Introduction to the disease
Anxiety is one of the most common emotional states. For example, if you are about to take an exam, you will be nervous and worried if you feel that you have not revised well. At this point, it is common to catch up on revision for the exam and actively do what you can to reduce your anxiety.
This anxiety is a protective response, also known as physiological anxiety, as people experience different levels of anxiety in different situations and will try to prevent adverse situations that cause anxiety and actively do activities to reduce anxiety. When the severity of anxiety does not match the objective event or situation, or when it lasts too long, it becomes pathological anxiety, called anxiety symptoms, and is diagnosed as anxiety disorder if it meets the relevant diagnostic criteria.
Causes
Why do you get anxiety disorders? The cause of the disease is still unclear. Studies have shown that anxiety disorders are related to genetic factors, personality traits, adverse events, stressors, and physical illnesses, which can lead to disruptions in the body’s neuro-endocrine system and imbalances in neurotransmitters, resulting in the appearance of symptoms such as anxiety. Patients with anxiety disorders often have imbalances in 5-HT (5-hydroxytryptamine), NE (norepinephrine) and other neurotransmitters, and anti-anxiety drugs can normalize the imbalanced neurotransmitters, so that anxiety symptoms disappear and emotions return to normal. Experts remind: the function of the brain is achieved through the transmission of various neurotransmitters, which are like letter carriers, different letter carriers transmit different information and perform different physiological functions. The neurotransmitters closely related to mood are 5-HT (5-hydroxytryptamine), NE (norepinephrine), DA (dopamine) and so on.
Disease Classification
There are many types of anxiety disorders, and according to the clinical presentation of the patient, anxiety is often classified as.
1) Generalized anxiety: In the absence of obvious triggers, patients often experience excessive worry, nervousness and fear, but the nervousness and fear often have no clear object or content. In addition, patients are often accompanied by physical symptoms such as dizziness, chest tightness, panic, shortness of breath, dry mouth, frequent urination, urgent urination, sweating, tremor, etc. This anxiety usually lasts for several months.
2) Acute anxiety attack (also known as panic attack): In a normal daily life environment, when there is no fearful situation, the patient suddenly develops extreme fearful tension, accompanied by a sense of near death or loss of control, along with obvious symptoms of the vegetative nervous system, such as chest tightness, panic, difficulty in breathing, sweating, and general shaking, which usually lasts from a few minutes to several hours. The seizure starts suddenly, reaches its peak rapidly, and the consciousness is clear during the seizure.
Note! The appearance of this type of anxiety is episodic and unpredictable. Because the clinical presentation of an acute anxiety attack is so similar to that of a coronary attack, patients often call the “120” emergency number to see a cardiology emergency room. Although the patient appears to have severe symptoms, most of the relevant tests are normal, so the diagnosis is often unclear, making the misdiagnosis rate of acute anxiety attacks high, which not only delays treatment but also causes a waste of medical resources.
3) Phobias (including social terror, place terror, and specific terror): The core manifestation of phobias, like acute anxiety attacks, is panic attacks. The difference is that anxiety attacks in phobias are caused by certain specific places or situations, and patients do not cause anxiety when they are not in these specific places or situations. For example, fear of social situations or interpersonal interactions, or fear of specific environments: airplanes, plazas, crowded places. The onset of anxiety in phobias is often predictable, and patients tend to adopt avoidance behaviors to avoid anxiety attacks. One patient is afraid of riding the subway or bus. As long as she takes the above-mentioned means of transportation, she has anxiety attacks and is extremely distressed. To avoid anxiety attacks, she takes a cab to and from work, because she is fine when she takes a cab.
There is another classification that you can understand: the American diagnostic criteria for mental disorders, anxiety disorders include: generalized anxiety, acute anxiety attacks, phobias, post-traumatic stress disorder, acute stress disorder, and obsessive-compulsive disorder. Because these disorders have one thing in common, that is, prominent anxiety symptoms.
Clinical manifestations
Anxiety disorders are arguably the most common mood disorder in the population. Research by the World Health Organization shows that the lifetime prevalence of anxiety disorders in the population is 13.6%-28.8%, and 90% of anxiety disorders develop before the age of 35, often more in women than in men. China lacks national survey data on anxiety disorders. Surveys in Hebei, Zhejiang and several other provinces show that the prevalence of anxiety disorders is 5%-7%, and it is estimated that there are more than 50 million anxiety disorder patients in the country. Symptoms of the disease
First of all, let’s talk about the definition of anxiety disorder. Anxiety is an unpleasant, painful emotional state accompanied by a somatic experience of discomfort. Anxiety disorders, on the other hand, are a group of mood disorders in which anxiety symptoms are the main clinical phase and often contain two groups of symptoms.
