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Focus is increasing on prevention of anxiety disorders. There is tentative evidence to support the use of cognitive behavior therapy and mindfulness therapy. As of 2013, there are no effective measures to prevent GAD in adults.
Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking. Stopping smoking has benefits in anxiety as large as or larger than those of medications.
Appropriate medications are effective for panic disorder. Selective serotonin reuptake inhibitors are first line treatments rather than benzodiazapines due to concerns with the latter regarding tolerance, dependence and abuse. Although there is little evidence that pharmacological interventions can directly alter phobias, few studies have been performed, and medication treatment of panic makes phobia treatment far easier (an example in Europe where only 8% of patients receive appropriate treatment). Medications can include:
- Antidepressants (SSRIs, MAOIs, tricyclic antidepressants and norepinephrine reuptake inhibitors): these are taken regularly every day, and alter neurotransmitter configurations which in turn can help to block symptoms. Although these medications are described as "antidepressants", nearly all of them — especially the tricyclic antidepressants — have anti-anxiety properties, in part, due to their sedative effects. SSRIs have been known to exacerbate symptoms in panic disorder patients, especially in the beginning of treatment and have even provoked panic attacks in otherwise healthy individuals. SSRIs are also known to produce withdrawal symptoms which include rebound anxiety and panic attacks. Comorbid depression has been cited as imparting the worst course, leading to chronic, disabling illness.
- Antianxiety agents (benzodiazepines): Use of benzodiazepines for panic disorder is controversial with opinion differing in the medical literature. The American Psychiatric Association states that benzodiazepines can be effective for the treatment of panic disorder and recommends that the choice of whether to use benzodiazepines, antidepressants with anti-panic properties or psychotherapy should be based on the individual patient's history and characteristics. Other experts believe that benzodiazepines are best avoided due to the risks of the development of tolerance and physical dependence. The World Federation of Societies of Biological Psychiatry, say that benzodiazepines should not be used as a first-line treatment option but are an option for treatment-resistant cases of panic disorder. Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety as recommended best practice, benzodiazepines have remained a commonly used medication for panic disorder. They reported that in their view there is insufficient evidence to recommend one treatment over another for panic disorder. The APA noted that while benzodiazepines have the advantage of a rapid onset of action, that this is offset by the risk of developing a benzodiazepine dependence. The National Institute of Clinical Excellence came to a different conclusion, they pointed out the problems of using uncontrolled clinical trials to assess the effectiveness of pharmacotherapy and based on placebo-controlled research they concluded that benzodiazepines were not effective in the long-term for panic disorder and recommended that benzodiazepines not be used for longer than 4 weeks for panic disorder. Instead NICE clinical guidelines recommend alternative pharmacotherapeutic or psychotherapeutic interventions.
Panic disorder is a serious health problem that in many cases can be successfully treated, although there is no known cure. Identification of treatments that engender as full a response as possible, and can minimize relapse, is imperative. Cognitive behavioural therapy and positive self-talk specific for panic are the treatment of choice for panic disorder. Several studies show that 85 to 90 percent of panic disorder patients treated with CBT recover completely from their panic attacks within 12 weeks. When cognitive behavioral therapy is not an option, pharmacotherapy can be used. SSRIs are considered a first-line pharmacotherapeutic option.
Mental disorders are difficult to prevent, but many techniques are available to help relieve and manage anxiety. Many sufferers have found ease by relaxation exercises, deep breathing practice, and meditation. Additionally, avoidance of caffeine may prevent GAD. Avoiding nicotine also can decrease the risk for the development of anxiety disorders including generalized anxiety disorder.
Meta-analysis indicates that both cognitive behavioral therapy (CBT) and medications (such as SSRIs) have been shown to be effective in reducing anxiety. A comparison of overall outcomes of CBT and medication on anxiety did not show statistically significant differences (i.e. they were equally effective in treating anxiety). However, CBT is significantly more effective in reducing depression severity, and its effects are more likely to be maintained in the long term, whereas the effectiveness of pharmacologic treatment tends to lessen if medication is discontinued. A combination of both CBT and medication is generally seen as the most desirable approach to treatment. Use of medication to lower extreme anxiety levels can be important in enabling patients to engage effectively in CBT.
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are first choice medication for generalized social phobia but a second line treatment. Compared to older forms of medication, there is less risk of tolerability and drug dependency associated with SSRIs.
In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55 percent of patients with generalized social anxiety disorder, compared with 23.9 percent of those taking placebo. An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, or a placebo. The first four sets saw improvement in 50.8 to 54.2 percent of the patients. Of those assigned to receive only a placebo, 31.7 percent achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.
General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established. In late 2004 much media attention was given to a proposed link between SSRI use and suicidality [a term that encompasses suicidal ideation and attempts at suicide as well as suicide]. For this reason, [although evidential causality between SSRI use and actual suicide has not been demonstrated] the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor. Recent studies have shown no increase in rates of suicide. These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder.
