Stress symptoms
Stress symptoms
Anxiety is characterized by feelings of apprehension, tension, uneasiness, terror faced with the risk of indeterminate nature. It is often expressed by the patient in terms of nervousness or worry. The anxiety must be distinguished from fear responding to a threatening situation real.
We differentiate panic disorder (corresponding to acute anxiety attacks occur periodically) and the constant anxiety (generalized anxiety disorder or anxiety neurosis), which affects individuals in a sustainable manner.
This distinction is important because treatments are different. Panic disorder has a preventive treatment for the occurrence of seizures by antidepressants while GAD is available on conventional tranquilizers.
Anxiety disorders are common, they affect each year about 2-8% of the adult population and are more common in women. The average age of onset of symptoms is between 20 and 30.
Anxiety can be normal, even necessary to life by its adaptive function, or conversely, debilitating disease. The boundaries between normal anxiety reaction that involves the subject to face a difficult situation and pathological anxiety is unclear.
It is generally considered that anxiety is normal when it is well tolerated by the subject, he can control it, he does not perceive as unreasonable hardship, it has no impact on its daily life and it is unlikely somatisée. Anxiety is normal experience that each of us has experienced: fear before an exam, concern for the health of a parent, anxious reactions in accidents, disasters … Anxiety is an emotion so helpful. It is a psychological reaction to stress. It is a state that is part of our adaptive responses to external stimuli by allowing us to engage our attention, to raise our vigilance in situations of novelty, choice, crisis or conflict.
In addition to neurotic disorders (generalized anxiety and panic disorder) whose actual cause is unknown and is the subject of various theories, there are easily identifiable causes.
In the hysterical neurosis, anxiety is converted into physical symptoms with no organic support. But this conversion is often incomplete and some anxiety persists in general.
In social phobia, anxiety is attached to specific situations (crowds, enclosed spaces or very wide open, animals …), and anxiety is manifested only to those situations and disappears along with them.
The posttraumatic stress disorder (PTSD) is due to an extraordinary event that would cause obvious symptoms of distress in most people. The event is constantly relived as memories, dreams, feeling it will happen again …The subject tries to avoid anything that reminds him of the event and suffers from hypertension autonomic (irritability, hypervigilance, hyperreactivity to stress, difficulty falling asleep …).
Finally anxiety can be a single personality trait (anxious person) and thus is a permanent arrangement, is a transient state occurring in certain circumstances.
Anxiety is a symptom experienced as a vague feeling of pain and waiting for a vague danger, always imminent. This suffering is very often accompanied by various somatic signs that sometimes dominate the clinical picture: they are mainly respiratory symptoms, cardiac, digestive, urinary, neurological. They say that patients somatizers their anxiety, that is to say that they express through their bodies.
Anxiety neurosis is a chronic anxiety state where anxiety is present over a two-day, for at least six months. It is independent of a phobic situation (which can cause phobias, anxiety), an obsessive fear as in obsessional neurosis, and not n’émaille the evolution of a psychotic disorder or depression.She has at least six symptoms from a list of eighteen:
Generalized anxiety disorder is manifested by a feeling of permanent insecurity with ruminations on the past and various fears about the future. The chronic anxiety is very difficult to make a decision or choice, being subject to perpetual doubt. It is hyperemotional, unstable, and reacts strongly to external stimuli. Phobias and depression are common.
The anxious wait is the most constant symptom. Everyday worries are magnified enormously. The anxiety apprehends the worst for him and his family. Very dependent on his entourage, he can not bear the separation.
In the interval between episodes of acute anxiety, most patients have no trouble. Others continue to feel fatigue, headache or other manifestations of anxiety.
In anxiety neurosis, anxiety is floating and isolated pure. Against this background of permanent anxiety can occur without acute attacks paroxysmal obvious precipitating cause.
The disease progresses through phases of remission and exacerbation of symptoms. Some decompensation are possible: depression, suicide, drug addiction, alcoholism … The patient may develop into an organization neurotic phobic, hysterical or hypochondriacal.
