I. What is anxiety disorder?
Anxiety disorder, also known as anxiety neurosis, is a brain dysfunction with persistent anxiety, fear, tension and impaired plant nerve activity, often accompanied by motor restlessness and somatic discomfort. It occurs in young adults, and there is no significant difference in the incidence between men and women. Generalized anxiety disorder (chronic anxiety disorder) and episodic panic disorder (acute anxiety disorder) are the main clinical manifestations, often accompanied by dizziness, chest tightness, palpitations, dyspnea, dry mouth, urinary frequency, urinary urgency, sweating, tremors and motor restlessness, etc. The anxiety is not caused by actual threats or the degree of tension and panic is very disproportionate to the reality of the situation.
Anxiety disorders are different from normal anxiety reactions: first, they are unprovoked anxiety, tension, and fear without a clear object or content; second, they point to the future, as if some threat is imminent, but the patient himself cannot say what kind of threat or danger exists; third, they last for a long time, and without active and effective treatment, they can be prolonged for weeks, months, or even years. Finally, anxiety disorders present a persistent or episodic state of panic in addition to a variety of physical symptoms.
In short, pathological anxiety is a form of unfounded panic and nervousness, experienced psychologically as generalized worry and panic with no fixed goal, and physiologically accompanied by physical symptoms of increased alertness.
These symptoms are not only found in simple anxiety disorders, but also in some psychiatric disorders, such as schizophrenia, obsessive-compulsive disorder, and other psychiatric disorders. The anxiety symptoms of these disorders are only one of their symptoms. These anxiety symptoms are not essentially different from simple anxiety disorder in terms of clinical symptoms and psychiatry, and may be more complex than simple anxiety disorder in terms of treatment, because while treating their anxiety symptoms, other symptoms of such patients should also be treated, so there is a need to differentiate them from simple anxiety disorder here.
II. Causes of anxiety disorders
Researchers from different schools of thought have different opinions about the causes of anxiety disorders. These opinions are not necessarily conflicting, but rather complementary, and may be caused by a combination of factors.
1. Genetic factors
Noyes et al. (1987) reported a 19.5% prevalence of the disorder in first-degree relatives of people with GAD, which is much higher than the prevalence in the general population. Kendler et al. (1992) studied 1033 female twin pairs and concluded that there is a clear genetic predisposition for anxiety disorders, which is mainly seen in panic disorder but not in GAD-free patients.
2. Biochemical factors
The lactate hypothesis: panic attacks are one of the few psychiatric disorders that can be induced experimentally. pitts et al. (1967) injected anxiety disorder patients with sodium lactate, and as a result, panic attacks were induced in most patients. However, the mechanism by which this phenomenon occurs is not yet clear.
Norepinephrine (NE): Patients with anxiety disorders have enhanced NEergic activity. The supporting evidence is.
(1) increased metabolites of NE in the cerebrospinal fluid during anxiety states.
(2) Catecholamines (epinephrine and NE) induce anxiety and can induce panic attacks in patients with a history of panic attacks.
(3) The blue spot contains more than 50% of NE neurons throughout the central nervous system, and NE levels are regulated by the cytosol and α2 autoreceptors in the nucleus of the blue spot.
(4) Human studies have found that alpha2 receptor nodulators such as yohimbine can increase NE and cause anxiety, while the alpha2 agonist colistin is effective for anxiety treatment.
5-hydroxytryptamine: Many drugs that primarily affect central 5-HT are effective for anxiety symptoms, suggesting that 5-HT is involved in the firing of anxiety, but the exact mechanism is unclear.
In addition, there are numerous studies on the relationship between dopamine, γ-aminobutyric acid, benzodiazepine social bodies and anxiety, although it is difficult to reach a consistent conclusion.
3. Psychological factors
Behaviorist theory believes that anxiety is a conditioned reflex formed by the fear of certain environmental stimuli. Take animal experiments as an example: if pressing a pedal causes an electric shock, pressing the pedal becomes a conditioned stimulus before the electric shock, and this conditioned stimulus can cause the animal to develop an anxious conditioned reflex, and this conditioned reflex causes the animal to avoid pressing the pedal and avoiding the electric shock. The success of the avoidance behavior reinforces the animal’s avoidance behavior, which leads to a decrease in anxiety levels. This animal model suggests that anxiety attacks are conditioned responses to scary situations acquired through learning. Psychodynamic theory suggests that anxiety arises from internal psychological conflicts, which are repressed in childhood or adolescence or activated in the subconscious during adulthood, resulting in anxiety. There may be the following psychological factors.
