Anxiety in men

An article by Madeline R. Vann, MPH caught my eye and I’d like to share some of it with you. Madeline wrote: “Anxiety disorder in men is real and treatable through therapy and medication.”

In her article, New Jersey-based freelance journalist Scott Neumyer, at 35, said he can look back and recognize signs of anxiety from as early as his childhood.

Irishtimes.com

But perhaps because men find anxiety easier to overlook than women do, he didn’t have to face his anxiety head-on until a crescendo event when he was 25. Neumyer was attending a Bruce Springsteen concert with a colleague when his first panic attack drove him into a bathroom. He can catalogue the many times after that first panic attack when anxiety symptoms made social and work relationships difficult, and when he began to fear going out in public.

Someone close to Neumyer had been through anxiety treatment so he knew that seeing a doctor was the first step. He tried anxiety medication and went through several types before settling on Zoloft (Sertraline). But he also knew that medication alone wasn’t going to solve the problem, so he sought out therapy.

“Cognitive behavioral therapy has been the most effective for me,” he says, adding that he also read as many books as he could about living with an anxiety disorder. “Along with the panic and anxiety usually comes some form of agoraphobia, a fear of doing certain things and going certain places.

featurepics.com

I personally got to the stage where I hated going to watch my sons swimming because of the seating – all those steps looking down over the pool? The same with the cinema, those dreaded stairs – and in the dark! I also disliked the tube stations in London and the further down I had to go, the more I panicked, so in the end I had to get taxis (if I couldn’t park at whichever venue).

My two (now adult ) sons have experienced anxiety and panic attacks in the past. They’re both black belts in Karate, they’re club swimmers and play football each week. My eldest is a Research fellow, currently working in the States, researching neuromuscular disorders and my the youngest is a Physiotherapist. So, although they both claim to be geeky in a science-type way, they’re not weedy or wussie; nor do they come across as lads who would have panic attacks. Some family and friends have been shocked, like “Wow, I didn’t think he would have mental health problems.” So, really what I’m saying guys is, it doesn’t mean you’re a weak person, anyone can experience anxiety; it doesn’t care where you’re from, what class you belong to or what job you do.

Here are some other anxiety statistics from No Panic in the UK

  • Mental health problems are one of the main causes of the overall disease burden worldwide.
  • Mental health and behavioural problems (e.g. depression, anxiety and drug use) are reported to be the primary drivers of disability worldwide, causing over 40 million years of disability in 20 to 29-year-olds.
  • Major depression is thought to be the second leading cause of disability worldwide and a major contributor to the burden of suicide and ischemic heart disease.

Most common problems

  • A UK survey published in 2016 showed that 5.9 in 100 people suffer with a generalised anxiety disorder
  • Mixed anxiety & depression is the most common mental disorder in Britain, with 7.8% of people meeting criteria for diagnosis.
  • 4-10% of people in England will experience depression in their lifetime.
  • Common mental health problems such as depression and anxiety are distributed according to a gradient of economic disadvantage across society. The poorer and more disadvantaged are disproportionately affected by common mental health problems and their adverse consequences.
  • Mixed anxiety and depression has been estimated to cause one fifth of days lost from work in Britain.
  • One adult in six had a common mental disorder.
  • In 2013, there were 8.2 million cases of anxiety in the UK.
  • In England women are almost twice as likely to be diagnosed with anxiety disorders as men.

Men and women

  • In England, women are more likely than men to have a common mental health problem and are almost twice as likely to be diagnosed with anxiety disorders.
  • In 2013, 6,233 suicides were recorded in the UK for people aged 15 and older. Of these, 78% were male and 22% were female.
  • 10% of mothers and 6% of fathers in the UK have mental health problems at any given time.
  • One in five (19.1%) women had CMD symptoms, compared with one in eight men (12.2%)
Counsellingondemand.com

Madeline quoted “Scientists still aren’t sure whether anxiety disorders are more common in women than men because of biological differences, such as estrogen and other hormones, or because women may express distress differently than men do”, says Mark Pollack, MD, psychiatrist and chairman of the department of psychiatry at Rush University Medical Center in Chicago.

