for 8 weeks and also a ‘retreat’ i.e. a 7 ½ hour intensive and more or less silent period. There were also homework sessions and a number of different meditation methods were used. The participants were distributed among a number of classes which contained patients with a variety of conditions, both medical and psychological, and the instructors involved were not told which patients were taking part in the study. The report of the results showed measurable positive results. However it must be asked would similar results have been obtained by taking medication? There was no measurements against patients being treated in other ways i.e. with anti-depressives or with a Benzodiazepine drug. Nor is there any explanation as to how these changes take place in view of the supposed physiological or biochemical differences recorded by others. According to Grohol ( 2004) the most effective treatments are those which are a combination of psychological and medication methods, with the latter only usually being used in relatively short term i.e. for a few weeks. He suggests that as well as relaxation techniques the sufferers form anxiety should also be taught coping methods so that they can lead relatively normal lives. He also feels that group therapy is not necessarily an appropriate method if the person has social phobias e.g. agoraphobia and stresses that those with generalized anxiety disorder should be treated in a different way from those with more specific phobias. Anxiety disorders can affect people of all ages. In their work specifically dealing with children and adolescents, March and Ollendick ( page 141, 2004) state that :- It is increasingly clear that psychotropic medications work by biasing specific central nervous system information processes; it is less commonly acknowledged but no less true that psychosocial treatments also have both a somatic substrate and psychosocial valence. Conclusion It is clear that there is no one known cause for generalized anxiety disorder – physiological, biochemical or psychological. This means that a variety of possible interventions can be of value – chemical and psychological and perhaps most usefully in combination as Grohal ( 2004) suggests. However it will always seem easier to some physicians to treat people with a course of tablets than to give more individualized program teaching relaxation and coping mechanisms. It is also apparently more cost effective – just the cost of a few tablets , and of course does not disrupt the patient’s life initially so much as going on a prolonged course of meditation. The long term results must however be considered, especially in view of the fact that the commonly used Benzodiazepines have on occasions very serious side effects and difficulties with withdrawal, and that anti- depressives take several weeks to become effective. References Bruder,G., Fong,R., Tenke ,C., Leite, P., Towey,J., Stewart,J., McGrath,P., Quitkin, P., 1996, Regional brain asymmetries in major depression with or without an anxiety disorder: A quantitative electroencephalographic study, Biological Psychiatry, Volume 41, Issue 9, 1 May 1997, Pages 939-948 retrieved 3rd October 2011 from http://www.sciencedirect.com/science/article/pii/S0006322396002600 Grohal, J., 2004, Generalized Anxiety Disorder Treatment, PsychCentral, retrieved 4th October 2011 from http://psychcentral.com/disorders/sx24t.htm Hnmilton, M., 1959, Hamilton Anxiety Rating Scale, The Assessment of Anxiety States by Rating, British Journal of Medical Psychology, retrieved 4th October 2011 from http://www.assessmentpsychology.com/HAM-A-scoring.pdf Kabat-Zinn, J., Massion,A., Kristeller, J., Peterson, L., Fletcher, K., Pbert,L.,Lenderking, W. and Santorelli,S., 1992, Effectiveness of a meditation –based stress reduction program in the treatment of anxiety disorders., American Journal of Psychiatry, 146, pages 936 – 943., retrieved 3rd October 2011 from http://www.columbia.edu/itc/hs/medical/cp4/client_edit/topic4/sg3b-1.pdf Ollendick, T, March,J,, 2004, Phobic and Anxiety Disorders in Children and Adolescents, A Clinician’s Guide to Effective Psychological and Pharmacological Intervention, New York, Oxford University Press. 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The Royal College of Psychiatrists, 2011, Benzodiazepines, retrieved 3rd October 2011 from http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/benzodiazepines.aspx Read More