Anxiety and co…

Anxiety disorders are the most commonly encountered psychological disorders among adults


If you have never felt anxious, something is wrong with you. It is okay to worry temporarily especially when we have to make important decisions when we are faced with a challenge or a test/exam. However, it is a different case entirely when this is blown out of proportion. Anxiety disorders are the most commonly encountered psychological disorders among adults and they interfere with performance, relationships and other healthy daily activities.  Have you read about Stress?

Anxiety disorders are the most commonly encountered psychological disorders among adults and they interfere with performance, relationships and other healthy daily activities.


Nobody wants to be labeled as crazy, especially in an African society where stigmatization thrives like wild-fire. For this reasons, critical issues pertinent to assessing anxiety disorders are bordered on;

  • Sensitivity to making the diagnosis
  • Anxiety in a mask of productivity
  • Other psychiatric diagnoses associated with it
  • Medical conditions and medications that can cause or exacerbate anxiety disorders.

Risk Factors

  • Shyness, or behavioral inhibition, in childhood
  • Being female
  • Having poor economic resources
  • Being divorced or widowed
  • Exposure to stressful life events in childhood and adulthood
  • Anxiety disorders in close biological relatives
  • Parental history of mental disorders


The anxiety disorders that will be examined in this write-up will include:

  1. Panic disorder
  2. Generalized anxiety disorder
  3. Obsessive compulsive disorder
  4. Post-traumatic stress disorder
  5. Social phobia and specific phobia.

As each disorder is explored, emphasis will be placed on assessment of commonly encountered psychiatric and medical conditions that contribute to anxiety symptoms. However, before considering the specific anxiety disorders to be presented in this program, it is useful to highlight the following issues:

Psychiatric Disorders associated with Anxiety Disorders

  • Major depressive disorder
  • Substance abuse disorders – alcohol, marijuana
  • Somatization disorders (fatigue, chest pain, headache, insomnia, non-specific GI complaints)
  • Complex anxiety disorders – ( Post-traumatic stress disorder with Panic disorder)

Medical Conditions associated with Exacerbating Anxiety

  • Hyperthyroidism
  • Adrenal Dysfunction
  • Angina
  • Hypoglycemia

Medications and Substances associated with Exacerbating Anxiety

  • Stimulants (Amphetamines, caffeine, cocaine, and other over the counter “natural stimulants”)
  • Withdrawal from drugs, including alcohol
  • Heavy metals and toxins
  • Steroids
  • Rapid withdrawal from some antidepressants

General Action plan in dealing with anxiety and associated disorders

  1. Assessment for suicide risk, particularly in patients with depression and panic disorder, substance abuse or high levels of agitation.
  2. Identification of severity of anxiety disorder (chronic or episodic)
  3. Identification of substance abuse
  4. Assessment of key symptoms of panic disorder, fear of dying and/or fear of going crazy
  5. Assessment for depression or other mood disorder
  6. Inquiry as to the presence of anti-social behavior
  7. Exploration of presence of precipitating event or trauma
  8. Being alert to people with anxiety disorders who have insomnia, headache, non-specific GI complaints, cognitive complaints

We will be talking extensively about mental health and major associative conditions in the comings weeks. Stay tuned. Read about Stress here.

Stress as a Lifestyle Disease

Are you interested in hearing more about stress and its health effects?

Stress is not really a disease or a diagnosis in itself. It is generally defined as a feeling of threat to your physical or mental well-being. This feeling is worsened  when you think your normal coping mechanism  is inadequate.  These may present in the form of job stress, relationship conflicts, or even money problems.


Chronic stress often may be experienced with symptoms of fatigue and low energy, but may also be associated with irritation, sleep disturbances, and feeling depressed or down. The physical symptoms of chronic stress can include headaches, GI upset, and muscle tension, among others.

So what are the effects that stress can have on our bodies?

Chronic stress may give rise to medical conditions such as heart disease, heart attacks, strokes, high blood pressure, depression, and anxiety disorders.

The good news is there are many simple, inexpensive strategies available to choose from. When employed in a regular, consistent way, these strategies significantly moderate the impact of both acute and chronic stress.


There are no specific laboratory tests for stress. The doctor’s approach will be based on your presenting complaint (which can vary considerably with stress) and the presence of any suspected underlying disorders based on your history and physical examination. Generally, a full blood count to check your blood levels, other investigations to rule out infections will be done. A fasting lipid profile (cholesterol) may be needed and some hormones like the thyroid hormones may be screened.

Inform the doctor of any supplements or herbal preparations that you are using or are considering to use. We doctors frown on some herbal mixtures, but we may just surprise you!

How to deal with Stress

Improving poor sleep patterns will have the greatest potential for fatigue reduction. Research has shown that poor sleep lasting one year is associated with a subsequent major depression, an anxiety disorder, and for substance abuse.

