# Mental Anxiety

Anxiety is a normal emotion. It’s your brain’s way of reacting to stress and alerting you of potential danger ahead. 

Everyone feels anxious now and then. For example, you may worry when faced with a problem at work, before taking a test, or before making an important decision.

Occasional anxiety is OK. But anxiety disorders are different. They’re a group of mental illnesses that cause constant and overwhelming anxiety and fear.  The excessive anxiety can make you avoid work, school, family get-togethers, and other social situations that might trigger or worsen your symptoms. 

With treatment, many people with anxiety disorders can manage their feelings.

Types of Anxiety Disorders
There are several types of anxiety disorders:

Generalized anxiety disorder. You feel excessive, unrealistic worry and tension with little or no reason.
Panic disorder. You feel sudden, intense fear that brings on a panic attack. During a panic attack you may break out in a sweat, have chest pain, and have a pounding heartbeat (palpitations). Sometimes you may feel like you’re choking or having a heart attack.
Social anxiety disorder. Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You obsessively worry about others judging you or being embarrassed or ridiculed.
Specific phobias. You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations.
Agoraphobia.You have an intense fear of being in a place where it seems hard to escape or get help if an emergency occurs. For example, you may panic or feel anxious when on an airplane, public transportation, or standing in line with a crowd.  
Separation anxiety. Little kids aren’t the only ones who feel scared or anxious when a loved one leaves. Anyone can get separation anxiety disorder. If you do, you’ll feel very anxious or fearful when a person you’re close with leaves your sight. You’ll always worry that something bad may happen to your loved one. 
Selective mutism. This is a type of social anxiety in which young kids who talk normally with their family don’t speak in public, like at school.
Medication-induced anxiety disorder. Use of certain medications or illegal drugs, or withdrawal from certain drugs, can trigger some symptoms of anxiety disorder.
Anxiety Disorder Symptoms
The main symptom of anxiety disorders is excessive fear or worry. Anxiety disorders can also make it hard to breathe, sleep, stay still, and concentrate.  Your specific symptoms depend on the type of anxiety disorder you have. 

Common symptoms are: 

Panic, fear, and uneasiness
Feelings of panic, doom, or danger
Sleep problems
Not being able to stay calm and still
Cold, sweaty, numb, or tingling hands or feet
Shortness of breath
Breathing faster and more quickly than normal (hyperventilation)
Heart palpitations
Dry mouth
Nausea
Tense muscles
Dizziness
Thinking about a problem over and over again and unable to stop (rumination)
Inability to concentrate
Intensely or obsessively avoiding feared objects or places
Anxiety Disorder Causes and Risk Factors
Researchers don’t know exactly what brings on anxiety disorders. A complex mix of things play a role in who does and doesn’t get one. 

Causes of Anxiety Disorder
Some causes of anxiety disorders are: 

Genetics. Anxiety disorders can run in families. 
Brain chemistry. Some research suggests anxiety disorders may be linked to faulty circuits in the brain that control fear and emotions. 
Environmental stress. This refers to stressful events you have seen or lived through. Life events often linked to anxiety disorders include childhood abuse and neglect, a death of a loved one, or being attacked or seeing violence.  
Drug withdrawal or misuse. Certain drugs may be used to hide or decrease certain anxiety symptoms. Anxiety disorder often goes hand in hand with alcohol and substance use.
Medical conditions. Some heart, lung, and thyroid conditions can cause symptoms similar to anxiety disorders or make anxiety symptoms worse. It’s important to get a full physical exam to rule out other medical conditions when talking to your doctor about anxiety. 
Risk Factors for Anxiety Disorder
Some things also make you more likely to develop an anxiety disorder. These are called risk factors. Some risk factors you can’t change, but others you can. 

Risk factors for anxiety disorders include: 

History of mental health disorder. Having another mental health disorder, like depression, raises your risk for anxiety disorder. 
Childhood sexual abuse. Emotional, physical, and sexual abuse or neglect during childhood is linked to anxiety disorders later in life. 
Trauma. Living through a traumatic event increases the risk of posttraumatic stress disorder (PTSD), which can cause panic attacks.
Negative life events. Stressful or negative life events, like losing a parent in early childhood, increase your risk for anxiety disorder.  
Severe illness or chronic health condition. Constant worry about your health or the health of a loved one, or caring for someone who is sick, can cause you to feel overwhelmed and anxious. 
Substance abuse. The use of alcohol and illegal drugs makes you more likely to get an anxiety disorder. Some people also use these substances to hide or ease anxiety symptoms.
Being shy as a child. Shyness and withdrawal from unfamiliar people and places during childhood is linked to social anxiety in teens and adults. 
Low self-esteem. Negative perceptions about yourself may lead to social anxiety disorder.
Anxiety Disorder Diagnosis
If you have symptoms, your doctor will examine you and ask questions about your medical history. They may run tests to rule out other health conditions that might be causing your symptoms. No lab tests can specifically diagnose anxiety disorders.