The basic treatment is based on psychotherapy and relaxation. Tranquilizers or anxiolytics (benzodiazepines in particular) are used by periods.
The treatment of acute anxiety attack based on the attitude of the physician who must be calm and understanding, isolation, anxiolytics by injection for a rapid and powerful.
Panic disorder is characterized by the occurrence of anxiety attacks or acute anxiety attacks. By definition, to speak of panic disorder, the patient must make at least four panic attacks in four weeks (or at least if it is followed by the persistent fear of having another attack). These panic attacks are unpredictable and not triggered by particular situations (trac) or organic factors.
Panic disorder (acute anxiety) is sudden onset.The patient feels a sense of imminent, violent, imprecise (fear of imminent death, going crazy, not to control his thoughts or actions, disaster …), next feeling of helplessness, helplessness, intense fear, not applicable.
The patient is pale, covered with sweat, agitated or prostrate, uptight, tense, covered with sweat, lively tremor. It can be frozen by the anguish or suffering from a feverish excitement. Breathing is rapid, irregular. Nausea, vomiting, diarrhea, aches and pains, palpitations, tremor, feelings of dizziness, blurred vision, sharp reflexes are common. The heart is quick and wards can be dilated.
The hyperventilation syndrome associated with tachypnoea, shallow breathing, numbness around the mouth, tingling and numbness of the extremities and is closer to tetany (spasmophilia).
In mild forms of anxiety are prescribed as anxiolytics benzodiazepines at low doses.
In panic attacks, tranquilizers are sometimes inadequate and then antidepressants are the only active ingredient. They are also used in prevention.
Psychotherapy is useful when the patient seeks dialogue. It is more efficient that anxiety is related to a psychological problem, especially if the patient is isolated, with little help from friends. Relaxation yields good results in generalized anxiety.
In specific phobias (agoraphobia, fear of driving, airplane, shops, lifts, etc..) Behavioral techniques give excellent results when patients adhere fully to the program of desensitization and daily tasks to home. Adherence to treatment is a prerequisite for the success of this type of care.
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Meditation helps to fight against relapse of depression, stress and all its related diseases. It took thirty years for this certainty came from the United States, is spreading across Europe:Germany, Belgium, Great Britain … And France?
Anne-Laure Gannac
Association for the Development of mindfulness136 Street Crimea, 75019 ParisT. : 08 71 43 13 54www.association-mindfulness.orgStress Reduction Clinic, Center for Mindfulness today in Medicine, Health Care, and Society.www.umassmed.edu / content.aspx? Id = 41252
Thirty psychologists and doctors only – including psychiatrists Christophe André, Sainte-Anne hospital in Paris, and David Servan-Schreiber – now trying to promote meditation. Facing them, the reluctance are many: medical education with little room for the power of the mind, fear of the religious and sectarian risk, very strong influence of psychoanalysis in our psycho-medical culture.
It’s in the fight against the evils of stress is meditation ‘medical’ first demonstrated its effectiveness.In 1979 in his Stress Reduction Clinic (Clinic stress reduction), University of Massachusetts, U.S., biologist Jon Kabat-Zinn has developed a series of meditation exercises, breathing and attention in the context of the ‘stress reduction based on mindfulness. Cognitive therapy based on the same principle adds to these exercises on the one hand, work on awareness of time, little by little, the depression sets (rumination of dark thoughts, lowered self-esteem …) secondly, a progressive training to control such mental processes as gently let go, accept without judging, and let thoughts and emotions ‘like clouds in the sky.’
This therapeutic approach, which combines body and mind, is still poorly known and little used in France. Yet the results are there, confirmed by science and by patients. Take time to heal otherwise, it depends on everyone: doctors, government, media, but also each of us.
1. ‘Influence of a mindfulness meditation-based stress reduction intervention were spleens of skin clearing in patients with moderate to severe psoriasis With Undergoing Photochemotherapy and phototherapy (PUVA)’ by J. Kabat-Zinn, E. Wheeler et al. Psychosomatic Medicine in 1998.
