Anxiety disorders

Introduction

Anxiety disorders encompass a group of pathologies characterized by excessive, persistent, or recurring anxiety that significantly disrupts daily life. They include generalized anxiety disorder, panic disorder, agoraphobia, specific phobias, social anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). These disorders affect about 15 to 20% of the population during their lifetime and constitute one of the most common psychiatric conditions. If properly treated, they can improve significantly.

If you experience pervasive anxiety, panic attacks, or persistent sleep disturbances, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our app available on the App Store and Google Play.

Who is at risk of suffering from them?

Anxiety disorders affect all ages, with a female predominance (twice as common in women). Risk factors include: family history of anxiety or depressive disorders, anxious temperament in childhood, traumatic life events (bereavement, violence, accidents, abuse), chronic stress (work, insecurity, family conflicts), chronic or painful illnesses, substance use (alcohol, drugs, excessive caffeine), certain periods of life (adolescence, postpartum, menopause, aging, bereavement), and specific medical conditions (hyperthyroidism, cardiovascular disorders).

Symptoms of anxiety disorders

Symptoms can be physical, psychological, and behavioral. Their expression varies depending on the disorder.

Main symptoms

• Psychological symptoms: excessive worries, intrusive thoughts, irrational fear, negative anticipation, ruminations, sensation of impending doom, difficulty concentrating, irritability.

• Physical symptoms: palpitations, tachycardia, chest tightness, dyspnea, sweating, shaking, feeling of choking, dizziness, paresthesia, dry mouth, nausea, abdominal pain, muscle tension.

• Behavioral symptoms: avoidance of anxiety-provoking situations, hyperactivity or withdrawal, irritability, social withdrawal.

• Sleep disorders: difficulty falling asleep, nighttime awakenings, unrefreshing sleep.

• Panic attack: acute crisis combining intense fear, palpitations, sweating, sensation of impending death or loss of control, lasting 5 to 30 minutes.

• OCD: obsessive thoughts and ritualized compulsions (washing, checking).

• PTSD: flashbacks, nightmares, hypervigilance after a traumatic event.

When to consult in an emergency?

An emergency consultation is necessary in the following situations:

• Very intense panic attack with a feeling of impending death, chest pain, or dyspnea — an organic cause must first be ruled out (heart attack, pulmonary embolism) before concluding it is an anxiety disorder.

• Suicidal thoughts or dark thoughts — call 143 (La Main Tendue / The Helping Hand) or 144 in case of an acute crisis.

• Highly debilitating anxiety preventing any functioning.

• Severe and prolonged insomnia.

• Sudden onset of anxiety in a person with no history (suspicion of an organic cause).

• Anxiety disorder in pregnant or postpartum women.

• Poorly controlled withdrawal from benzodiazepines, alcohol, or drugs.

What to do before calling Docadom? Practice slow breathing exercises, isolate yourself in a calm place, and contact your primary care physician first, who knows your profile and can support you. If they are unreachable or if you need a doctor at home outside operating hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone app (App Store and Google Play). In case of suicidal thoughts, contact La Main Tendue (143) or 144 immediately. In case of chest pain suggestive of a heart problem, call 144 without hesitation.

Causes of anxiety disorders

Biological and genetic factors

Anxiety disorders have a significant hereditary component. Abnormalities in certain neurotransmitters (serotonine, noradrenaline, GABA) and hyperreactivity of the brain's amygdala are involved.

Psychological and environmental factors

• Life events: bereavement, separation, loss of employment, assault, accident.

• Traumatic history, particularly in childhood (abuse, maltreatment).

• Chronic stress at work or in the family.

• Anxious or overprotective parenting style in childhood.

• Personality traits (perfectionism, low self-esteem).

Medical and toxic factors

• Hyperthyroidism, hypoglycemia, pheochromocytoma.

• Cardiovascular diseases (arrhythmias, heart attack).

• Neurological diseases, chronic pain.

• Medications: corticosteroids, certain antibiotics, bronchodilators.

• Substances: alcohol, stimulant drugs (cocaine, amphetamines), excessive caffeine, withdrawal from benzodiazepines.

