A. Treatment of anxiety 1. Examinations: for anxiety patients, he has to ask you whether to take the examination, you say, according to your own feelings, you feel sure to take the examination; feel unsure not to take the examination.” Don’t give clear advice regardless of the patient’s feelings; you say, “You have to take the test; you will regret it in the future if you don’t.” If the patient is already unsure, and you encourage him to take the test, he interprets it as you forcing him to take the test, so he becomes more anxious.” On the contrary, you say, “You’d better not take the test, get well first, and we’ll talk about it next year.” If the patient takes the test as the foundation of his life and sees the disease as a disability, and you don’t let him take the test, he thinks you treat him as an invalid and will be unhappy. 2, inclusion: anxiety disorder irritability and anxiety is contradictory and unified, said he unified, because irritability and anxiety are both cortical over-alert, are emotional over-reaction; said he contradictory, because anxiety for worry and fear, irritability for anger attack. The irritability of anxiety is particularly paper tiger, to family members, he can control people fierce, temper, outsiders, he can not control people is very afraid, a hidden, so people feel annoyed, when you understand that this phenomenon is his disease, more or less tolerate some of it. Second, living and eating 1, sleep: anxiety patients often like to sleep late and get up late, and because of work and school and forced to get up early, so sleep is not enough, sleep deprivation makes the cerebral cortex weakened, can not control the thalamus to filter through unnecessary information, useless information too much influx into the cerebral cortex, causing excessive alertness, aggravating anxiety, so you do not say I have good spirit at night, the brain is awake, learning or high efficiency, think about it You use tonight’s efficiency in exchange for tomorrow’s anxiety, scratch that? 2, exercise: anxiety patients are usually good brain, not good hands, good meditation, not good body movement, encourage patients to do more handicrafts, more body movement, so that the brain can rest, there is no possibility of both exercise, and at the same time in anxiety? Yes, if you take a walk alone, you have just the right amount of free time to think about which anxiety, but if you increase the amount of exercise, such as running, lifting dumbbells, exertion quickly squeezes out your anxiety. And exertion also helps you sleep tonight. Note: After strong physical exercise, 2 to 3 hours before going to sleep, just after doing strong physical exercise, due to increased muscle afferent impulses, but will not sleep. 3, diet: smoking relaxes the spirit and relieves anxiety, the patient will unconsciously use smoking as self-medication, the formation of tobacco dependence over time; alcohol has a sedative effect, drinking alcohol to relieve anxiety, but when alcohol withdrawal, anxiety rebound aggravates, driving patients to drink further, long-term heavy drinking alcohol tolerance is formed, alcohol and benzodiazepines (a group of anti-anxiety drugs) anxiolytic mechanism of action similar, when alcohol When alcohol is tolerated, the anxiolytic effect of taking benzodiazepines will also be tolerated. Patients are not sensitive to benzodiazepines and need to take a large dose to be effective, because of this, patients will privately use super therapeutic amounts, leading to abuse, which is caused by alcohol abuse, so it is called secondary abuse. Green tea contains theophylline, coffee and cola contain caffeine, both increase wakefulness, aggravate anxiety and cause insomnia. Therefore, patients with anxiety disorders should not use tobacco, alcohol, tea, coffee or cola. Some patients use clonazepam to fight panic attacks, because of fatigue and drink a lot of coffee and tea to refresh, until after the refreshment, panic attacks and aggravated, clonazepam and then increase the amount, panic attacks again to relieve, fatigue again, and then more coffee and tea, and so on a vicious cycle. Doctors do not ask, the patient does not describe, you can not detect the cause of worsening panic. Third, high blood pressure Panic attack is an acute anxiety attack, the patient’s blood pressure may normally be normal, but when the panic attack, the body is in a state of stress, blood pressure appears temporarily elevated, this patient usually do not need to routinely take antihypertensive drugs, as long as the panic attack is controlled, blood pressure will remain normal. On the contrary, if you do take anti-hypertensive drugs routinely, your blood pressure will be normally low. For example, a patient whose highest blood pressure record was 190/108mmHg when he had a panic attack is now taking Betaloc 23,75mg a day, and his usual blood pressure is only 100/58mmHg. Fourth, why is it that anxiety disorders are often non-compliant with medication? 1, the risk of taking the drug: the drug manual is the development of the drug and after the market to see all the adverse reactions are listed, these adverse reactions if all occur in a person, enough to let a person die 100 times. Since it can become a state-licensed drug, it is safe for the vast majority of people, and its benefits are greater than the dangers, otherwise the state will not allow it to market, doctors dare not use. To the doctor, rather than let the patient treatment is ineffective, not to let the patient produce serious adverse reactions, so before prescribing the drug, the doctor has weighed the benefits outweigh the risks, before giving you this drug. 2, review the safety: anxiety patients on the one hand, the psychiatrist’s experience in treating anxiety disorders than their own, on the other hand, also believe that doctors have a hundred times, if this oversight is oversight in their own body, damage to the liver and kidneys, it is too bad, therefore, the doctor prescribed drugs, patients should carefully review before taking it again, how to review? Is to read the drug instructions, see so many side effects on the instructions, it is assumed that these side effects occur in their own situation, thus afraid to take, so that the anxiety can not be relieved. 