Anxiety

Clinic

• Anxiety is Dual Purpose word. Sometimes it is used as a symptoms means uneasiness, Worry and sometimes used as an entity which is a package of sign, symptoms as below.

Sign / Symptoms

Neurological	GI	Respiratory	Cardiac	Muscular	Cutaneous	Uro-genital	Mental	General
Headache	Abdominal Pain /Tightness	Shortness of breath	Palpitations	Fatigue	Perspiration	Frequency	Problems in concentration	Restlessness
Paresthesias	Nausea	Sighing breathing	Tachycardia	Tremor	Pruritis	Urgency	Nervous behavior	Presyncope
Fasciculation	Diarrhea	Inability to catch one's breath	Chest pain	Tetany		Dyspareunia
Vertigo	Indigestion			Muscular tension		Impotence
	Dry mouth
	Bolus

Anxiety vs panic attack

• Panic attack is exaggerated anxiety. Simply I could say if anxity as an entity goes to acute state, it is named Panic attack, and if goes to chronic state, it is named GAD . As you could see panic attacks in the image of GAD.

Anxiety vs. Fear

Four main domains	Fear	Anxiety
Duration of emotional experience	Short	Long
Temporal focus	Present	Futute
Specificity of the threat	Specific	Diffuse
Motivated direction	Escape	Additional associated cognitive activity

Entity / Miasms

	TBE	RBS	PLV	CXA/B, ECHO	VZV
Anxiety	+++	+++	+++	+++	+++
Fasciculation	+++	+++	+++
Paresthesia	+++	+++	+++	+++	+++
Tremor	+++	+++		+++	+++
Tachicardia	+++	+++	+++	+++	+++
Tachipnea	+++	+++		+++	+++
Concentration impared	+++	+++	+++		+++
Fatigue	+++		+++	+++
HYpotention		+++		+++

Related diseases

• Generalized anxiety disorder
• Specific phobia
• Social anxiety disorder
• Separation anxiety disorder
• Agoraphobia
• Panic disorder
• Selective mutism
• IBS
• Chronic pelvic pain syndrome
• MDD
• Bipolar disorder
• Eating disorders
• Certain personality disorders
• Personality traits such as neuroticism
• Obsessive-compulsive disorder
• Dissociative disorders
• Somatoform disorders
• Intrusive thoughts

Neuroanatomy

• Amygdala (which regulates emotions like anxiety and fear, stimulating the HPA axis and sympathetic nervous system). People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala. Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.
• Hippocampus (which is implicated in emotional memory along with the amygdala)

• Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward. This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents".

The gut-brain axis

• The microbes of the gut can connect with the brain to affect anxiety. Gut microbes such as Bifidobacterium and Bacillus produce GABA and dopamine, respectively.
• Another key pathway is HPA axis. The microbes can control the levels of cytokines in the body, and altering cytokine levels creates direct effects on areas of the brain such as the hypothalamus, the area that triggers HPA axis activity.
• HPA axis regulates production of cortisol. When HPA activity spikes, cortisol levels increase, processing and reducing anxiety in stressful situations.