In addition, studies show that more socially phobic patients treated with anti-depressant medication develop hypomania than non-phobic controls. The hypomania can be seen as the medication creating a new problem.
Other prescription drugs are also used, if other methods are not effective. Before the introduction of SSRIs, monoamine oxidase inhibitors (MAOIs) such as phenelzine were frequently used in the treatment of social anxiety. Evidence continues to indicate that MAOIs are effective in the treatment and management of social anxiety disorder and they are still used, but generally only as a last resort medication, owing to concerns about dietary restrictions, possible adverse drug interactions and a recommendation of multiple doses per day. A newer type of this medication, Reversible inhibitors of monoamine oxidase subtype A (RIMAs) such as the drug moclobemide, bind reversibly to the MAO-A enzyme, greatly reducing the risk of hypertensive crisis with dietary tyramine intake.
Benzodiazepines such as clonazepam are an alternative to SSRIs. These drugs are often used for short-term relief of severe, disabling anxiety. Although benzodiazepines are still sometimes prescribed for long-term everyday use in some countries, there is concern over the development of drug tolerance, dependency and misuse. It has been recommended that benzodiazepines be considered only for individuals who fail to respond to other medications. Benzodiazepines augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually begin to appear within minutes or hours. In most patients, tolerance rapidly develops to the sedative effects of benzodiazepines, but not to the anxiolytic effects. Long-term use of benzodiazepine may result in physical dependence, and abrupt discontinuation of the drug should be avoided due to high potential for withdrawal symptoms (including tremor, insomnia, and in rare cases, seizures). A gradual tapering of the dose of clonazepam (a decrease of 0.25 mg every 2 weeks), however, has been shown to be well tolerated by patients with social anxiety disorder. Benzodiazepines are not recommended as monotherapy for patients who have major depression in addition to social anxiety disorder and should be avoided in patients with a history of substance abuse.
Certain anticonvulsant drugs such as gabapentin are effective in social anxiety disorder and may be a possible treatment alternative to benzodiazepines.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine have shown similar effectiveness to the SSRIs. In Japan, Milnacipran is used in the treatment of Taijin kyofusho, a Japanese variant of social anxiety disorder. The atypical antidepressants mirtazapine and bupropion have been studied for the treatment of social anxiety disorder, and rendered mixed results.
Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical manifestation of anxiety and can be taken before a public performance.
A novel treatment approach has recently been developed as a result of translational research. It has been shown that a combination of acute dosing of d-cycloserine (DCS) with exposure therapy facilitates the effects of exposure therapy of social phobia. DCS is an old antibiotic medication used for treating tuberculosis and does not have any anxiolytic properties per se. However, it acts as an agonist at the glutamatergic N-methyl-D-aspartate (NMDA) receptor site, which is important for learning and memory.
Kava-kava has also attracted attention as a possible treatment, although safety concerns exist.
Panic disorder can be effectively treated with a variety of interventions, including psychological therapies and medication with the strongest and most consistent evidence indicating that cognitive behavioral therapy has the most complete and longest duration of effect, followed by specific selective serotonin reuptake inhibitors. Subsequent research by Barbara Milrod and her colleagues suggests that psychoanalytic psychotherapy might be effective in relieving panic attacks, however, those results alone should be addressed with care. While the results obtained in joint treatments that include cognitive behavioral therapy and selective serotonin reuptake inhibitors are corroborated by many studies and meta-analysis, those obtained by Barbara Milrod are not. Scientific reliability of psychoanalytic psychotherapy for treating panic disorder has not yet been addressed. Specifically, the mechanisms by which psychoanalysis reduces panic are not understood; whereas cognitive-behavioral therapy has a clear conceptual basis that can be applied to panic. The term "anxiolytic" has become nearly synonymous with the benzodiazepines because these compounds have been, for almost 40 years, the drugs of choice for stress-related anxiety.
Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. Benzodiazepines, monoamine oxidase inhibitor, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia. Antidepressants are important because some have antipanic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy. A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.
Benzodiazepines, antianxiety medications such as alprazolam and clonazepam, are used to treat anxiety and can also help control the symptoms of a panic attack. If taken in doses larger than those prescribed, or for too long, they can cause dependence. Side effects may include confusion, drowsiness, light-headedness, loss of balance, and memory loss.
Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results. As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.
Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.
In the great majority of cases hyperventilation is involved, exacerbating the effects of the panic attack. Breathing retraining exercise helps to rebalance the oxygen and CO levels in the blood.
