Everyone feels anxious from time to time, but people with anxiety disorders experience frequent and severe worry that disrupts their normal life.

What is anxiety?

Feeling anxiety before a specific event, such as a test, is normal.

Usually, anxiety is temporary. But someone with an anxiety disorder experiences regular, severe worry. The anxiety may be debilitating and prevent them from doing their normal activities.

Anxiety disorders are common. According to the National Institute of Mental Health, approximately 19.1% of adults in the United States have an anxiety disorder.

Types of anxiety disorder

Agoraphobia

Agoraphobia is the fear of space where it is difficult to escape or receive help if something goes wrong.People with this type of phobia tend to avoid specific places or situations. For example, they might avoid crowds or public transport. Some people may become housebound in severe cases.

Generalized anxiety disorder

Generalized anxiety disorder (GAD) involves constant worrying over everyday things. The anxiety might have no clear cause or trigger. This chronic condition can cause trouble sleeping, irritability, and muscle tension.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) causes distressing, intrusive thoughts that a person may manage by carrying out repetitive behaviors that provide temporary relief.

Examples include compulsively washing the hands in fear of contamination. If a person does not perform the compulsion, they may feel more anxious as a result.

Phobias

Agoraphobia is one type of phobia, or fear. However, many other phobias exist. Some are common and relatively mild, such as a fear of spiders, or arachnophobia. Others may be more disruptive to a person’s life.

Panic disorder

Those with panic disorder are prone to panic attacks. These panic attacks cause physical symptoms similar to a heart attack.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) can develop after a person experiences trauma. For example, someone may develop PTSD after an accident, assault, or a natural disaster.In some people, symptoms are temporary. But others will experience PTSD over long periods.

Selective mutism

People who have this rare disorder avoid speaking, despite having the ability to do so. Those with selective mutism are typically very shy. They fear social judgment and embarrassment.

Separation anxiety

Separation anxiety is common in children, but adults also experience it. People with this type of anxiety disorder have an intense fear of separation from the people who are close to them in their lives.

Social anxiety disorder

People with this anxiety disorder have an intense fear of social interactions. They typically fear social humiliation and worry about judgment from others.

What is an anxiety attack?

An anxiety or panic attack involves a sudden burst of intense anxiety that produces physical symptoms. The symptoms might include difficulty breathing, chest pain, and dizziness.

Some people use the terms anxiety attack and panic attack interchangeably. Panic attacks can last as long as anywhere from 5–30 minutes.

Having a panic attack is frightening, and people who experience them are usually fearful of triggering another. Some people go to great lengths to avoid certain situations that might produce another episode.

Symptoms of a panic attack

Symptoms of a panic attack are not life threatening despite their intensity. They include:

• sweating
• shaking
• trembling
• dizziness
• panting and shortness of breath
• nausea
• heart palpitations
• increased heart rate
• depersonalization
• hot and cold flushes

Some people experience these kinds of symptoms with their regular anxiety. What makes a panic attack different is how intense and sudden the physical sensations are.

Causes of anxiety

The causes of anxiety are complex. Some potential causes of an anxiety disorder might include:

• Environment: A person’s life experiences, upbringing, and home environment have a significant impact on whether someone develops anxiety. A 2014 study suggests that some parenting styles increase the risk of anxiety disorders.
• Genetics: People with a family history of anxiety disorders are more likely to develop one.
• Health conditions: Some health problems might cause anxiety symptoms, such as thyroid or heart conditions.

Females are also more likely than males to develop an anxiety disorder.

Treatments

There are effective treatment options for anxiety disorders. The type of treatment will vary depending on the anxiety disorder.

Some anxiety treatments include:

Psychotherapy

Talk therapies, such as cognitive behavioral therapy (CBT), are a standard treatment for anxiety disorders. CBT teaches individuals with anxiety to approach their anxious feelings and thoughts differently. CBT can also involve exposure therapy for treating phobias, which means a person gradually and intentionally exposing themselves to their fear.

Medications

In some cases, medications, such as antidepressants and anti-anxiety medication, may help reduce the symptoms of an anxiety disorder. These are helpful for people who have severe symptoms.

A doctor may prescribe beta-blockers to someone with panic disorder. Beta-blockers can help with the physical symptoms of anxiety, such as rapid heartbeat and shaking.

Management

Some self-care strategies can help a person manage anxiety in their daily life. People with severe anxiety should not use these methods to replace help from a mental health professional.

Support groups

Support groups can provide people with anxiety a place to talk about their experiences with others who understand their condition. Additionally, being involved in spiritual groups that focus on compassion and forgiveness may help some people with anxiety.