If your doctor doesn’t find any physical reason for how you’re feeling, they may send you to a psychiatrist, psychologist, or another mental health specialist. Those doctors will ask you questions and use tools and testing to find out if you may have an anxiety disorder.

Your doctors will consider how long you’ve had symptoms and how intense they are  when diagnosing you. It’s important to let your doctors or counselors know if your anxiety makes it hard to enjoy or complete everyday tasks at home, work, or school. 

The United States Preventive Service Task Force recommends screening for anxiety in children and adolescents ages 8 to 18 years and screening for major depressive disorder (MDD) in adolescents ages 12 to 18 years.

Anxiety Disorder Treatments
There are many treatments to reduce and manage symptoms of anxiety disorder. Usually, people with anxiety disorder take medicine and go to counseling. 

Treatments for anxiety disorder include: 

Medication. Several types of drugs are used to treat anxiety disorders. Talk to your doctor or psychiatrist about the pros and cons of each medicine to decide which one is best for you. 

 Antidepressants. Modern antidepressants (SSRIs and SNRIs) are typically the first drugs prescribed to someone with an anxiety disorder.  Examples of SSRIs are escitalopram (Lexapro) and fluoxetine (Prozac). SNRIs include duloxetine (Cymbalta)and venlafaxine (Effexor).
Bupropion. This is another type of antidepressant commonly used to treat chronic anxiety. It works differently than SSRIs and SNRIs.
Other antidepressants. These include tricyclics and monoamine oxidase inhibitors (MAOIs). They are less commonly used because side effects, like drops in blood pressure, dry mouth, blurry vision, and urinary retention, can be unpleasant or unsafe for some people.  
Benzodiazepines. Your doctor may prescribe one of these drugs if you’re having persistent panicky feelings or anxiety. They help lower anxiety. Examples are alprazolam (Xanax) and clonazepam (Klonopin). They work quickly, but you can become dependent on them. Usually, they’re meant to be an add-on to your anxiety disorder treatment and you shouldn’t take them for a long time. 
Beta-blockers. This type of high blood pressure drug can help you feel better if you’re having physical symptoms of anxiety, such as a racing heart, trembling, or shaking.  A beta-blocker may help you relax during an acute anxiety attack.
Anticonvulsants. Used to prevent seizures in people with epilepsy, these drugs also can relieve certain anxiety disorder symptoms. 
Antipsychotics. Low doses of these drugs can be added to help make other treatments work better. 
Buspirone (BuSpar). This anti-anxiety drug is sometimes used to treat chronic anxiety. You’ll need to take it for a few weeks before seeing full symptom relief. 
Psychotherapy: This is a type of counseling that helps you learn how your emotions affect your behaviors. It’s sometimes called talk therapy. A trained mental health specialist listens and talks to you about your thoughts and feelings and suggests ways to understand and manage them and your anxiety disorder.

Cognitive behavioral therapy (CBT): This common type of psychotherapy teaches you how to turn negative, or panic-causing, thoughts and behaviors into positive ones. You’ll learn ways to carefully approach and manage fearful or worrisome situations without anxiety. Some places offer family CBT sessions.
Managing Anxiety Disorder Symptoms
These tips may help you control or lessen your symptoms:

