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Anxiety in dysautonomia
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Anxiety in dysautonomia

We've discussed the topic of the differential diagnosis of anxiety states in dysautonomia in the past:

http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/Psych-Eval/show/1209919

http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/Mental-health-and-dysautonomia/show/1032741

In light of more recent discussions of anxiety, though, and a passage I happened to come across while reading one of my medical textbooks this week, I thought it would be a good topic to revisit.  Here's the passage to which I'm referring, from _Stress,_Catecholamines,_and_Cardiovascular_Disease_ by Dr. David S. Goldstein (New York:  Oxford UP 1995, pp. 40-41):

"Neurochemical activation alone does not itself produce distress (Cameron et al., 1990).  The experience of distress requires both physiological arousal and appropriate cognitions by the organism (Schachter and Singer, 1962).  Although several emotions include distressing elements (e.g., fear, anxiety, panic, guilt), other emotions do not (e.g., libido, joy), yet adrenomedullary activation accompanies even positive emotional experiences (Frankenhaeuser, 1975).  According to the present concept, adrenomedullary activation does not imply the experience of distress, because such an experience requires appropriate cognitions and because sympathetic activation can accompany even nondistressing emotions . . . "


I'm not sure how much of that makes sense to a layperson outside of the context of having some background in this field.  Unfortunately sometimes it's hard for me to step outside of myself and imagine how these things read to a person who *doesn't* sit around reading textbooks on catecholamines "for funsies."  :-p  I think the take-home lesson from this, similar to the linked journal articles in the threads I referred to above, is that the physiological symptoms in dysautonomia which are one and the same with many of the physiological symptoms of anxiety states are not an indication that a person with dysautonomia is experiencing anxiety, per se.  This is the real nugget of gold up there, and it bears repeating:  "sympathetic activation can accompany even nondistressing emotions."  When I turned this over and over in my head, a new dimension of this understanding regarding the difference between the symptoms of an overactive sympathetic nervous system and true anxiety finally began to take shape.  The MIND may or may not interpret these symptoms as indicative of something worthy of distress, depending on context.  The same cluster of symptoms (racing heart, flushed face, tremulousness from adrenaline, etc.) can be interpreted with negative emotion in one context (such as a panic attack or if it happens in response to something scary that startles you) while being interpreted with positive emotion in a different context (such as if it occurs in response to opening your door and finding Publisher's Clearinghouse at it with a giant check in your name or, as put benignly in the quote, "libido").  

The thing for me is, there's no burglar breaking down my door, but neither is there Publisher's Clearinghouse ringing my doorbell.  Most days, I'd prefer to live life on a bit of an even keel without sudden unprovoked onsets of those symptoms coming and going throughout the day.  What some doctors may fail to realize (or fully think about) is that the physiological changes that accompany these adrenomedullary and pituitary-adrenocortical activations include a sort of heightened sensitivity and hyperreactivity that can be rather ... unpleasant ... for those of us cycling through it throughout the day.  My hope is that armed with the research of experts like Goldstein, we can help our docs reach an understanding of what it is like to live inside our bodies, and help them better to treat us toward the end of an optimal quality of life.
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Avatar_f_tn
Heiferly-thanks for posting this. This is basically what the electrophysilogist told me and what I think my primary Dr is finally understanding. I am going to show him your information. Would you mind telling me what medical text you got this from? He told me today he is very interested in educating himself on dysautonomia and current treatments.
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Avatar_f_tn
Oh and also you just voiced what I am after. The best quality of life I can manage.
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612876_tn?1355518095
This quote is from Stress, Catecholamines, and Cardiovascular Disease by David S. Goldstein.

Here it is on amazon.com:

http://www.amazon.com/Stress-Catecholamines-Cardiovascular-Disease-Goldstein/dp/0195065387

Goldstein is a top authority on Catecholamines.  I have three (? ... looks around ... yeah, I think two hardcover and one ebook) of his texts, if that's a testament to my opinion of him.  You can see more of his titles here:

http://www.amazon.com/s/ref=ntt_at_ep_srch?ie=UTF8&search-alias=books&field-author=David+S.+Goldstein&sort=relevancerank

(Ignore the ones on the list that aren't about catecholamines/autonomic; there are other authors in other disciplines with the same name, apparently.)


If your doctor is looking for other "big name" authors in the field, here are my recommendations:

*Mathias:  I have the text below and it is AWESOME.  Expensive, but worth every penny.

http://www.amazon.com/Autonomic-Failure-Textbook-Disorders-Publications/dp/019262850X/ref=sr_1_1?s=books&ie=UTF8&qid=1296782946&sr=1-1


*Low:  Arguably THE big wig on our side of the pond.

http://www.amazon.com/Clinical-Autonomic-Disorders-Phillip-Low/dp/0781773814/ref=sr_1_1?s=books&ie=UTF8&qid=1296783037&sr=1-1


*Robertson:  Another superstar in the US.

http://www.amazon.com/Primer-Autonomic-Nervous-System-Second/dp/0125897626/ref=sr_ob_3?s=books&ie=UTF8&qid=1296783037&sr=1-3


*Grubb:  Beloved by patients and well known for his knowledge of syncope & POTS.

http://www.amazon.com/Syncope-Mechanisms-Management-Blair-Grubb/dp/1405122072/ref=sr_1_2?s=books&ie=UTF8&qid=1296783138&sr=1-2


Your doctor can likely get library access to any of these texts through the library of whichever hospital he has privileges at, or through the university medical library if he works through a university research hospital; anything not in local holdings can be borrowed through interlibrary loan without much difficulty.  None of these are obscure.  The nice thing about most of those texts is that the chapters stand alone well so you can pick and choose what is relevant to your interests at the time when reading and skip around.

Hope that helps!!
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Avatar_f_tn
Heiferly thank u! I will pass this on to him.
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875426_tn?1325532016
I felt uncomfortable with one of the things being mentioned in that post- I think you can guess.  But, anyway, while I do have problems with anxiety, I also can get a flushed face from talking to a friend on the phone, a very positive type of stress for me.  And sometimes I have felt "wired" because of my heart racing.
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Avatar_n_tn
i flush very easily to the face always but now it has got worse that i am awareof it. i can be in a conversation and it happens its awlfull what can i do. im avoiding situations now because of it or just not saying anthing in hope it wont happen
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I have facial flushing and high plasma nor epinephrine and labile BP.  All can be caused from severe sleep apnea or a rare adrenal tumor called a pheochromocytoma.  It has been determined I do have severe sleep apnea and I have started on treatment. (40 apneas per hour and up to 80 during REM sleep with sats down to 64%).  The possibility of an adrenal tumor still needs ruling out by a clonodine challange test which will be ordered hopefully in the next week.  Headaches are a new problem as well.  Marie

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875426_tn?1325532016
Please, don't let face flushing cramp your social life, Marley!  You don't want this to rule your life like that, I'm thinking.  May I offer a suggestion?  Maybe you could just tell the person you are avoiding tsaying anything to in the initial moment of conversing with them that you have a medical condition that can make your face flush easily, so don't be surprised if it happens.

Marie- would you please let me know the outcome of your test for pheo?
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