(1) Emotional symptoms
The patient feels that he or she is in a nervous, anxious, fearful, and apprehensive internal experience. What is the nervousness and fear? Some people may be able to specify the object of their fear, while others may not be able to say what they are afraid of, but they just feel afraid;
(2) Somatic symptoms
Patients who are nervous are often accompanied by autonomic hyperactivity, such as panic, shortness of breath, dry mouth, sweating, trembling, flushing, etc. Sometimes they also have a sense of near-death, feeling that they are going to die, and in severe cases, they may also feel out of control.
Danger of the disease
Without timely and correct diagnosis and treatment, patients with anxiety disorders will repeatedly go to the doctor, which will seriously affect their normal life and work, and also cause a huge waste of medical resources, with some studies showing that the medical costs of patients with anxiety disorders are nine times higher than those of the general population. One patient, who had an acute anxiety attack, repeatedly called “120” for emergency treatment because the performance of anxiety attacks is very similar to coronary heart disease, and patients with anxiety attacks were mistaken for coronary heart disease attacks and underwent cardiac angiography. It can be said that anxiety disorders bring great pain and burden to individuals and families.
Is the treatment situation for anxiety disorders good? Unfortunately, because of a general lack of general knowledge about mental health, including anxiety disorders, the vast majority of people with anxiety disorders do not receive timely and proper treatment. World Health Organization studies show that only 6.1% of people with anxiety disorders in China receive proper treatment, compared to 42% in the United States. I have a great responsibility as a psychiatrist.
Diagnosis Identification
Psychiatrists diagnose anxiety disorders primarily on the basis of
The patient’s medical history (duration of illness, bad presentation, etc.) provided by the family, psychiatric examination (results of the examination by talking to the patient), physical examination, scale measurements, and ancillary laboratory tests.
Diagnosing anxiety disorders is not a difficult task. Here is a simple anxiety self-assessment scale that you can self-assess. If your score is high, it is recommended that you go to the psychiatric department for a systematic examination. Of course, psychological tests are subject to certain errors, so this test is considered a screening test, and a high score does not necessarily mean anxiety.
Attachment: Anxiety Self-Assessment Scale (SAS)
Anxiety is a relatively common mental experience, and people who have long-standing anxiety reactions are prone to develop anxiety disorders. This scale contains 20 items and is divided into 4 levels. Please read the following carefully and click on the corresponding number according to how you have been feeling in the last week. For the current self-assessment of major emotional and somatic symptoms, please choose according to the degree of self-perceived symptoms. All questions share common answers, please tick under A, B, C, D. Limit one answer per question. Answer: A: No or little time; B: Little time; C: Quite a lot of time; D: Most or all of the time 1. I feel and am usually easily stressed and anxious A. B. C. D.
2. I feel scared for no reason A. B. C. D.
3. I get easily upset or feel frightened A. B. C. D.
4. I think I may be going crazy A. B. C. D.
5. I feel that everything is fine A. B. C. D.
6. my hands and feet were shaking and trembling A. B. C. D.
7. I suffer from headaches, head and neck pain and back pain A. B. C. D.
8. I feel easily weakened and tired A. B. C. D.
9. I feel calm and easy to sit quietly A. B. C. D.
10. I feel that my heart is beating fast A. B. C. D.
11. I am distressed by bouts of dizziness A. B. C. D.
12. I have fainting episodes or feel as if I am going to faint A. B. C. D.
13. I breathe in and out easily A. B. C. D.
14. I have numbness and tingling in my hands and feet A. B. C. D.
15. I suffer from stomach pain and indigestion A. B. C. D.
16. I often have to urinate A. B. C. D.
17. my hands are often wet A. B. C. D.
18. I am red and hot A. B. C. D.
19. I fall asleep easily and sleep well all night A. B. C. D. 20.
20. I have nightmares A. B. C. D.
Scoring: Forward scoring questions A, B, C, D are scored as 1, 2, 3, 4; reverse scoring questions A, B, C, D are scored as 4, 3, 2, 1, reverse scoring question numbers: 5, 9, 13, 17, 19. 20 items of scores are added together to get the total score, and then multiplied by 1.25 to get the whole number, that is, the standard score.