Learn about your disorder. The more you know, the better prepared you will be to manage symptoms and roadblocks along the way. Don’t be afraid to ask your doctor any questions you might have. Remember, you are a key part of your health care team. 
Stick to your treatment plan. Suddenly stopping your meds can cause unpleasant side effects and can even trigger anxiety symptoms. 
Cut down on foods and drinks that have caffeine, such as coffee, tea, cola, energy drinks, and chocolate. Caffeine is a mood-altering drug, and it may make symptoms of anxiety disorders worse.
Don’t use alcohol and recreational street drugs. Substance abuse increases your risk of anxiety disorders.
Eat right and exercise. Brisk aerobic exercises like jogging and biking help release brain chemicals that cut stress and improve your mood.
Get better sleep. Sleep problems and anxiety disorder often go hand in hand. Make getting good rest a priority. Follow a relaxing bedtime routine. Talk to your doctor if you still have trouble sleeping.
Learn to relax. Stress management is an important part of your anxiety disorder treatment plan. Things like meditation, or mindfulness, can help you unwind after a stressful day and may make your treatment work better.
Keep a journal. Writing down your thoughts before the day is down may help you relax so you’re not tossing and turning with anxious thoughts all night. 
Manage your negative thoughts. Thinking positive thoughts instead of worrisome ones can help reduce anxiety. This can be challenging if you have certain types of anxiety, however. Cognitive behavioral therapy can teach you how to redirect your thoughts. 
Get together with friends. Whether it’s in person, on the phone, or the computer, social connections help people thrive and stay healthy. People who have a close group of friends that support and chat with them have lower levels of social anxiety. 
Seek support. Some people find it helpful and uplifting to talk to others who are experiencing the same symptoms and emotions. Self-help or support groups let you share your concerns and achievements with others who are or who have been there. 
Ask your doctor or pharmacist before taking any over-the-counter meds or herbal remedies. Many have chemicals that can make anxiety symptoms worse.
Anxiety Disorder Outlook
It can be challenging and frustrating to live with an anxiety disorder. The constant worry and fear can make you feel tired and scared. If you’ve talked to a doctor about your symptoms, then you’ve taken the first step toward letting go of the worry. 

It can take some time to find the right treatment that works for you. If you have more than one anxiety disorder, you may need several kinds of treatment. For most people with anxiety disorders, a combination of medicine and counseling is best. With proper care and treatment, you can learn how to manage your symptoms and thrive.  

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Mental stress has increased so much that it has become a new menace

A new virus is taking over

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###### This is an article reproduced from Forbes. Original Article can be found at: https://www.forbes.com/sites/robertpearl/2021/02/01/why-telemedicine-is-much-more-than-a-digital-doctors-office/

## Why Telemedicine Is Much More Than A Digital Doctor’s Office
### Robert Pearl, M.D.
Contributor

Image by DCStudio on Freepik

When something innovative comes along, people instinctively compare it to something that already exists. 
Automobiles in the early 1900s, for instance, were thought of as nothing more than motorized versions of the horse-drawn carriage (all revved up on “horsepower”). Before there were highways, gas stations and roadside motels, people could only envision what was, not what could be. A century later, our jobs, food sources, cultural institutions and communities all revolve around our motorized vehicles.  

It almost always takes a generation for innovative technologies to gain proper recognition for all they can do. 
In this century, telemedicine is one such innovation, underappreciated and underused. 

Most physicians and patients view telemedicine (also: telehealth or virtual care) as a convenient alternative to an in-person medical visit. Granted, convenience is a notable benefit—one that appealed to millions of first-time users in the early days the coronavirus pandemic, when no one wanted to sit in a waiting room alongside people potentially infected with Covid-19.

But telemedicine has the potential to be so much more than a virtual exam room. 

This technology has the power to break down the barriers of time and distance that stand in the way of optimal care. Telemedicine can dramatically reduce healthcare costs and deliver top-notch medical expertise to people everywhere. Phrased differently, telemedicine is not a second-rate substitute for the traditional office visit. It is a way to dramatically improve medical care. 

In my last article, I wrote that telemedicine will transform healthcare in our post-pandemic world. Several readers—including those in healthcare and finance—wanted to better understand how that will happen. This column examines three ways to tap into this tech’s full potential. 

Note: The examples herein aren’t hypothetical. During my time as CEO of the Permanente Medical Group (the half of Kaiser Permanente responsible for providing patient care), these solutions were employed daily by the group’s 10,000 physicians. 

### 1. Telemedicine can make specialty care more efficient

Let’s say you have a problematic rash. You schedule a visit with your primary care physician, who isn’t sure of the diagnosis. The doctor refers you to a dermatologist and you call to make an appointment that same day. Then you wait to be seen, which could take up to three or four (very long and itchy) weeks. 

When the day arrives, you take a half day off work, drive across town and sit in the reception area for an hour before finally getting a definitive diagnosis and the prescription you need. A few weeks later, you receive a bill for $200, which you must pay out of pocket since it’s below your deductible.  
Two weeks and $200 is a lot of time and money to spend on a rash. Telemedicine offers a more efficient solution. Imagine this: Instead of sending you to see a dermatologist in person, your primary care doctor connects you with one instantly. Via video, the specialist observes your rash, listens as you describe the problem and—in conjunction with the primary care physician—explains your diagnosis and prescribes the appropriate treatment. You leave that day with a prescription in hand. Before the week is over, your problem disappears. This isn’t just possible. It’s happening. 

Even prior to the pandemic, physicians at Kaiser Permanente routinely used telemedicine to successfully resolve this type of dermatological concern. In fact, it worked 70% of the time in under five minutes and at a fraction of the cost. But telehealth benefits aren’t just limited to rashes. Factoring in all specialty referrals of every type, telemedicine at KP solves almost 40% of all patient problems. 

