It is Mental Health Awareness Week. So for the next post in our series covering mental health issues I welcome a new guest to the blog. Jaspreet Tehara, a member of the Crisis Resolution & Home Treatment team (CRHTT) at the Kent & Medway NHS Social Care Partnership Trust, provides some background and practical tips on dealing with anxiety disorders. He also shares his experiences of helping those in the community afflicted with them.
Working in the CRHTT is one of the most interesting roles I think I’ve had. No two days are the same. The remit of the CRHTT in the social care trust I work at includes; bed management, admissions and discharges, leave, home visits, medication reviews, section 136 and co-ordination of Mental Health Act (1983 and 2007) assessments.
As I said, no two days are the same! One day I could be out in the community, and another I could be in the 136 suite in the main hospital. Another day I could be working with a community psychiatric nurse delivering medications, and on another day I could be escorting the psychiatric doctor on medication reviews. And that’s part of the fun in the role.
The best part of it though, is patient care. No matter how you dress it up, it’s that feeling you get when you know you’re trying to help someone – and that you’re doing well – because we all become ill at some point, and we all need the help and assistance of medical professionals, be it physical or mental health. Working for CRHTT allows me the opportunity to meet some wonderful people too, with an array of different psychiatric diagnoses. Most commonly are schizophrenia, anxiety, bipolar disorder and personality disorder.
Patients with anxiety disorders for example – in my experience at least – have a variety of different reasons as to what is causing their anxieties to take over their lives. A lot of it relates back to personal experiences and personal traumas that have been suffered, coupled with a neurological issue that the patient may also have. Generalised anxiety can be measured via the GAD-7 questionnaire. Intervention takes place in the form of both psychopharmacological and therapeutic methods.Biologically, anxiety is caused by issues with the amygdala in the brain and a dysfunction with it’s processing of fear. This dysfunction causes access to sensory processes to scramble and induces the feeling of “threat”, which can cause very significant distress via fatigue, headaches, nausea and so on. Medications such as Venlafaxine, Duloxetine, Propranolol or Pregabalin act as Selective Serotonin Reuptake Inhibitors (SSRIs) – which sounds complicated – but in essence they slow down the intake of serotonin between neurotransmitters in the brain (the post synaptic and pre synaptic receptors) and allow the serotonin to stay in the synaptic gap longer than normal. This allows the neurotransmitters that react to serotonin to increase their activity due to the stimulation caused by the presence of serotonin between receptors.
In episodes of severe anxiety, Benzodiazepine can be prescribed “as needed” for adults, but due to the concerns over dependency, they’re not the preferred choice of medication and will be used cautiously. The reason for targeting serotonin in the brain is because serotonin is known as the “happiness chemical”.
Therapy is delivered in a variety of methods, from cognitive behavioural therapy (CBT) to ‘mindfulness’ and meditation, to stimulus control (bright light and sunlight therapy), exercise and changing diet. Patients are often given mood diaries and asked to complete them after an anxious episode. This can allow us to identify key triggers and possible events that may have caused past trauma in a patient’s life. It can also allow us the opportunity to find goal directives that a patient may have and allow us a chance to find a specialist or service that we can signpost to.
CBT delivered by a therapist has often shown good results because it teaches a patient how to access the skills needed to dampen an anxious episode. For example, relaxation (self control desensitisation and breathing techniques) and problem-solving are key factors in lowering anxiety levels. I say “good” because the evidence shows around 45% of patients have some form of positive outcome from CBT.
Other forms of therapy such as mindfulness, teach the skill of allowing a patient to distract themselves from their anxieties by learning to think about themselves ‘in the moment’. A person can be doing anything – washing dishes for example – but to be mindful of washing the dishes would include taking time to feel the bubbles on the hand, to smell the fragrance of the liquid, to watch the dishes as they are cleaned, to observe the food as it is rinsed off and washed away, to observe the way the water drips down the surface of the plate and begins to collect and run away on the sideboard. To be completely ‘in the moment’ allows some distraction from the anxiety which has become manifest.
With regard to diet, it’s widely perceived that caffeine is be avoided, whilst foods such as pulses, vegetables, milk & other foods high in tryptophan are recommended – especially milk and chick peas. This is yet to be ‘proven’ but early studies suggest increased levels of tryptophan aid the production of serotonin in the body.
If you are living with anxiety and feel as though you’re not able to cope, please do go and seek help from your local mental health services, as there will always be someone to listen to you. I hope this blog has been helpful to those that are suffering in silence.
By Jaspreet Tehara Copyright © 2014
You can follow Jaspreet on Twitter @JazzTehara
The views expressed are those of the writer(s) and may not reflect the views of JvdLD. This article does not constitute legal or medical advice. In relation to posts by a guest Author(s), these are made by them through their own practical experience or knowledge of the subject in question or as a matter of their own opinions. Opinion posts expressed by the Author(s) or by readers of the blog on the site’s comment section are those of the individuals in question and do not necessarily represent the views and opinions of John van der Luit-Drummond or JvdLD. The copyright of the individual Authors who guest post on this blog are theirs alone and John van der Luit-Drummond lays no claim to their intellectual property other than to be allowed through mutual agreement to display their posts/articles on this blog and share via social media such as sites as (although not limited to) Facebook, Twitter, or LinkedIn.