Those with scores below 50 are considered normal; those with scores of 50-60 are considered mild anxiety; those with scores of 61-70 are considered moderate anxiety; those with scores of 70 or more are considered severe anxiety; those with moderate anxiety are recommended to consult a psychiatrist to rule out anxiety disorders.
There are also more commonly used anxiety scales such as the Hamilton Anxiety Inventory, which is measured by doctors, and the Social Anxiety Inventory, which can be referred to.
Disease treatment
Anxiety disorder is a mood disorder that is well treated and has a good prognosis, so even if you are diagnosed with anxiety disorder, there is no need to worry too much. Treatment for anxiety disorders usually includes medication and psychotherapy.
Medication
1. Benzodiazepines (also known as tranquilizers)
1) Advantages.
①Fast onset of action, mostly within 30-60 minutes
②Anxiolytic effect is sure
③The price is generally relatively cheap
2) Disadvantages.
① short duration of effect, not suitable for long-term use in large quantities
② Possibility of dependence. Anti-anxiety drugs, like a car too fast, with the foot on the brake, works but is not suitable for common use.
3) Commonly used drugs.
Lorazepam (lorazepam): commonly used dose is 2-3 times a day, each time 0.5-1.0mg; Jiajing Valium (also known as alprazolam): commonly used dose is 2-3 times a day, each time 0.4mg; Oxazepam tablets (also known as Ufie): commonly used dose is 2-3 times a day, each time 15mg, these three drugs belong to the short and medium-acting tranquilizers, anxiolytic effect is good, the sedative effect is relatively weak, the impact on the daytime work is less. The effect on the daytime work is less. In fact, all Valium drugs can be anti-anxiety, only the side effects and effects vary, the above three drugs are more commonly used.
Common sense: where the drug is followed by a certain diazepam or a certain zolam, are Valium drugs.
4) How to use Valium drugs.
① intermittent dosing principle: temporary oral when anxiety is severe, not long-term large amounts.
② the principle of small doses: small doses work without large doses
③The principle of regular medication changes:
If the condition requires long-term use of Valium anti-anxiety drugs, change to another Valium drug in 3-4 weeks, which can effectively avoid the creation of dependence. Note that when changing medication, the original medication should be slowly reduced, and the new medication should be slowly added, and the two medications should be crossed for a period of time before withdrawing the original medication and adding the new medication to the treatment amount. If the patient is older, the dose of medication is not large, and the efficacy is good, you can also not change the medication, as long as the dose of Valium does not increase, within the normal range, and the efficacy does not diminish, you can assume that there is no dependence.
Experts remind.
In the early treatment of anxiety disorders should be used as soon as possible in full doses of Valium-type anti-anxiety drugs in order to control anxiety as soon as possible, because it often takes 2-3 weeks for antidepressants to play an anti-anxiety role, and if the anxiety symptoms are not controlled as soon as possible, it will have a negative impact on the recovery of the disease. Valium medications can be slowly reduced to discontinued after 4-6 weeks of use.
If you stop using Valium, please slowly reduce the dosage to stop, do not stop suddenly, otherwise it is very easy to cause withdrawal reactions and aggravate the disease.
2. Antidepressants
If you use the metaphor of anxiety as a car going too fast, then antidepressants are the throttle release, which can improve anxiety fundamentally because the cause of anxiety is closely related to the imbalance of neurotransmitters in the brain, and antidepressants can improve the imbalance of neurotransmitters in the brain, thus relieving anxiety and treating anxiety fundamentally. Chinese guidelines for the treatment of anxiety disorders state that
1) Generalized anxiety: The first-line treatment drugs are: paroxetine (Celerity), escitalopram (Lexapro), venlafaxine (Boloxin, Enos). The second-line drug of choice is duloxetine.
2) Panic attacks: first-line drugs are paroxetine (Celerity), escitalopram, and second-line drugs are clomipramine.
3) Social anxiety (social terror): first-line drugs are paroxetine (Serote), buspirone, second-line drugs are escitalopram, sertraline, venlafaxine.
First-line drugs mean the first choice with clear efficacy; second-line drugs mean the second choice if the first-line drugs are not effective. Through the treatment guidelines, you can see that Celerity is the first-line drug for all kinds of anxiety, and it is the first choice for all kinds of anxiety. It is followed by escitalopram, duloxetine and venlafaxine, which also work well. Sellett is mainly a relatively large side effect, not to be stopped suddenly, the discontinuation reaction is heavy.
The characteristics of this class of drugs are.
