Q. What is Somatization ?
Ans. Somatization disorder is a chronic syndrome of multiple somatic symptoms those cannot be explained medically. They are associated with psychosocial distress and often require medical help.
These disorders are derived mainly from unwanted activity in the musculature, the limbic system and autonomic (mainly sympathetic) nervous system, and are sometimes accompanied by metabolic changes.
Somatic disorders are often represented by recurrent chronic vague complaints. They involve multiple organ systems.
Patients often have a history of repeated change of doctors.
This disorder usually begins in second or third decade of life and is much more common in females.
Q. What are the common physical symptoms of anxiety and depression ?
Ans. As already discussed, the symptoms are recurrent, chronic and vague also there is an overlap between anxiety and depression symptoms.
The anxiety symptoms are as follows :
- Tremulousness
- Chest Pain
- Palpitation, tachycardia
- Hyperventilation : Increased breathing
- Dyspnoea : difficulty in breathing
- Muscle stiffness resulting into body aches and fatigue
- Increased frequency of micturation
- Diarrhoea
All above symptoms are observed in depression. Besides them some other commonly seen symptoms are :
- Lack of appetite or increased appetite
- Difficulty in sleep or increased sleep
- Lack of sexual desire
Q. Is stress synonymous to anxiety ?
Ans. Anxiety is a state regarded as a natural response to stress. In other words, stress can lead to anxiety.
A stressful situation triggers the release of adrenaline throughout the sympathetic nervous system so preparing body for 'fight, flight or fright'.
For this reason most people find that feeling slightly tensed on the day of examination or interview helps them to perform better in that situation.
However, when this stress starts affecting mental state of the person, may be with physical symptoms it is known as anxiety .
Q. What is a difference between anxiety and depression ?
Ans. Differential diagnosis between anxiety and depression is often very difficult, especially since so many patients have both together.
Even when anxiety is thought to be the underlying cause of depression it is essential to treat depression as well, since patients cannot identify and come in terms with anxiety until the depression is lifted.
Q. How do anxiety and depression affect cardiovascular system ?
Ans. Cardiosvascular system is commonly attacked by anxiety and depression. Anxiety
attacks can increase the heart rate and blood pressure.
Both anxiety and depression may give rise to chest pain and palpitation. In some persons palpitation may be one of the outstanding manifestations while in others, symptoms are present at the same time.
Chest pain or chest discomfort is commonly observed in such patients. Usually the discomfort is experienced as a sense of tightness, heaviness.
Q. How anxiety and depression affect musculo-skeletal system ?
Ans. Anxiety and depression affect musculo-sketelal system by various vague aches and pains.
In such situation muscle tension is increased which leads to muscular spasms. These spasms are perceived as pain.
The common problems of musculo-skeletal system under anxiety and depressive states are headache and backache.
Significant number of patients observed in general practice or in neurological clinic have headache for which no physical cause is found. The commonest in this type is 'tension' headache described as generalized feeling of pressure or tightness, extending around the head.
Backache is the second leading cause for visits to primary care doctors and major cause of disability. Most acute pain is transient but in about 20% of patients it persists for longer.
The other complaints include facial pain in which temporomandibular dysfunction is common (A dull ache around the temperomandibular joint). This condition is commonly presented to the dentists.
A typical facial pain is a deeper aching or throbbing pain which is more likely to be presented to neurologist.
Pelvic pain is one of the commonest symptoms reported by women attending gynaecology clinic.
Q. How anxiety and depression affects Gl system ?
Ans. Gastro-intestinal symptoms are often an expression of psychological disorders. Complaints of poor appetite, abdominal pain, diarrhoea or constipation can have psychiatric cause, specially in depressive and anxiety disorders.
Anxiety increases Gl motility thus can produce diarrhoea off and on.
Repeated attacks of anxiety causes increase in gastric acidity which may lead to gastritis or peptic ulcer. Ulcerative colitis too is commonly observed in patients with anxiety and depression.
Abdominal pain is commonly observed in patients undergoing apppendicectomy.
Irritable bowel syndrome is also often observed in patients with anxiety and depression. The irritable bowel syndrome can be explained as abdominal pain or discomfort with or without alteration of bowel habits persisting for longer than 3 months in absence of organic cause.
Besides these symptoms in depression there is loss of appetite, indigestion and constipation.
Q. How anxiety and depression affect gynaecological system ?
Ans. Anxiety and depression can affect hormonal level hence menstrual disturbances like amenorrhea (absence of menses), menorrhagia (excessive regular menstrual flow)
polymenorrhoea are observed.
Anxiety and depression is known to cause vaginism (painful muscular spasm of vaginal walls resulting in dyspareunia or painful colitis sterility in women).
Lack of sexual desire is one of the major complaints.
Anxiety and depression is often observed during pregnancy. These disorders are common in1st and 3rd trimester hence these could be increased complaints of somatization during this period.
Q. How is anxiety and depression associated with pain ?
Ans. Pain tolerance or threshold for pain goes down in presence of anxiety and depression.
This has been observed that if anxiety and depression is well controlled there could be decreased pain and disability.
Q. What are the treatment modalities of anxiety and depression ?
Ans. The treatment can be classified into three types pharmacotherapy, psychotherapy and behavioural therapy.
Pharmacotherapy : Several types of antidepressant drug treatments are available and the choice should be made according to the needs of individual patients, with particular consideration to likely side-effects.
The commonly used treatments are
- Antianxiety: Anxiolytics
- Antidepressants : Tricyclic, SSRI
Psychotherapy : The need for psychological treatment should be evaluated in each case. All depressed patients require support, encouragement and thorough explanation of illness they are suffering from. Psychotherapies can be categorised as
- Individual Psychotherapy
- Family Psychotherapy : It is a system formed by individuals in families rather than focus on individual. In this family interview is arranged specifically when there is a disorder of relationship.
- Group Psychotherapy : Five to eight patients meet with one or two therapists for one and half hours session each week.
The psychotherapy can be further classified as supportive and cognitive therapy.
- Supportive Psychotherapy : it is a problem solving therapy in which the therapist and patients identify the main problems of concern and devise feasible step by step approach of tackling them.
- Cognitive Psychotherapy : The essential aim of cognitive treatment is to help patients to modify their ways of thinking about the life situations.
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