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe, NHS. Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal. But some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.

The following information from the NHS is about a specific condition called generalised anxiety disorder (GAD). GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.

Symptoms of generalised anxiety disorder (GAD)

GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include:

  • feeling restless or worried
  • having trouble concentrating or sleeping
  • dizziness or heart palpitations

Although feelings of anxiety at certain times are completely normal, see a GP if anxiety is affecting your daily life or causing you distress. Your GP will ask about your symptoms and your worries, fears and emotions to find out if you could have GAD.

What causes generalised anxiety disorder (GAD)?

The exact cause of GAD is not fully understood, although it’s likely that a combination of several factors plays a role. Research has suggested that these may include:

  • overactivity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • the genes you inherit from your parents – you’re estimated to be 5 times more likely to develop GAD if you have a close relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • having a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol abuse
  • But many people develop GAD for no apparent reason.

Who is affected?

  • GAD is a common condition, estimated to affect up to 5% of the UK population.
  • Slightly more women are affected than men, and the condition is more common in people from the ages of 35 to 59.

How generalised anxiety disorder is treated

GAD can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms. These include:

With treatment, many people are able to control their anxiety levels. But some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

Psychcentral.com

Self help for generalised anxiety disorder (GAD)

There are also many things you can do yourself to help reduce your anxiety, such as: 

  • going on a self-help course
  • exercising regularly
  • stopping smoking
  • cutting down on the amount of alcohol and caffeine you drink
  • trying 1 of the mental health apps and tools in the NHS Apps Library

chha-b.org

Mental Health rehab works if the staff do

Teamwork

While I was a student on the rehab unit I had to complete my Practice Based Assessments (PBA’s) and I’d chosen four patients that I could work with to meet these over the twelve weeks placement. First there was Mandy who had Generalised Anxiety Disorder (GAD) and next was Sasha, Elsa and Edward who all had schizophrenia.

Mandy

I spent many pleasurable weeks working with Mandy, the lady who’d previously screamed for her medication and said that she could notice the reduction in nought point five mg. From my parenting days, I knew that distraction worked well when a child was upset so I hoped it might help Mandy. I would offer her a cup of tea and ask what her plans were for the day or about her collection of teapots rather than have the poor lady work herself into a panic attack. It’s a shame that other nurses hadn’t picked this up as it would have been far easier for them in the long run and certainly better for Mandy. However following discussions with her Primary Nurse, the nurse who has overall responsibility for a patient, her care plan was updated and read “When Mandy is upset and screaming her allocated nurse must use distraction techniques.” Care plans are prepared for each patient and wherever possible, is developed with the patient, rather than for the patient. The care plans are used to guide your practice with patients, to explain what care is required and how to carry it out.

Example care plan
How a care plan might look

Mandy would eventually accompany me to the local Primark to get cheap knickers. Grinning cheekily she would say the money she saved there allowed her to buy her favourite yoghurts from Marks and Sparks next door. Once I’d left the unit it always cheered me up when I saw Mandy and loved to stop for a chat.

Sasha

I had a lot of fun working with Sasha; she was witty, intelligent and was becoming much more cheerful as the weeks went on. Between us we managed to clear all the cereal boxes from her room along with the crumbs and mouldy, congealed leftovers we found in bowls under her bed. This wasn’t my favourite task but I laughed all the way through it because Sasha was getting really cheeky. When I was busy scrubbing the floor she’d sit on her bed reading or stand at the window waving at random passersby and she’d crack up when I spotted it. Many of Sasha’s care plans were updated or changed altogether because she’d made great progress in several areas and some of her care plans were now outdated. One care plan read ‘Encourage Sasha to keep her bedroom tidy and work with her if necessary.’ Another read ‘Encourage Sasha to spend time off the unit and accompany her if needed.’ I loved spending time with her in the cafe, a local haunt for both patients and staff. I always took my badge off when accompanying patients outside as I wanted them to feel equal in the community. It really bugged me seeing staff wearing badges when outside with patients, it was like ‘them and us’ and the staff member was in a position of authority which I thought was unfair.