David D. Burns recommends breathing exercises for those suffering from anxiety. One such breathing exercise is a 5-2-5 count. Using the stomach (or diaphragm)—and not the chest—inhale (feel the stomach come out, as opposed to the chest expanding) for 5 seconds. As the maximal point at inhalation is reached, hold the breath for 2 seconds. Then slowly exhale, over 5 seconds. Repeat this cycle twice and then breathe 'normally' for 5 cycles (1 cycle = 1 inhale + 1 exhale). The point is to focus on the breathing and relax the heart rate. Regular diaphragmatic breathing may be achieved by extending the outbreath by counting or humming.
Although breathing into a paper bag was a common recommendation for short-term treatment of symptoms of an acute panic attack, it has been criticized as inferior to measured breathing, potentially worsening the panic attack and possibly reducing needed blood oxygen. While the paper bag technique increases needed carbon dioxide and so reduces symptoms, it may excessively lower oxygen levels in the blood stream.
Capnometry, which provides exhaled CO levels, may help guide breathing.
There are various treatments available to calm racing thoughts, some of which involve medication. One type of treatment involves writing out the thoughts onto paper. Some treatments suggest using activities, such as painting, cooking, and other hobbies, to keep the mind busy and distract from the racing thoughts. Exercise may be used to tire the person, thereby calming their mind. When racing thoughts are anxiety induced during panic or anxiety attacks, it is recommended that the person wait it out. Using breathing and meditation techniques to calm the breath and mind simultaneously is another tool for handling racing thoughts induced by anxiety attacks. Mindfulness meditation has also shown to help with racing thoughts by allowing practitioners to face their thoughts head-on, without reacting.
While all of these techniques can be useful to cope with racing thoughts, it may prove necessary to seek medical attention and counsel. Since racing thoughts are associated with many other underlying mental illnesses, such as bipolar disorder, anxiety disorder, and ADHD, medications used commonly to treat these disorders will help calm racing thoughts in patients.
Treatment for the underlying causes of racing thoughts is helpful and useful in order to calm the racing thoughts more permanently. For example, in people with ADHD, medications used to promote focus and calm distracting thoughts, will help them with their ADHD. Also, people with insomnia who have resulting racing thoughts will find Sleep Apnea treatment & Nasal surgery helpful to eliminate their racing thoughts. It is important to look at the underlying defect that may be causing your racing thoughts in order to prevent them long-term.
Most research indicates that cognitive behavioral therapy (CBT) is an effective treatment for hypochondriasis. Much of this research is limited by methodological issues. A small amount of evidence suggests that selective serotonin reuptake inhibitors can also reduce symptoms, but further research is needed.
For individuals prescribed anti-anxiety medications such as Alprazolam (Xanax), caffeine can introduce further problems by increasing rates of cytotoxicity and cell death by necrosis. This leads to these medications being essentially ruled out as viable treatments for caffeine-induced anxiety. Due to caffeine’s negative interaction with anti-anxiety medications such as benzodiazepines, treatments for caffeine-induced anxiety disorder tend to focus on abstinence from or a reduction of caffeine intake and behavioral therapy. Some doctors may recommend a continuance of caffeine consumption but with the provision that the patient actively takes note of physiological changes that happen after caffeine intake. The goal of this approach is to help patients better understand the effects of caffeine on the body and to distinguish threatening symptoms from normal reactions.
The following are two therapies normally used in treating specific phobia:
Cognitive behavioral therapy (CBT), a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior, is effective in treating specific phobias. Exposure therapy is a particularly effective form of CBT for specific phobias. Medications to aid CBT have not been as encouraging with the exception of adjunctive D-clycoserine.
In general anxiolytic medication is not seen as helpful in specific phobia but benzodiazepines are sometimes used to help resolve acute episodes; as 2007 data were sparse for efficacy of any drug.
Psychotherapy, more specifically, cognitive behavioral therapy (CBT), is the most widely used form of treatment for Somatic symptom disorder. In 2016, a randomized 12-week study suggested steady and significant improvement in health anxiety measures with cognitive behavioral therapy compared to the control group.
CBT can help in some of the following ways:
- Learn to reduce stress
- Learn to cope with physical symptoms
- Learn to deal with depression and other psychological issues
- Improve quality of life
- Reduce preoccupation with symptom
Moreover, brief psychodynamic interpersonal psychotherapy (PIT) for patients with multisomatoform disorder has shown its long-term efficacy for improving the physical quality of life in patients with multiple, difficult-to-treat, medically unexplained symptoms.
Antidepressant medication has also been used to treat some of the symptoms of depression and anxiety that are common among people who have somatic symptom disorder. Medications will not cure somatic symptom disorder, but can help the treatment process when combined with CBT.
