subject: CLINICAL FEATURES OF ANXIETY DISORDER IN USM [print this page] CLINICAL FEATURES OF ANXIETY DISORDER IN USM
CLINICAL FEATURES
It has been observed that in Unani System various psychiatric disorders manifest such symptoms which are similar up to some extent with GAD, where as initial stage of melancholia is very much similar to features of GAD. As mentioned by Ibn Sina:
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"Clinical features of initial stage of melancholia are false thinking, unrealistic fear, quick anger, preference to loneliness, palpitation, dizziness and tinnitus".
Razi has illustrated the features of initial stage of melancholia in these words: "If a person suffers from worry, apprehension, sadness along with apperence of irrational thoughts, it suggests that it is the initial stage of melancholia".
The symptoms which are mainly present in this disease are:
Fearfulness
Excessive worry
False perceptions
Low self esteem
Vague sense of apprehension
Social isolation and loneliness
loss of pleasure in virtually all activities
Irritability
Feeling of tightness in chest
Restlessness
Sleeplessness
Irregular small and slow pulse etc.
Mental disorders are mainly due to some dysfunction in the brain itself or as a consequence of heart, stomach, liver and spleen disorders. Earlier it comes to our knowledge that roohe nafsaaniya basically originates from the heart as roohe haivaaniya, then it matured in brain and becomes roohe nafsaaniya in a usable form for quwate nafsaniya and as stated by famous philosopher Arastu that heart is the origin of all faculties of the body. This may be the reason that in most of psychiatric diseases cardiovascular symptoms especially palpitation is also present.
Due to the Functional correlation of stomach with the brain, some gastric symptoms are also observed in izterabe nafsani umoomi.viz.
Pain in abdomen
indigestion
nausea and vomiting
burning sensation in epigastria
abdominal distention
Flatulence
Constipation
Diarrhea
Most activities of quwae nafsaniya are originated by sensory experience emanating a'za mudrikah zahirah (sensory receptors) such as usual auditory and other kind of receptors. So in addition to above symptoms the manifestations related to motor and sensory organs are also present in this disease like:
Giddiness
Tremors
Tinnitus
delusion
hallucination
blurring of vision
ringing in ears
Headache etc.
ONSET AND COURSE
Patients with GAD often present with life long history of generalized anxiety, dating back to childhood. Respective reports from respondents in community epidemiological surveys and from patients in clinical studies consistently suggest that onset of GAD is usually before the age of 20and only in a small number of patients first onset occurs subsequent to mid 30s. Nevertheless some people with GAD do report an onset in adulthood and it has been suggested that compared to early onset GAD, stressful life events may play a strong role in onset of GAD occurring later in life.
The community epidemiological data collected in epidemiological catchment area (ECA) show that the duration and course of GAD typically chronic with episodes commonly persisting for a decade or longer.
COMORBID CONDITIONS WITH GAD
Although GAD was once thought to be a relatively minor problem that was not associated with a high degree of distress and impairment, recent data indicates that this is not the case, because of its high comorbidity with other psychiatric illnesses. Research has routinely shown that GAD rarely present in isolation. Community surveys indicate that 80 90% of persons with GAD have a history of some other mental disorder at some point in their lives. The NCS estimated that 65% of persons with current GAD had at least one other disorder at the time of assessment. The "pure" GAD without comorbid psychiatric disorders constitute only about one third of the total prevalence.
The most common comorbid condition associated with GAD is major depressive disorder (MDD) as estimated about 42%. Results from the National comorbidity survey (NCS) found that 58% of respondents who had a life time prevalence of MDD suffered from an anxiety disorder as well.
The other commonly diagnosed comorbid mental disorders with GAD include social phobia (23%), dysthymia (22%), specific phobia, and panic disorder (11%), post traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD) (6.5%). Substance abuse disordersare also a common comorbid condition (16%) in current GAD as suggested by NCS. GAD is also highly comorbid with chronic medical conditions including coronary heart disease, hypertension, asthma and diabetes mellitus.
In an ongoing longitudinal naturalistic study of anxiety disorder in primary care setting, 36% of patients with GAD had 1 other anxiety disorders, 14 % had 2 others and 4% had 3 others. Forty one subjects with anxiety had comorbid major depression.