Relaxation techniques

Activities that calm the nervous system can help ease anxiety, such as:

• spending time in nature
• meditation and mindfulness
• activities a person finds fun

Lifestyle changes

Substances such as caffeine and some nutritional deficiencies can make anxiety worse. Additionally, getting enough exercise and eating a nutrient-rich diet can help to reduce it.

A person with an anxiety disorder may feel some benefits from:

• reducing caffeine intake
• focusing on eating whole foods, such as fruits, vegetables, and fish
• getting regular exercise

Summary

Anxiety is a normal reaction to stress and change, but anxiety disorders are highly disruptive conditions. There are many types of anxiety disorder, including PTSD, OCD, GAD, and phobias.

Treatment for an anxiety disorder might include a combination of therapy and medication. People should seek help for anxiety that regularly affects their normal life.

Alzheimer’s disease progressively degrades a person’s memory and cognitive abilities, often resulting in dementia. Amid efforts to find novel treatments for this disease, a recent breakthrough study by scientists from Japan shows that oxytocin―the hormone that we commonly know to induce feelings of love and well-being―can also effectively reverse some of the damage caused by amyloid plaques in the learning and memory center of the brain in an animal model of Alzheimer’s.

Alzheimer’s disease is a progressive disorder in which the nerve cells (neurons) in a person’s brain and the connections among them degenerate slowly, causing severe memory loss, intellectual deficiencies, and deterioration in motor skills and communication. One of the main causes of Alzheimer’s is the accumulation of a protein called amyloid β (Aβ) in clusters around neurons in the brain, which hampers their activity and triggers their degeneration. Studies in animal models have found that increasing the aggregation of Aβ in the hippocampus―the brain’s main learning and memory center―causes a decline in the signal transmission potential of the neurons therein. This degeneration affects a specific trait of the neurons, called “synaptic plasticity,” which is the ability of synapses (the site of signal exchange between neurons) to adapt to an increase or decrease in signaling activity over time. Synaptic plasticity is crucial to the development of learning and cognitive functions in the hippocampus. Thus, Aβ and its role in causing cognitive memory and deficits have been the focus of most research aimed at finding treatments for Alzheimer’s.

Now, advancing this research effort, a team of scientists from Japan, has looked at oxytocin, a hormone conventionally known for its role in the female reproductive system and in inducing the feelings of love and well-being. “Oxytocin was recently found to be involved in regulating learning and memory performance, but so far, no previous study deals with the effect of oxytocin on Aβ-induced cognitive impairment. Realizing this.

Oxytocin is known to facilitate certain cellular chemical activities that are important in strengthening neuronal signaling potential and formation of memories, such as influx of calcium ions. Previous studies have suspected that Aβ suppresses some of these chemical activities. When the scientists artificially blocked these chemical activities, they found that addition of oxytocin addition to the hippocampal slices did not reverse the damage to synaptic plasticity caused by Aβ. Additionally, they found that oxytocin itself does not have any effect on synaptic plasticity in the hippocampus, but it is somehow able to reverse the ill―effects of Aβ.

COVID-19 patients on the antiviral remdesivir recovered about 30 percent faster than those on a placebo, the results of a major clinical trial showed Wednesday, as a top US scientist hailed the drug’s “clear-cut” benefit.

The patients taking part in a clinical trial of the drug have all had severe respiratory symptoms and fever, but were able to leave the hospital after less than a week of treatment, STAT quoted the doctor leading the trial as saying.

“The best news is that most of our patients have already been discharged, which is great.

“Partial data from an ongoing clinical trial is by definition incomplete and should never be used to draw conclusions about the safety or efficacy of a potential treatment that is under investigation.

There is no approved therapy for the Covid-19, which can cause severe pneumonia and acute respiratory distress syndrome in some patients. But the National Institutes of Health is organizing trials of several drugs and other treatments, among them remdesivir.

The drug, made by Gilead Sciences, was tested against Ebola with little success, but multiple studies in animals showed the drug could both prevent and treat coronaviruses related to Covid-19, including SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

Back in February, the World Health Organization said remdesivir showed potential against Covid-19.

Most of our patients are severe and most of them are leaving at six days, so that tells us duration of therapy doesn’t have to be 10 days.

However, the trial does not include what’s known as a control group, so it will be difficult to say whether the drug is truly helping patients recover better. With a control arm, some patients do not receive the drug being tested so that doctors can determine whether it’s the drug that is really affecting their condition.