1) Advantages: ①Anxiolytic effect is sure
② Improve anxiety from the root
③ Non-addictive, suitable for long-term use.
2) Disadvantages: ①Anxiolytic effect is slow to take effect, 2-3 weeks after the onset of action, often need to be combined with short-term Valium drugs.
②The price is expensive.
The doctor will generally consider the specific drug to be used according to the patient’s condition, physical condition, economic situation and other factors.
Experts remind that.
1) Anxiety may increase at the beginning of the medication, which is related to the side effects of the medication and usually disappears after 2 weeks. Pay attention to a smaller dose at the beginning of the medication, and slowly increase the dose. If anxiety is obvious, add Valium in time to relieve anxiety.
2) After the symptoms are relieved, it is recommended to take the medication for about 1-2 years. Please consult your doctor for discontinuation and dosage increase, and do not adjust your medication regimen on your own.
3) Side effects may occur during medication, do not panic, and consult your doctor promptly. Generally speaking, most of the side effects will disappear after 2 weeks because the body has already adapted to them. If the side effects are not tolerated by the patient, ask the doctor to help adjust the treatment plan.
4) Individualized differences in psychiatric medications refer to the fact that different patients, with the same diagnosis, same age and gender, and similar physique, have significant differences in the effects of medication. The dose of medication that takes effect and the side effects of the medication can also use a great difference. Patients should pay attention to keep in touch with their doctors when taking medication, solve problems in time, and don’t be afraid of the side effects of medication, they can figure out how to solve it together.
Combined with clinical experience with medication, review these drugs.
1) Paroxetine tablets: trade name Sellett, Leyou, etc., belong to the SSRI class of drugs, acting on the 5-HT system, the common dose is 20-60mg/day, a single dose can be, the anxiolytic effect is outstanding, is the first choice of drugs for the treatment of all types of anxiety disorders, because it is really effective, especially in the treatment of anxiety disorders more prominent, when other drugs are not effective, switch to Sellett can still be effective. Therefore, in the guidelines for the treatment of anxiety disorders, it is clearly stated that it is the drug of choice for all kinds of anxiety disorders. A little experience in its application: When you start taking Celerity, take 0.25-0.5 tablets, and then increase it to 0.5-1 tablet after a few days. If you discontinue the medication, slowly reduce the dosage and do not stop using Serote at once. Individual patients have a certain sedative effect after taking the drug, can be put into the evening dose, usually in the morning; individual patients will appear a transient hypertension, hypertensive patients need to monitor blood pressure. The disadvantage is that the side effects are relatively large and the drug needs to be used with skill when used.
2) Escitalopram: the trade name is Lysop, Bailout, also belongs to the SSRI class of drugs, acting on the 5-HT system, the common dose is 10-20mg/day. The anti-anxiety effect is good, and the side effects are small, especially for the elderly and patients with cardiovascular disease, but the price is expensive.
3) Duloxetine: the trade name is Ximperdal, Ospin, there are slow-release preparations and immediate-release preparations, is also a dual-receptor principle of action of the drug, the action of 5-HT and NE two neurotransmitters,
The most common dose is 60mg-120mg/day, the most important feature of this drug is its advantages in the degree of dual receptor action, antidepressant, anxiolytic effect is better, especially for symptoms with somatization and chronic pain symptoms.
4) Venlafaxine: trade name Enos, Boloxin, there is an extended-release formulation and also an immediate-release formulation. The drug is a dual-receptor drug, acting on both 5-HT and NE neurotransmitters, the common dose is 75-225mg/day. It has good antidepressant and anxiolytic effects. Note that there is a possibility that anxiety will increase at the beginning of the drug, you need to add Valium, which usually lasts for two weeks mostly disappears.
5) Drugs like sertraline, Lanxai, Xipomol, fluoxetine, clomipramine, etc. are often used as the second tier of drugs.
3. buspirone, tandospirone
It is a 5-HT-1A agonist with good effect on social anxiety and no dependence. The disadvantage is that the effect is slow, 2-3 weeks, and the effect is not satisfactory if the patient has taken Valium first and then takes buspirone.
4. Other medications
1) Acute anxiety attack can be considered to take propranolol (insulin) 10-20mg, temporary, can improve the symptoms.
2) Tricyclic drugs: such as chlorpromazine, amitriptyline, etc., the efficacy is good, the price is also cheaper, but the side effects are large, is no longer the first choice of drugs.
