Giovanna Spantigati

The Generalized Anxiety Disorder (GAD) affects 5% of the Italian population, about three million people. Anxiety is defined as an instinctive defence reaction, an alarm for self-preservation, but also as a state of emotional tension that is often accompanied by physical symptoms such as tremor, sweating, palpitations and increased heart rate. Anxiety is an emotion that anticipates the danger and is accompanied by an increase in vigilance and the setting of a complex physiological mechanism of alarm. The pathological anxiety is an inappropriate response to concerns about existential or environmental fears whose main effect is represented by an alteration of the normal individual capacities.

The anxious syndrome includes psychic, somatic and behavioral symptoms. As for the clinical picture, patients with this disorder are chronically anxious and apprehensive, and are always preoccupied in any circumstances of their everyday life. In the absence of serious, and realistic reasons, they are apprehensive about the health and physical safety of family members, the financial situation, the ability to work or school performance. A clear example in this regard is the mother who fears for her son, temporarily absent, whenever she hears the horn of an ambulance or any unexpected telephone ring, despite being aware that he is not in a situation of real danger. This state of alert and hypervigilance is continuous and due to the belief that negative events might occur.

The somatic associated component consists of symptoms involving the neurovegetative system, like shortness of breath, palpitations, sweating, particularly in the palm of the hand, dry mouth, the sensation of a lump in one's throat, and light-headedness, hot flushes ; gastrointestinal disorders are very common: flatulence, dyspepsia, nausea and diarrhea. The symptoms caused by a strong muscle tension, particularly in the head, neck and back, are often responsible for widespread pain and headaches localized in the occipital and frontal sides. Sometimes the involvement of the muscles area causes tremor and / or contraction and stiffening in the upper limbs. The state of apprehension also creates problems to the cognitive symptoms (reduced concentration, easy distractibility, memory problems), and supervision (restlessness, irritability, nervousness, easiness to startle, alarm status). Sleep disorders show up in the form of initial or middle insomnia, or sleep interrupted by frequent awakenings. Insomnia may be one of the symptoms that lead the patient to the family doctor and / or this can create problems because of the indiscriminate use of hypnotics or anxiolytic in general. When a patient ha less serious somatic symptoms, he thinks they are a series of isolated or recurrent physical illnesses. Generally, these symptoms motivate the request of the medical intervention, especially the general practitioner, and head to laboratory tests and even complex radiological investigations with repercussions on social and health costs, denying a psychic origin of his diseases, sometimes giving the dignity of the disease to elements of low clinical significance (arterial hypotension, gastralgia , irritable bowel syndrome). (Dr. Salvatore Di Salvo) End of Part Six.

Giovanna Spantigati