2. ‘Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in The Treatment of Anxiety Disorders’ by JJ Miller, K. Fletcher and J. Kabat-Zinn, in General Hospital Psychiatry, 1995.
3. ‘The clinical use of mindfulness meditation for the Self-regulation of chronic pain’ by J. Kabat-Zinn, L. Lipworth and R. Burney, in Journal of Behavioral Medicine, 1985.
4. ‘A randomized, wait-list controlled clinical trial: the effect of mindfulness meditation has-Based Stress Reduction Program on Mood and Symptoms of stress in cancer outpatients’ M. Speca, LE Carlson, E. Goodey and M. Angen, in Psychosomatic Medicine, 2000.
5. ‘The impact of a meditation-based stress reduction program is fibromyalgia’ KH Kaplan, DL Goldenberg and M. Galvin-Nadeau, in General Hospital Psychiatry, 1993.
6.’Mindfulness meditation training effects were CD4 T lymphocytes in HIV-1 infected adults’ Creswell JD, Myers HF, SW Cole and MR Irwin, in Brain, Behavior, and Immunity, 2009.
7. ‘Reducing risk of recurrence of major depression using mindfulness-based cognitive therapy ‘JD Teasdale, ZV Segal, JMG Williams et al., In Journal of Consulting and Clinical Psychology, 2000.
8. ‘Alterations in Brain and Immune Function Produced by Mindfulness Meditation’ by RJ Davidson, J. Kabat-Zinn et al. Psychosomatic Medicine in 2003.
9. ‘Meditation, melatonin and breast / prostate cancer’ AO Massion, J. Teas, Hebert JR, Wertheimer MD and J. Kabat-Zinn, in Medical Hypotheses, 1995.
Meditation helps to fight against relapse of depression, stress and all its related diseases. It took thirty years for this certainty came from the United States, is spreading across Europe: Germany, Belgium, Great Britain … And France?
Consequences of psychological trauma
Immediate Events
During the traumatic event, the body reacts: the reaction is very short of immobility or freezing’Parasympathetic system (stunning cognitive, affective and motor), then the leakage / battle of the sympathetic system (tachycardia, hyperventilation) which may manifest as behavioral agitation, panic flight, mimetic reactions or events neurotic (hysterical phobia) or psychotic (delusions, disorientation) in susceptible individuals.
Once the event ended, comes the phase of acute stress reaction (agitation, anxiety, intrusive memories, no emotions …). These reactions are normal and natural after a traumatic experience.
Deferred events
After a period, it may happen that the reactions take the form of symptoms such as somatic hyperarousal (agitation, anxiety), repetition syndrome (recurrent intrusive memories, nightmares), dissociation (detachment) and avoidance (situational anxiety or social). This corresponds to the posttraumatic stress disorder (PTSD).Finally, this condition can become chronic and associated with other problems (alcoholism, depression, anxiety, sleep disorders, ….).
Sequelae
Consequences of psychological trauma
Immediate Events
During the traumatic event, the body reacts: the reaction is very short of immobility or freezing of the parasympathetic system (stunning cognitive, affective and motor), then the flight / fight of the sympathetic nervous system (tachycardia, hyperventilation) may manifest as behavioral agitation, panic flight, mimetic reactions or events neurotic (hysterical, phobic) or psychotic (delusions, disorientation) in susceptible individuals.
Once the event ended, comes the phase of acute stress reaction (agitation, anxiety, intrusive memories, no emotions …). These reactions are normal and natural after a traumatic experience.
Deferred events
After a period, it may happen that the reactions take the form of symptoms such as somatic hyperarousal (agitation, anxiety), repetition syndrome (recurrent intrusive memories, nightmares), dissociation (detachment) and avoidance (situational anxiety or social). This corresponds to the posttraumatic stress disorder (PTSD). Finally, this condition can become chronic and associated with other problems (alcoholism, depression, anxiety, sleep disorders, ….).