Trials of the drug are ongoing at dozens of other clinical centers, as well. Gilead is sponsoring tests of the drug in 2,400 patients with severe Covid-19 symptoms in 152 trial sites around the world. It’s also testing the drug in 1,600 patients with moderate symptoms at 169 hospitals and clinics around the world.

Gilead said it expected results from the trial by the end of the month.

“We understand the urgent need for a COVID-19 treatment and the resulting interest in data on our investigational antiviral drug remdesivir,” the company said in a statement. But it said a few stories about patients are just that.

“The totality of the data need to be analyzed in order to draw any conclusions from the trial. Anecdotal reports, while encouraging, do not provide the statistical power necessary to determine the safety and efficacy profile of remdesivir as a treatment for Covid-19.

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Three physicians from Johns Hopkins University, in Baltimore, MD, have joined efforts to write an article outlining key action points that the United States healthcare community should take in response to COVID-19.

Drs. Amesh A. Adalja, Eric Toner, and Thomas V. Inglesby wrote the paper, titled “Priorities for the U.S. Health Community Responding to COVID-19.”

The doctors are all from the Johns Hopkins Center for Health Security, as well as the university’s Department of Environmental Health and Engineering.

Appearing in the journal JAMA, the article draws from experiences with similar epidemics — such as the 2009 influenza pandemic, the SARS epidemic in 2003, and the avian influenza A epidemic in 2005 — to outline key measures that the U.S. government and healthcare sector should take to deal with the new coronavirus.

Hospitals, clinics, and other facilities

First, write the authors, healthcare institutions should update preparedness plans that had been developed for the previous epidemics.

“Broadly speaking, those plans addressed the protection of healthcare workers, how to deal with staffing shortages, surges in patient numbers, triage issues, and management of scarce resources,” write Dr. Adalja and colleagues.

Second, hospitals and clinics, which have “critical roles” in the response to COVID-19, must establish clear “protocols for triaging and isolating patients suspected of having infection in emergency departments and urgent care centers.”

Importantly, write the authors, “Similar procedures need to be established in outpatient clinics, dialysis centers, and other medical facilities — especially nursing homes, assisted living centers, and long-term care facilities with particularly vulnerable populations.”

This is to prevent COVID-19 from disrupting regular treatments in medical care units, which would “compound the direct morbidity and mortality of the disease.”

Healthcare workers and ICU units

Protecting healthcare workers is another key priority in the COVID-19 response. This will require the use of personal protective equipment, updated hospital administrative policies, and special training of hospital staff, the authors note.

A considerable number of patients are likely to be severely ill, so hospitals must pay specific attention to preparing their intensive care units (ICUs), Dr. Adalja and colleagues write, explaining: 

“This planning includes evaluation of ICU bed capacity, the ability to augment ICU-level bed space with alternative care sites such as step-down units and postanesthesia care units, mechanical ventilator stock and supply chains, and the logistics of isolating and cohorting patients.” 

“Many hospitals operate at or near capacity already, and even an above-average flu season can cause operational disruption,” the authors point out.

Finally, the team emphasizes that — even though too little is currently known about COVID-19, and healthcare professionals will have to adapt their clinical approaches as more information becomes available — sticking to existing guidelines for pneumonia, sepsis, and acute respiratory distress syndrome (ARDS) is the best course of action.

“This may include the use of investigational antiviral or monoclonal antibody therapy,” the authors note.

More diagnostic tests needed ‘rapidly’

Furthermore, they write, clinicians must “rapidly” extend their diagnostic testing.

“To better understand the burden of COVID-19, medical and public health experts need to expand testing to all patients who have unexplained ARDS or severe pneumonia and ultimately to patients who have mild symptoms consistent with COVID-19.”

The researchers explain that the Centers for Disease Control and Prevention (CDC) — which initially performed all diagnostic tests — and public health labs do not have the capacity to perform testing on the scale that is necessary right now.

“To reach a high level testing capacity will require the major clinical diagnostic companies to develop and manufacture testing kits at large scale. Diagnostic companies may simply be able to add SARS-CoV-2 to existing nucleic acid–based respiratory viral panels or create standalone tests. Ideally, such diagnostic tests would be rapid,” the article cautions.

Also, serological assays, blood tests for specific antibodies, are necessary to help determine an accurate case fatality rate and for monitoring purposes, the authors point out.

Public health and social distancing

“From the outset, SARS-CoV-2 posed a near-impossible challenge for containment,” the team writes.

This is because the virus transmits very effectively; the authors note that the virus was “surreptitiously spreading for at least 6 weeks” and that it has “an epidemic doubling time of about 1 week.”

“As more and more countries report cases, including those with no link to the disease epicenter, it is clear that there are many more unrecognized cases in the world and that community transmission is happening in many countries.”