3, miscalculation: the newer the drug, the more detailed the drug instructions, the more adverse reactions listed; the older the drug, the simpler the drug instructions, the less adverse reactions listed. However, old drugs often (but not always) more adverse reactions than new drugs, while the instructions listed but less, and you judge the safety of drugs according to drug instructions, often miscalculated. 4, the importance of the odds: drug instructions list the types of adverse reactions, not listed on the odds of adverse reactions, or even if the odds are listed, the patient did not take into account. Need to know the importance of chance in the evaluation of the risk, you eat fish today, the chance of being stuck in the fish? Yes, but it is very small, so it does not prevent you from eating fish. Yes, but it is very small, so it does not prevent you from going out. Do you have the chance of serious adverse reactions to medication? Yes, but if the chance is very small, it does not prevent you from taking the medication decision. 5, the focus of anxiety becomes narrower: anxiety patients will be overly concerned about the disadvantages to themselves, even if the risk of disadvantages is very small, because of his excessive concern, he will see the danger as great, and ignore the whole thing compared to the pros and cons. This is like a white paper with a big red dot and a small black dot on it, placed a foot away from you, you will clearly see that the red dot is bigger than the black dot, but you only look at the black dot, put will gradually pull the paper closer, the result is full of black dots, and the red dot is out of sight, this black dot is the adverse effect, the red dot is the curative effect. 6. How terrible is drug dependence? Anxiety patients should focus on the stability of their condition, not on drug dependence. If there is a withdrawal reaction to drug reduction, it suggests drug dependence, and the severity of drug dependence and morphine addiction is not at all in the same order of magnitude, and it is not terrible, is it not that there is a withdrawal reaction to drug withdrawal? You can gradually stop the drug by reducing it more slowly. If anxiety relapses after stopping the drug, you should continue to take it even if you have drug dependence, what does this mean? Anxiety is heavier in nature than drug dependence. 7. What is the attitude of anxiety disorder patients toward medication? Anxiety disorders are frequently fluctuating illnesses, with medication being adjusted upward when heavy and adjusted downward when light. The characteristics of this kind of patients are: they see drugs as a lifesaver when they are sick, and they see drugs as an enemy when they are sick. Just like the ancient mediocre ruler, there is a foreign enemy invasion, it will worship the general out of the war, the military generals courtesy; and so the foreign enemy eliminated, see how the military generals also do not look good, uneasy, will be removed. 8, paroxetine and clonazepam hazards: paroxetine and clonazepam is harmless to the heart, liver, lungs and kidneys, these two drugs mainly inhibit sexual function, clonazepam also reduces the next day’s energy and vitality, 3 days after stopping the drug, the adverse effects disappear. Fifth, the relationship with the doctor is easily strained Anxious patients, despite their reluctance to contradict the doctor, actually often make the doctor intolerable: first, and not in accordance with medical advice to take medication, but still come to that doctor, resulting in doctor dissatisfaction; second, when the doctor gives a choice of options, the patient will hesitate, repeatedly modify the decision, tormenting the doctor’s patience; third, excessive use of communication resources with the doctor, finally making the doctor impatient. Sixth, mental anxiety What can’t be changed is not urgent: the ending that you can change, urgent may make yourself work hard to improve the ending. For example, the college entrance exam is still 3 months away, anxious may make you study harder and improve your college entrance exam results. On the contrary, if you can’t change the ending, it’s useless to be anxious, so you should be frank. For example, you are taking a cab to catch a train, and now you are stuck in a traffic jam, and you are so anxious that you are afraid you will not be able to catch the train. Ask: Did your anxiety play a role in catching the train or not? No. Therefore, whether you are anxious or not, can not change the end of the event, but hindered your quality of life, so the calculation down, it is better not to rush. For example, if a patient is worried about the death of a loved one in the future, what if he or she cannot bear it? What if they are worried about the pain they will experience when they die in the future? The thought of such events is enough to make everyone afraid? But is it useful for you to be anxious? No, it is useless, so it is better not to be anxious, put in the back of the mind. Somatic anxiety Somatic anxiety is anxiety symptoms that cannot be expressed verbally, but only expressed through the physical body, which is characterized by wandering, sporadic, and no organic problems can be detected. For example, wandering numbness all over the body, fingertips, arms, feet, calves, face, scalp is not necessarily numb at that moment, like the feeling of hair strands ruffled, and like small insects crawling through, with clonazepam effect is good.