Sequelae
History
In Lessons 18-22 Lessons on diseases of the nervous system (1885-1887), on seven cases of male hysteria, Jean Martin Charcot stated that hysterical symptoms are due to ‘shock’ causing a traumatic dissociation consciousness. Thus, the memory remains unconscious. He thus laid the foundations of the theory ‘traumatico-dissociative ‘neuroses to be developed by Pierre Janet, Joseph Breuer and Sigmund Freud. The latter, between 1888 and 1889, attempt to ‘regain’Under hypnosis, traumatic memories of their patients.
For Freud, hysteria was the result of psychological trauma, most often as a sexual ‘seduction’ more or less active and explicit adult towards a child. This event, which drove back to adolescence, showed an effect on sexual life, real or fantasmatique.L primary event was recalled by another event ‘apparently ordinary’ in adolescence. It is the disproportion of the reaction to it and the symptoms related thereto that suggested an origin older child. (Cf. the Dora case in the Five Psychanalyses.Par Subsequently, this theory goes beyond Freud (his neurotica) and grants authority to the fantasy traumatic or more specifically, derivatives of the unconscious.
The question of the trauma resurfaced with the text ‘Beyond the Pleasure Principle (1920) where Freud starts from the traumatic neurosis, neuroses of war and the repetition compulsion. The advent of the second topography.Trauma is seen as an intrusion and full binding capacity of the psychic apparatus, which forms a symptom under the influence of repetition. The latter is then at once, as resistance to progress in treatment (the patient seems to repeat endlessly memories and traumatic experiences) and as an attempt by the psychic apparatus to resume control or bind.
Even if the emphasis previously placed on the real event, was moved to the psyche, psychoanalysis is marked by the history of trauma. On this point, theories have developed (Sandor Ferenczi, etc..). Today Freud is criticized for hiding the abuse allegedly suffered by many of his patients (see Alice Miller). The trial of intent behind these criticisms will not remove a crucial fact: the ability to produce the psyche of unconscious fantasies that can be disturbing. This revolution is still struggling to be heard. We prefer to think that what is traumatic just outside and everything that comes from the unconscious to be about imagination.
Effectively with the progress of neuroscience, new approaches have emerged from the trauma and then returned precisely on a reality long ruled in favor of pure fantasy by psychoanalysts; propensity already denounced by Sandor Ferenczi (Congress of the International Psychoanalytical Association in Wiesbaden – 1932 ). According to this view, the psyche is designed with a view Psycho. That is to say that the organization of the system depends on the psychological development of individuals and various information received during his life (cf. the work of Endel Tulving and Jean Piaget among others). This involves both the cognitive (semantic memory) as engines (procedural memory). Over the functioning of the psyche is inseparable from that of the brain in terms of relations between different sensory areas, emotional (limbic system), perceptual representation, premotor, motor, etc.., As and when it was seized by the sense organs.
According to J.Roques (2004 – 2007 – 2008) any new information must be stored long term, that is to say ‘digested’, which corresponds to the start of the vagal system (cholinergic relaxation process). Now every event is first processed by the limbic system (include the thalamus and the amygdala – See the two circuits of fear of J. Ledoux). When it comes to a potentially traumatic, the subject can not avoid it or confront it. No more setting long-term memory can not be done. Therefore the event remains pending, filed in implicit memory / motor (see Francine Shapiro). It appears constantly in view of its resolution as soon as the subject relaxes or calms down (parasympathetic). The centers of fear (amygdala among others) are then again seized and instantly give the scoop to the sympathetic system. In the emergency no relaxation is possible. The mechanism of survival has primacy over that of memorization.
This model can well account for the repetition compulsion, already described by Freud and all the various pathological phenomena that accompany the psychological trauma.
Under what circumstances can we talk about trauma?
When trauma means that the effect on the individual event, we talk about traumatic or potentially traumatic event. The concept of psychic trauma is not limited to this design factual. Furthermore, a single ‘event’ experienced by many people, may have traumatic effects of a very different person to person.
