Anxiety disorders: When worry gets out of control

Dear Doc,

What is the cause of excessive nervousness or anxiety? Also, what is stage fright?

Dear reader,

It is normal to experience nervousness or anxiety in situations that are new or that have associated risk or significant pressure. When the anxiety is excessive or it is affecting activities of daily living, performance and there is excessive reaction to the trigger and you are unable to control this response,  it is termed as an anxiety disorder. The risk of developing anxiety disorders is increased by a combination of genetic and environmental factors such as a family history of mental illness, some personality traits, exposure to stressful or adverse conditions in childhood or adulthood, experiencing trauma or as a result of some illnesses such as thyroid disease, some heart diseases and possibly hormonal fluctuations.

There are different types of anxiety disorders:

     Generalised anxiety disorder – persistent excessive worry and anxiety that is accompanied by physical symptoms and interferes with daily activities. Usually the worry is about everyday things like responsibilities.

     Social anxiety disorder - previously called social phobia, this is the excessive worry about being embarrassed, humiliated, rejected or despised in social interactions.

     Selective mutism – usually in children, where they do not speak at all in certain situations or with certain people and speak while with others.

     Specific phobias where someone has intense fear of specific things or situations or activities such as fear of heights, water and germs.

     Panic disorder where someone suffers intense panic attacks, and this may or may not be accompanied by agoraphobia. Agoraphobia is the excessive worry over being in a place where escape would be difficult or embarrassing, or there may be no help, especially in case the individual experiences a panic attack.

     Separation anxiety disorder – excessive fear or anxiety about being separated from persons that someone is attached to. It affects both children and adults.

If someone has excessive nervousness, it is advisable for them to be reviewed by a mental health professional. Anxiety disorders can be managed through psychotherapy and using medication where necessary.

Stage fright or performance anxiety is anxiety about speaking or performing in front of many people. It is quite common, even among people who regularly perform in front of audiences. It is usually driven by embarrassment and/or worry about how someone will be perceived or judged by the audience. For some people, it can be very severe as a subset of social anxiety disorder. Stage fright can be managed by preparing adequately, practise, carrying notes, practising relaxation techniques, understanding and getting comfortable with the audience, and applying other performance management techniques. There are also some medications that can be prescribed to reduce anxiety before a performance such as propranolol. Where it is part of social anxiety disorder, it can be managed with the assistance of a mental health professional.

Of late I am experiencing chronic dry cough and slight fever. What could be causing it? Could it be bronchitis or asthma?

Alnashir D Walji

Dear Alnashir,

A chronic cough is a cough that has been present for eight weeks or more while a persistent cough is one that has lasted for three weeks or more.

There are several possible causes of a chronic cough:

     Infection: a chronic cough accompanied by fever is likely to be as a result of a longstanding infection like tuberculosis or fungal infection. These are treated with specific anti-microbial medications.

     Post nasal drip – there is mucus dripping from the back of the nose to the throat, which may trigger a cough. The excessive mucus may be due to allergies, inflamed sinuses, or as a result of acid reflux. To manage post nasal drip and cough, drink a lot of fluids, keep your head elevated, gargle with salt water and you can use a humidifier or steam inhalation. You may also benefit from anti-histamine medication and prescribed nasal sprays.

     Asthma – this is a condition where there is hypersensitivity to certain triggers, leading to narrowing of the airways in the chest and excessive production of mucus, which then cause difficulty in breathing and/or cough. Treatment includes nebulisation, inhaled steroids and inhaled broncho-dilators, and pills to manage the hypersensitivity

     Acid reflux: this is reflux of acid digestive enzymes from the stomach to the throat and/or mouth. The irritation at the throat triggers the cough. Management includes medication to reduce reflux, reduce acid secretion and dietary management.

     Chronic obstructive pulmonary disease – there is obstructed airflow due to longstanding inflammation. It may be in the form of chronic bronchitis or emphysema, both of which present with a chronic cough

     Other triggers: these include some hypertension medication, smoking, dust, pollen and animal dander.

     Other diseases: the chronic cough may be due to heart failure, interstitial lung disease, cystic fibrosis, sarcoidosis, bronchiolitis, or rarely, lung cancer

Because of the persistence of the cough and the fever, it is advisable for you to be urgently reviewed by a doctor. In addition, you require tests like a full blood count and erythrocyte sedimentation rate, sputum examination for bacterial and tuberculosis infection, chest radiograph, and other tests that will be guided by the examination and test findings. The treatment will be tailored to the specific underlying cause.

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