Nationwide, doctors make more than 210 million specialist referrals each year. If every physician practice in the country could deflect 40% of all those in-person specialty visits, replacing them with telehealth, the cost savings would be measured in the hundreds of billions of dollars. 

Often, primary care physicians only need a small piece of advice to appropriately care for a patient. However, the prevailing model of U.S. healthcare delivery requires that patients either get a full specialty consultation or nothing. Telemedicine makes it possible for doctors of every medical and surgical specialty to consult virtually with dozens of primary care physicians on any given day. It’s not just a more convenient solution. It’s a superior solution that happens to be more efficient, too. 

2. Telemedicine can eliminate geographic distance 
### 
When patients discover they have a complex or unusual medical issue, the most common question is: Who’s the best physician for my problem? Usually, the correct answer is a physician practicing far, far away. Patients are, therefore, left to choose from doctors practicing in their community. 
Telemedicine broadens the horizons of medical expertise. In Northern California, a region of Kaiser Permanente that stretches 100 miles in every direction, there are dozens of specialists who are recognized as world leaders in their respective areas—from rare congenital birth defects to complex cancers. 

One such physician focuses exclusively on kidney cancer. Given his location, some patients have to drive three hours to visit with him. Since it’s not convenient or even possible for everyone with this malignancy to travel halfway across the state for a consultation, our medical group began offering patients three options: visit with a different urologist in the community, consult with the kidney cancer expert in his office or connect with him via telemedicine. 

More than half of eligible patients chose the virtual meeting and, in follow-up surveys, nearly all believed they picked the best option.

Of course, they lauded the convenience. But that’s not all. They also marveled at how much could be accomplished over a screen. The specialist used telehealth technologies to review patient X-rays, look at pathology slides and review the technical details of the planned operative procedure.
Across the United States, patients with rare and complex problems tend to bounce from one doctor to another, paying high prices for second, third and fourth opinions—sometimes never getting a correct diagnosis or optimal treatment. This is often the consequence of our nation’s stubborn physician culture, which prevents doctors from admitting the limitations of their knowledge and abilities. But this dilemma is solvable. 
Telemedicine provides a safe, high-quality, personalized and expert solution to the problem of geographic distance. 

3. Telemedicine can keep patients out of the ER
### Here’s something technology can’t do:

It can’t prevent you from getting sick or injured when your doctor’s office is closed. Medical problems happen 24/7 and yet no physician can be expected to care for patients around the clock. 
As a result, people who need care on weekends or after 5 p.m. on weekdays are almost always told to go to the emergency department, where care is very expensive (up to 12 times more than visiting a physician’s office) and very slow (averaging more than two hours per visit in many states). These visits are also largely unnecessary. It’s estimated that two-thirds of all trips to the emergency department are avoidable. 

In the mid-Atlantic states, Kaiser Permanente offers “after-hours” video visits to any patient who needs one. Although KP members can go to the local ED if they prefer (insurance covers the bill either way), the majority opt for a video consultation with an emergency physician stationed in the region’s call center. Those who choose the virtual visit have their issue resolved more than 70% of the time—typically in a matter of minutes, not hours, without ever having to leave their homes. 

### Telemedicine vs. tradition

Putting the pieces together, one thing is clear: Telemedicine is capable of far more than delivering traditional office care virtually. Done right, it’s superior medical care, that’s also more convenient. Telehealth solutions are less expensive and can be made available anywhere at any time. They’re quicker to access and, as a result, often yield higher quality outcomes. 

Prior to the coronavirus pandemic, I predicted virtual visits would replace 30% of all medical services provided in a doctor’s office. I’m now convinced that telemedicine is a superior solution for 40% or more of all medical problems. 
But this transformative technology won’t reach its full potential as long as doctors and patients think of it merely as a more convenient alternative to an exam room, or a way to avoid personal contact with someone who may be sick. Americans are fed up with the old medical model. Their healthcare experiences are cumbersome, redundant, time-consuming and expensive. The only reason people tolerate what exists today is because they don’t realize a better alternative is already available. 

Back when Model T’s were still rolling off the assembly line, vehicular transportation served one function: getting from one side of town to the other. Therefore, most Americans deemed Ford’s innovation as only marginally better than the horse and buggy. Hardly anyone could have imagined a future in which people would travel across the country in great comfort and at minimal cost. 

Once people realized the true potential of the automobile, they gladly abandoned the clunky transport solutions of the past. The same will be true for telemedicine.
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