3) Dextran: not commonly used this drug, the efficacy is general, the pharmacological advantages are not great, it is an antipsychotic and an antidepressant mixture of products.
As for which drug is appropriate for each patient, it is necessary to consider the patient’s condition, previous medication experience, efficacy after taking the drug, the patient’s tolerance of the drug and side effects, and also consider the patient’s economic situation to make a decision after comprehensive consideration. It is also necessary to closely follow up with the patient and adjust the treatment plan at any time, so that the patient can gradually move towards recovery.
Psychotherapy
Psychotherapy refers to clinicians establishing a good doctor-patient relationship with patients through verbal or non-verbal conversation, and applying knowledge about psychology and medicine to guide and help patients overcome and correct poor lifestyles, behavioral habits, emotional disorders, cognitive biases, and adaptation problems. Medication and psychotherapy are the two legs to help anxiety patients recover. Medication is essential to send charcoal in the snow; psychotherapy is the icing on the cake that will allow patients to further recover and is also very important.
So, what is the best person to see for psychotherapy?
(1) Psychiatrists
There are some psychiatrists whose specialty is psychotherapy, and this is the most suitable psychiatrist to do psychotherapy, because this is the most competent psychiatrist. Other psychiatrists may not specialize in psychotherapy, but can also do psychotherapy, such as supportive therapy, cognitive therapy, etc;
(2) Clinical psychologists, such as hospital psychotherapists, who have knowledge of clinical psychology.
Suitable psychotherapy for anxiety disorders are: supportive therapy, behavioral therapy, cognitive therapy, biofeedback therapy, etc.
Chinese medicine psychotherapy.
Based on the theory and practice of Chinese medicine, combined with the knowledge of modern psychology, it is a science that studies psychological phenomena, the laws of psychological diseases and treatment, and is a secondary discipline of Chinese medicine. It is a combination of traditional Chinese medicine qigong therapy and western hypnotherapy and cognitive therapy, through verbal and behavioral induction, to make the treated person enter a certain intermediate state of the process from wakefulness to sleep, and to put a certain “idea, concept” composed of verbal and behavioral information composed by the therapist according to certain treatment needs. “TIP is an innovative Chinese psychotherapy method that has been developed through more than 20 years of clinical practice and has become a complete technical system. The unique advantage of TIP therapy, combined with our self-developed retrospective personality questionnaire, is that it can discover the personality problems of patients during their growth process, and allow the defective personality of anxiety patients to grow again during treatment, thus reshaping their personality, improving the personality susceptibility of anxiety patients, increasing the treatment compliance of anxiety patients, reducing the relapse rate, and potentially improving the prognosis of anxiety disorders from the root. This therapy is also in line with the characteristics of Chinese medicine that the treatment must be based on the root of the disease.
The following relaxation therapy is introduced to you.
Relaxation training is to achieve psychological relaxation through physical relaxation, relatively simple such as deep breathing method: anxiety when closed eyes, slowly breathe in through the nose, mouth and nose exhale, repeated three to five times. You can also use meditation: that is, consciously think of a happy thing, as real and concrete as possible. When you are overly tense and anxious, first close your eyes lightly, relax your whole body, take several even and rhythmic deep breaths, and repeatedly suggest to yourself: “Don’t be anxious”, “Relax, relax”, and after a few minutes, your emotions will be smooth.
Prognosis of the disease
The prognosis for anxiety disorders is often good. After treatment, most patients will recover and resume their old smiles. For all types of anxiety disorders, it is necessary to insist on taking antidepressants for a period of time; please consult your doctor for stopping the medication and increasing or decreasing the dosage, and never adjust the medication regimen on your own to avoid aggravating the condition.
Expert opinion
1, anxiety disorder is the most common mood disorder, it is treatable, preventable and has a very good prognosis.
2, anxiety disorders need to be treated with medication under the guidance of a psychiatrist, and you need to adhere to the medication for a period of time after the symptoms are relieved, and not to stop the medication on your own. In combination with psychotherapy, the effect is better for the recovery of anxiety disorders.
3, Sellett is the first-line drug for the treatment of anxiety disorders, with excellent efficacy and suitable for all types of anti-anxiety drugs. Escitalopram, duloxetine and venlafaxine are also the most commonly used anti-anxiety drugs. Early co-administration of Valium is more significant to improve anxiety as soon as possible.
4, it is recommended that the majority of patients learn more about various general mental health, so that early detection, early diagnosis and early treatment of the disease is of great significance to reduce the pain of the disease.