Diagnosis of anxiety disorders

Diagnostic methods

• Anamnesis: nature and duration of symptoms, impact on daily life, personal and family history, life events, substance use.

• Clinical examination: searching for an organic cause (heart, thyroid).

• Evaluation scales: GAD-7 for generalized anxiety disorder, PHQ-9 for associated depression, Hamilton rating scale.

• Biological assessment: TSH, CBC, blood glucose to rule out an organic cause.

• Electrocardiogram in case of palpitations.

• No specific biological marker for anxiety disorders.

Alternative diagnoses

• Cardiovascular pathologies (arrhythmias, acute coronary syndrome, pulmonary embolism): must always be ruled out in the event of an attack.

• Hyperthyroidism.

• Asthma or COPD exacerbation.

• Depression is often associated.

• Schizophrenia or other psychiatric disorders.

• Withdrawal or intoxication.

Treatment of anxiety disorders

Treatment combines psychotherapy, medication, and lifestyle and dietary measures.

Psychotherapies

• Cognitive Behavioral Therapy (CBT): gold standard treatment for anxiety disorders. Highly effective, structured, limited duration.

• EMDR: indicated in post-traumatic stress disorder.

• Mindfulness-based therapies (MBSR, MBCT), Acceptance and Commitment Therapy (ACT).

• Analytical psychotherapies, psychological support.

Medical treatment

• SSRI Antidepressants (escitalopram, sertraline, paroxetine) and SNRI (venlafaxine, duloxetine): recommended long-term treatment. Delayed effect (2 to 6 weeks).

• Benzodiazepines: useful in the short term (≤ 2 to 4 weeks) in case of acute crisis. Risk of dependence.

• Buspirone, pregabalin in some generalized anxiety disorders.

• Beta-blockers (propranolol) for physical symptoms (palpitations, shaking), especially in performance anxiety.

• Low-dose antipsychotics in some resistant forms.

Lifestyle and dietary measures

• Regular physical activity: proven anxiolytic effect.

• Reduction of caffeine, alcohol, and tobacco.

• Quality sleep on a regular schedule.

• Relaxation, breathing, and meditation techniques.

• Limitation of screens and social media.

• Pleasurable activities, socialization, support from loved ones.

• Avoid self-medication, particularly with benzodiazepines.

Prevention of anxiety disorders

• Balanced lifestyle.

• Early identification of signs of pathological anxiety.

• Stress management through appropriate tools (meditation, sports, relaxation).

• Social support, regular exchanges with loved ones.

• Early management of traumatic events (PTSD).

• Reduction of use of anxiety-provoking substances.

• Medical follow-up in case of personal or family history.

• Learning breathing and mindfulness techniques.

Possible complications

Untreated anxiety disorders can become chronic and lead to: depression (very often associated), addictions (alcohol, medication, drugs), chronic insomnia, social isolation, job loss, chronic somatization, cardiovascular impact (hypertension, coronary events), and suicidal thoughts and behaviors. On a family level, they often affect loved ones and children. The economic and social impact is significant.

When to contact a doctor for anxiety disorders

Any anxiety that impacts daily life warrants a medical opinion:

• First-line care: contact your primary care physician, who can evaluate the situation and refer you to a psychologist or a psychiatrist if necessary.

• If your primary care physician is unavailable (evenings, weekends, holidays) and you are experiencing an anxiety crisis or acute sleep disturbance, Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of suicidal thoughts or dark thoughts, immediately contact La Main Tendue at 143 (available 24/7 in Switzerland), or dial 144 in case of immediate danger.

Conclusion: do not remain alone in the face of anxiety

Anxiety disorders are common conditions that cause great suffering, but they are highly responsive to treatment. They are characterized by excessive anxiety, various physical symptoms, and a marked impact on daily life, which can lead to complications such as depression, addiction, chronic insomnia, or suicidal thoughts. Cognitive behavioral therapy and antidepressants (SSRIs, SNRIs) are the cornerstones of treatment, accompanied by a suitable lifestyle.

At the slightest persistent symptom, consult your primary care physician first. If they are not available, Docadom provides an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation. In case of suicidal thoughts, do not wait: 143 (La Main Tendue) or 144.