To have a potentially traumatic event must represent a threat to the integrity of the person, beyond its possible reactions, occurring suddenly and unanticipated, and accompanied by a feeling of terror, distress, with fear, loneliness, abandonment. traumatogenic The range of events is large:
The trauma of type 2 corresponds to a situation that repeats itself:the individual is re-exposed to danger the same or comparable (family violence, wars, secondary trauma professional assistance, etc..).
History
In Lessons 18-22 Lessons on diseases of the nervous system (1885-1887), on seven cases of male hysteria, Jean Martin Charcot stated that hysterical symptoms are due to ‘shock’ causing a traumatic dissociation consciousness. Thus, the memory remains unconscious. He thus laid the foundations of the theory ‘traumatico-dissociative ‘neuroses to be developed by Pierre Janet, Joseph Breuer and Sigmund Freud. The latter, between 1888 and 1889, attempt to ‘recover’, under hypnosis, traumatic memories of their patients.
For Freud, hysteria was the result of psychological trauma, most often as a sexual ‘seduction’ more or less active and explicit adult towards a child. This event, which drove back to adolescence, showed an effect on sexual life, real or fantasy.The first event was recalled by another event ‘apparently ordinary’ in adolescence. It is the disproportion of the reaction to it and the symptoms related thereto that suggested an origin older child. (Cf. the Dora case in the Five Psychanalyses.Par Subsequently, this theory goes beyond Freud (his neurotica) and grants authority to the fantasy traumatic or more specifically, derivatives of the unconscious.
The question of the trauma resurfaced with the text ‘Beyond the Pleasure Principle (1920) where Freud starts from the traumatic neurosis, neuroses of war and the repetition compulsion. The advent of the second topography. Trauma is seen as an intrusion and full binding capacity of the psychic apparatus, which forms a symptom under the influence of repetition. The latter is then at once, as resistance to progress in treatment (the patient seems to repeat endlessly memories and traumatic experiences) and as an attempt by the psychic apparatus to resume control or bind.
Even if the emphasis previously placed on the real event, was moved to the psyche, psychoanalysis is marked by the history of trauma. On this point, theories have developed (Sandor Ferenczi, etc..). Today Freud is criticized for hiding the abuse allegedly suffered by many of his patients (see Alice Miller). The trial of intent behind these criticisms will not remove a crucial fact: the ability to produce the psyche of unconscious fantasies that can be disturbing. This revolution is still struggling to be heard. We prefer to think that what is traumatic just outside and everything that comes from the unconscious to be about imagination.
Effectively with the progress of neuroscience, new approaches have emerged from the trauma and then returned precisely on a reality long ruled in favor of pure fantasy by psychoanalysts; propensity already denounced by Sandor Ferenczi (Congress of the International Psychoanalytical Association in Wiesbaden – 1932 ).According to this view, the psyche is designed with a view Psycho. That is to say that the organization of the system depends on the psychological development of individuals and various information received during his life (cf. the work of Endel Tulving and Jean Piaget among others). This involves both the cognitive (semantic memory) as engines (procedural memory). Over the functioning of the psyche is inseparable from that of the brain in terms of relations between different sensory areas, emotional (limbic system), perceptual representation, premotor, motor, etc.., As and when it was seized by the sense organs.
According to J. Roques (2004 – 2007 – 2008) any new information must be stored long term, that is to say ‘digested’, which corresponds to the start of the vagal system (cholinergic relaxation process). Now every event is first processed by the limbic system (include the thalamus and the amygdala – See the two circuits of fear of J. Ledoux).When it comes to a potentially traumatic, the subject can not avoid it or confront it. No more setting long-term memory can not be done. Therefore the event remains pending, filed in implicit memory / motor (see Francine Shapiro). It appears constantly in view of its resolution as soon as the subject relaxes or calms down (parasympathetic). The centers of fear (amygdala among others) are then again seized and instantly give the scoop to the sympathetic system. In the emergency no relaxation is possible. The mechanism of survival has primacy over that of memorization.
This model can well account for the repetition compulsion, already described by Freud and all the various pathological phenomena that accompany the psychological trauma.