– Dr. Amesh A. Adalja et al.

Public health measures such as providing rapid diagnoses and isolating people with the virus are the most important actions that can slow the spread of SARS-CoV-2.

Tracking the contacts of people with the virus and placing them in quarantine may also be effective at this early stage of the epidemic.

“However, beyond a certain threshold, it will no longer be feasible to track all contacts.” At this point, actions classified as “social distancing” may be necessary. These include “cancellation of large gatherings, telecommuting to work when feasible, and school closures.”

However, such measures would come at a cost that must be accounted for. For instance, school closures would mean that “Many children who depend on school meals will not receive them, and many single parents will be out of the workforce.”

Finally, in addition to communicating health measures that everyone should take to reduce the spread of the infection, “It will also be important to communicate […] that persons who test positive for this virus but who do not need hospital care should stay at home while they are ill and not go to hospitals.”

“Hospitals may have serious challenges in handling the number of people who do need acute care, so it will be important for those who are infected but otherwise well to not contribute to hospital demands.” Dr. Adalja and colleagues conclude:

“Preparation will take time, so healthcare and public health systems need to move quickly forward in their efforts to be ready to confront this disease around the country.”

For information on how to prevent the spread of coronavirus, this CDC page provides advice.

MRI scans shows showing the average measurable difference in white matter brain damage in people with low inflammatory blood test scores (below median) and those with high scores (above median). 

A UCLA-led study has found that levels of six proteins in the blood can be used to gauge a person’s risk for cerebral small vessel disease, or CSVD, a brain disease that affects an estimated 11 million older adults in the U.S. CSVD can lead to dementia and stroke, but currently it can only be diagnosed with an MRI scan of the brain.

“The hope is that this will spawn a novel diagnostic test that clinicians can start to use as a quantitative measure of brain health in people who are at risk of developing cerebral small vessel disease,” said Dr. Jason Hinman, a UCLA assistant professor of neurology and lead author of the paper, which is published in the journal PLoS One.

CSVD is characterized by changes to the brain’s white matter—the areas of the brain that have a high concentration of myelin, a fatty tissue that insulates and protects the long extensions of brain cells. In CSVD, small blood vessels that snake through the white matter become damaged over time and the myelin begins to break down. This slows the communication between cells in the brain and can lead to problems with cognition and difficulty walking. And if the blood vessels become completely blocked, it can cause stroke.

The disease is also associated with a heightened risk for multiple forms of dementia, including Alzheimer’s disease.

Typically, doctors diagnose CSVD with an MRI scan after a person has experienced dementia or suffered a stroke. About a quarter of all strokes in the U.S. are associated with CSVD. But many cases of the disease go undiagnosed because of mild symptoms, such as trouble with walking or memory, that can often be attributed to normal aging.

In the new study, Hinman and colleagues focused on six proteins related to the immune system’s inflammatory response and centered on a molecule called interleukin-18, or IL-18. They hypothesized that inflammatory proteins that damage the brain in CSVD may be detectable in the bloodstream.

The researchers measured the levels of the proteins in the blood of 167 people whose average age was 76.4, and who had either normal cognition or mild cognitive impairment. As part of their voluntary participation in the study, 110 participants also underwent an MRI brain scan and 49 received a more advanced scan called diffusion tensor imaging.

People whose MRI or diffusion tensor imaging tests showed signs of CSVD had significantly higher levels of the six blood proteins, the researchers discovered. If a person had higher-than-average levels of the six inflammatory proteins, they were twice as likely to have signs of CSVD on an MRI scan and 10% more likely to very early signs of white matter damage. Moreover, for every CSVD risk factor that a person had—such as high blood pressure, diabetes, or a previous stroke—the inflammatory protein levels in their blood were twice as high, on average.

To confirm the results, the team performed the blood test in a group with a much higher risk for CSVD: 131 people who visited a UCLA Health emergency department with signs of stroke. Once again, the blood test results were correlated with white matter changes in the brain that were detected by an MRI.

“I was pleasantly surprised that we were able to associate blood stream inflammation with CSVD in two fairly different populations,” Hinman said.

In MRI reports, the changes in the brain’s white matter caused by CSVD are usually only categorized in general terms—as mild, moderate or severe. The blood test is a step forward, Hinman said, because it provides a more quantitative scale for evaluating the disease. That means the blood test can be used to follow the progression of the disease or to identify people who are candidates for prevention efforts or treatments for CSVD.

“We’re hopeful that this will set the field on more quantitative efforts for CSVD so we can better guide therapies and new interventions,” Hinman said.