A problem with culture-bound syndromes is that they are resistant to Western-style medicine.} The standard Japanese treatment for taijin kyofusho is Morita therapy, developed by Shoma Morita in the 1910s as a treatment for the Japanese mental disorders taijin kyofusho and shinkeishitsu (nervousness). The original regimen involved patient isolation, enforced bed rest, diary writing, manual labor, and lectures on the importance of self-acceptance and positive endeavor. Since the 1930s, the treatment has been modified to include out-patient and group treatments. This modified version is known as neo-Morita therapy. Medications have also gained acceptance as a treatment option for taijin kyofusho. Other treatments include systematic desensitization, which includes slowly exposing one self to the fear, and learning relaxation skills, to extinguish fear and anxiety.
Milnacipran, a serotonin–norepinephrine reuptake inhibitor (SNRI), is currently used in the treatment of taijin kyofusho and has been shown to be efficacious for the related social anxiety disorder. The primary aspect of treating this disorder is getting patients to focus their attention on their body parts and sensations.
Hypochondria is currently considered a psychosomatic disorder, as in a mental illness with physical symptoms. Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the Internet. The media and the Internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.
Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease.
Overly protective caregivers and an excessive focus on minor health concerns have been implicated as a potential cause of hypochondriasis development.
It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms.
Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families. Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder).
Anxiety disorder, the most common mental illness in the United States, affects 40 million people, ages 10 and older; this accounts for 18% of the U.S. population. Most people suffering from anxiety disorder report some form of racing thoughts symptom
The prevalence of OCD in every culture studied is at least 2% of the population, and the majority of those have obsessions, or racing thoughts. With these reportings, estimates of more than 2 million people in the United States (as of 2000) suffer from racing thoughts.
Currently, scholarly accepted and empirically proven treatments are very limited due to its relatively new concept. However, promising treatments include cognitive-behavioral psychotherapy and combined with pharmacological interventions. Treatments using tranylcypromine and clonazepam were successful in reducing the effects of nomophobia.
Cognitive behavioral therapy seems to be effective by reinforcing autonomous behavior independent from technological influences, however, this form of treatment lacks randomized trails. Another possible treatment is "Reality Approach," or Reality therapy asking patient to focus behaviors away from cell phones. In extreme or severe cases, neuropsychopharmacology may be advantageous, ranging from benzodiazepines to antidepressants in usual doses. Patients were also successfully treated using tranylcypromine combined with clonazepam. However, it is important to note that these medications were designed to treat social anxiety disorder and not nomophobia directly. It may be rather difficult to treat nomophobia directly, but more plausible to investigate, identify, and treat any underlying mental disorders if any exist.
Even though nomophobia is a fairly new concept, there are validated psychometric scales available to help in the diagnostic, an example of one of these scales is the "Questionnaire of Dependence of Mobile Phone/Test of Mobile Phone Dependence (QDMP/TMPD)".
There are various methods used to treat phobias. These methods include systematic desensitization, progressive relaxation, virtual reality, modeling, medication and hypnotherapy.
Medications can help regulate the apprehension and fear that come from thinking about or being exposed to a particular fearful object or situation. Antidepressant medications such as SSRIs or MAOIs may be helpful in some cases of phobia. SSRIs (antidepressants) act on serotonin, a neurotransmitter in the brain. Since serotonin impacts mood, patients may be prescribed an antidepressant. Sedatives such as benzodiazepines may also be prescribed, which can help patients relax by reducing the amount of anxiety they feel. Benzodiazepines may be useful in acute treatment of severe symptoms, but the risk-benefit ratio is against their long-term use in phobic disorders. This class of medication has recently been shown as effective if used with negative behaviors such as alcohol abuse. Despite this positive finding, benzodiazepines should be used with caution. Beta blockers are another medicinal option as they may stop the stimulating effects of adrenaline, such as sweating, increased heart rate, elevated blood pressure, tremors and the feeling of a pounding heart. By taking beta blockers before a phobic event, these symptoms are decreased, causing the event to be less frightening.
Specific phobias have a one-year prevalence of 8.7% in the USA with 21.9% of the cases being severe, 30.0% moderate and 48.1% mild. The usual age of onset is childhood to adolescence. Women are twice as likely to suffer from specific phobias as men.
Evolutionary psychology argues that infants or children develop specific phobias to things that could possibly harm them, so their phobias alert them to the danger.
The most common co-occurring disorder for children with a specific phobia is another anxiety disorder. Although comorbidity is frequent for children with specific phobias, it tends to be lower than for other anxiety disorders.
Onset is typically between 7 and 9 years of age. Specific phobias can occur at any age but seem to peak between 10 and 13 years of age.
It is proposed that ameliorating the stress response will allow neurotransmission to return to homeostasis. Anxiolytic medications that act as 5-HT receptor agonists (in particular, 5-HT1A) together with CRH and/or cortisol antagonists (which are implicated in the stress response) are hypothesized to be an appropriate method of achieving this therapeutic response. Psychological interventions can also help to raise the threshold for stress and thereby restore the stress response to normal.