Common sleep hygiene recommendations include the following:

  • Avoid evening use of caffeine, alcohol, or tobacco.
  • Establish a regular wind-down period one to two hours before bedtime, in which stimulating activities such as work or exercise are not done.
  • Avoid television late at night.
  •  Regulate noise and temperature extremes in the bedroom when attempting to sleep
  • Stimulus control methods include using the bed only for sleep and sex (no reading or TV in bed) and going to bed only when drowsy. If not asleep in 20 minutes you get up, go to another room, engage in a relaxing non-stimulating activity such as reading or very light housework, and do not attempt to sleep until you’re drowsy again (repeat this pattern as often as necessary). Stimulus control techniques are associated with a 58% reduction in sleep onset time
  • You can keep a sleep diary for the two weeks to help track any subsequent changes to your sleep status. As a way of monitoring progress you can rate your energy levels on a scale from 1 to 10 and record them on a daily basis.


Regular aerobic exercise has been shown to have a positive influence on mental health outcomes largely in the area of mood enhancement. Moderate exercise is associated with improving;

  • Immediate mood and energy.
  • Mood and energy boost over weeks.
  • Long-term sleep quality (avoid within three hours of bedtime)

Start small

  • 10- to 20-minute brisk walk at lunch during the week for at least three days a week.
  • The weekends may provide additional opportunity to exercise by being active or playing sports with your children, friends or colleagues.
  • You can use the gym, dance, walk up and down your staircase, just be creative and sweat!

Behavioral methods

Many activities can reduce tension and foster the feeling of calmness. Common activities can include physical activity, listening to music, walking with a friend, reading, or practicing a repetitive leisure activity such as gardening, pottery, or woodwork.

More formal types of calming activities that involve inducing a relaxation response, such as meditation and yoga have been studied and often show an accompanying decrease in heart rate, breathing rate, blood pressure, and a metabolic slowing coupled with feelings of peace and relaxation.

Relaxation techniques are also used to decrease sleep latency. In addition to a regular daytime relaxation practice, it is suggested that the relaxation response technique be used after closing the eyes when attempting to go to sleep at night. There is a significant improvement in sleep onset time if relaxation techniques are practiced and a greater benefit (up to 77% reduction in sleep onset time) if relaxation techniques are combined.

Healthy lifestyle behaviors are protective and negative coping behaviors will likely worsen the long-term effects of stress. The following strategies should be avoided whenever possible:

  • Overuse of alcohol
  • Smoking
  • Frequent use of caffeine
  • Overeating or under-eating
  • Regular or inappropriate use of over-the-counter medications

Alcohol does hasten sleep onset but the toxic effect of ethanol metabolites can disturb normal sleep architecture later in the night. In addition, regular alcohol use can worsen the effects of chronic stress.

Consider limiting coffee to a maximum of two cups a day, as excessive use can be construed as negative coping as well. Although it may assist in reducing fatigue during the day, four to five 8 cups of coffee a day can increase subjective feelings of tension at work and amplify stress effects on blood pressure and heart rate.

Social Support

Social support is frequently under-assessed and under-utilized and they may protect against psychosocial stressors and subsequent adverse impact on health.

Social support may assist by positively influencing an individual’s response to cognitive and emotional states, as well as improving self esteem, self efficacy, and effect. Social support can positively influence health behaviors such as alcohol consumption, exercise, dietary patterns, and illicit drug use. Social disconnection is associated with alcohol consumption, inactivity, and obesity. Social support in general and specifically perceived emotional support, are associated with a reduction in the risk of depression and depressive symptoms following stressful life events.

Social relationships and contacts can also be negative and in turn be perceived as stressful. This is especially true with individuals who have frequent contact that includes conflict in the workplace or family. Negative lifestyle habits can also be influenced by social relationships. A person’s chances of becoming obese increased by 57% if he or she had a friend who became obese; and in marriage, if one spouse became obese, the likelihood that the other spouse would become obese increased by 37%.

So ask yourself

  • Do you have someone who you can really count on to help you feel more relaxed when you are under pressure?
  • Do you have someone who you can count on to be dependable when you need help?

If conflict or negative social relationships are contributing to stress, consider resolving this conflict first.

Weight Management

Weight gain combined with poor diet patterns increases the risk for developing metabolic syndrome. This can worsen stress coping mechanisms drastically. Abdominal obesity (waist circumference greater than 102 cm in men) as well as eating large amount of red meat/pork per day and consuming daily fried foods is associated with an increased risk of developing this metabolic disorder.

Periods of high stress are associated with increased consumption of high fat, low fiber “fast foods”. The number of times eating fast foods may increase by 37% during stressful weeks, and men in particular will increase red meat consumption by 45% during weeks rated as high stress.

A balanced diet and healthy nutrition are one of the most effective steps in weight management, especially when combined with physical activity. Explore taking a healthy lunch to work or alternatively looking for healthier and convenient restaurant choices.  Simple dietary guidelines such as reducing fat content and increasing dietary fiber (fruits and vegetables) have multiple long-term health benefits, and will contribute to maintaining a healthy weight when combined with a regular physical activity program.

Take a vacation


This option is highly recommended for those who are tensed due to their work schedule and burn out almost on a daily basis in order to meet deadlines and cope with other work pressure. Work related stress accounts for majority of the complaints related to stress and it is because people tends to take their work home that they disrupt the environment that should refresh them in the first place.

Hope you can form strategies to cope with stress now, don’t hesitate to ask us questions or share our pages with loved ones.

Watch out for other articles on lifestyle diseases that will talk about obesity, hypertension and diabetes, chronic back pain and more.

Greater things are yet to come!