Anxiety

Clinic

• Anxiety is an Entity and should not be confused with GAD or Panic attacks which is a disease
• It is an unpleasant state of emotion characterized by feelings of dread over anticipated events.
• It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.
• Anxiety is often accompanied by muscular tension, restlessness, fatigue, inability to catch one's breath, tightness in the abdominal region, nausea, and problems in concentration.
• Anxiety is closely related to fear, which is a response to a real or perceived immediate threat (fight or flight response); anxiety involves the expectation of future threat including dread. People facing anxiety may withdraw from situations which have provoked anxiety in the past.

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.

Related entities

	Neurological	GI	Respiratory	Cardiac	Muscular	Cutaneous	Uro-genital
	Headache	Abdominal pain	Shortness of breath	Palpitations	fatigue	Perspiration	Frequency
	Paresthesias	Nausea	Sighing breathing	Tachycardia	tremors	Pruritis	Urgency
	Fasciculations,	Diarrhea		Chest pain	tetany		Dyspareunia
	Vertigo	Indigestion					Impotence
	Presyncope	Dry mouth
		Bolus

Anxiety disorders	Related diseases	Miasms	Remedies
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	PLV DHF, LSSV, NVCJD, RBS, STLE, TBE, VZV CXA, CXB, ECHO, EBV, EV71, RBOL, RNV, SAHF	Ars Phos Sec

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.