Elsa

At forty eight Elsa hadn’t aged well at all. She originally came from Turkey and her face was craggy from the sun. She had short wiry grey hair which she hacked at herself, staring in the mirror taking great clumps out with almost blunt scissors. These scissors were eventually taken from her as she’d often say to fellow-patients and staff “I will kill you.” She did this with a wicked grin so I didn’t think she was really serious but the scissors might have posed a risk to both her and others. One care plan was updated and read ‘When Elsa wants to cut her hair a staff member must be with her and remove the scissors back to the office once finished.’ I wanted to find out why Elsa chose to use her clothes as toilet paper but despite using one of our translators she just shrugged and grinned when asked why and what can we do to help. However, it was something we had to work on. I asked several staff nurses what has been tried in the past and what worked but was told “That’s just Elsa. She always does it and nothing works.” Elsa had been on the unit for months and nobody could tell me what had been tried.

When I was on duty as a nursing assistant (NA) or there on my student placement I tried to speak with Elsa every couple of hours to see if she needed the bathroom. I tried taking her to the toilet, getting her to sit for a while to see if she would poop, her favourite word. Sometimes it worked and I had to wait while I encouraged her to use toilet paper. “Too small.” she would grin “No enough.” and she’d try to use her skirt. Ah! Next time I accompanied her to the bathroom I took a roll of the large hand drying paper. One of her care plans was updated to read ‘Encourage Elsa to use the toilet throughout the shift and have hand paper available.’ though I know this rarely happened as I never saw it documented. The NMC’s Code of Conduct states that nurses should respect, support and document a person’s right to accept or refuse care and treatment. It did not say ‘if patient refuses support, leave it at that.’ Once my placement ended I would later hear that Elsa had reverted back to using her clothing to wipe herself. I was truly mad that the nurses had allowed this to happen. It was like they’d given up caring and they were just passing time until retirement. However I learned how not to nurse and their disassociation made me even more determined to be a good nurse. Our patients deserved better.

Edward

Edward had long been on a medication called chlorpromazine, the first antipsychotic which was widely shown to be significantly more effective than later antipsychotics. However this drug had a range of distressing side effects, one of which Edward had was the shuffling gait known to nurses as the ‘chlorpromazine shuffle.’ He would also complain of constipation and impotence. He was prescribed a regular dose laxatives and he often requested Viagra but would talk about not being able to get rid of his erection for hours. You had to laugh with him, his tales were hilarious. He told me about one time when he was on the bus returning to the unit and the movement gave him an erection just as his stop was coming up. It was summer and he was wearing just shorts and a vest so he had no way of covering the erection. He had to stay on the bus and went miles out his way.

My main task with Edward was to get him to take better care of his hygiene. He was physically fit and more than able but he really needed a ‘kick up the backside with my tiny size three’s’ I’d tell him. He also picked his nose and would later want to shake my hand. This was one habit that would have to go and I told him I would never shake his hand if he hadn’t washed it and that I wouldn’t accompany him in the community if he was wearing his usual attire of stained tracksuit bottoms and a dirty old t-shirt. I often used my sons as examples, telling Edward that I wouldn’t go out with them if they weren’t clean. One afternoon I arrived on the unit and there was Edward, spick and span. Clean and reeking of aftershave, his receding hair carefully dampened down and wearing almost spotless but mismatched clothes. He’d been waiting for me since after lunch. How could I not take him out to the local snooker hall? This was his favourite outing as the voices he heard were much quieter and encouraging when he was concentrating. It became a weekly treat while I was there but I later saw him shuffling along the street, head down and miserable. I don’t know why the nurses on the rehab unit ignored any improvement or the hard work that was done, scorned updated care plans and thought it was okay to let patients revert to their old habits.

Rehab does work but only if the staff do!

*The Purpose of the Written Care Plan is to ensure continuity of care. The care plan is a means of communicating and organizing the actions of a constantly changing nursing staff. As the patient’s needs are attended to, the updated plan is passed on to the nursing staff at shift change and during ward rounds. http://www.rncentral.com/nursing-library/careplans