First, although somatic diseases or biological dysfunction would not be the only cause of anxiety, in some rare cases, a patient’s anxiety symptoms can be triggered by somatic factors, for example, hyperthyroidism or adrenal tumors. Many researchers have tried to discover if it is the central nervous system, specifically certain neurotransmitters, that is responsible for triggering anxiety in patients with anxiety disorders. Much research has focused on two neurotransmitters: norepinephrine and serotonin. Many studies have found that when patients are in a state of anxiety, their brain levels of norepinephrine and serotonin change dramatically, but it has not been determined whether these changes are a cause or a consequence of anxiety symptoms.
Second, cognitive processes, or thinking, play an extremely important role in the development of anxiety symptoms. Studies have found that depressed patients are more inclined than the general population to interpret ambiguous, even benign, events as harbingers of crisis, to believe that bad things will fall into their laps, to think that failure awaits them, and to underestimate their ability to control negative events.
Third, anxiety disorders are more likely to occur in the presence of stressful events.
I argue that since anxiety is an instinct of positive stress, stressful behaviors, including stress preparation, are the main cause of anxiety becoming a disorder. Due to the reinforcement of stressful behaviors, in some cases (e.g., lack of information), there is a wrong stimulus-response association, or the degree is not properly controlled, so that the accumulated or invoked psychological energy during stress preparation is not effectively released, and persistent tension, panic, etc., affects the subsequent behaviors, while the disturbance (overproduction) of thyroxine and norepinephrine, hormones related to tension, has an effect on the above The process has an amplifying effect. As for worry and paranoia, they are also signs of excessive thinking energy.
Clinical classification and characteristics of anxiety disorders
(A) Generalized anxiety disorder
Also known as chronic anxiety disorder, it is the most common form of anxiety disorder. It often starts slowly, with frequent or persistent anxiety as the main clinical phase. It has the following manifestations.
1.Mental anxiety
Excessive mental worry is the core of anxiety symptoms. It manifests as frequent worry about some dangerous or unfortunate event that may occur in the future and is difficult to anticipate. Some patients cannot clearly realize part of the object or content of his worry, but only an intense internal experience of being on edge and fearful, called free-floating anxiety. Some patients worry about things that may happen in real life, but their level of worry, anxiety and annoyance is very disproportionate to reality, called their anxiety. Patients often have a premonition of panic, and spend their days distracted, worried, restless, and seem to have a sense of imminent disaster.
2.Somatic anxiety
The symptoms are motor anxiety and a variety of physical symptoms. Motor anxiety: It can be manifested as frustration, inability to sit still, constantly walking back and forth, and an increase in purposeless small movements. Some patients show tremors of the tongue, lips and finger muscles or tremors of the limbs. Somatic symptoms: A feeling of compression behind the sternum is a common manifestation of anxiety, often accompanied by shortness of breath. Muscle tension: It manifests as a subjective feeling of unbound tension in one or more groups of muscles, with muscle aches and pains in severe cases, mostly in the chest, neck and back shoulder muscles, and tension headaches are also common. Autonomic dysfunction: Symptoms include tachycardia, flushed or pale skin, dry mouth, constipation or diarrhea, sweating, and frequent urination. Some patients may experience premature ejaculation, impotence, menstrual disorders and other symptoms.
3.Increased arousal
Exhibit excessive alertness, sensitivity to external stimuli and easy startle reaction; difficulty in concentration and susceptibility to infection. Difficult to fall asleep, easy to wake up during sleep; emotional irritability; sensory hypersensitivity, some patients can experience the throbbing of their own muscles, fluctuation of blood vessels, peristaltic movement of the gastrointestinal tract, etc.
4.Other symptoms
Patients with generalized anxiety disorder often have a combination of fatigue, depression, obsessions, fears, panic attacks and depersonalization, but these symptoms are often not the main clinical phase of the disease.
(B) Panic disorder
Panic disorder is also known as acute anxiety disorder. It is characterized by the unpredictability and suddenness of the attack, the intensity of the reaction, and the patient often experiences the fear and dread of a near catastrophic end, and the termination is also rapid.
Patients often feel a sudden and frightening experience without a specific fearful situation, with a sense of near death or loss of control and severe autonomic dysfunction. The patient may feel as if death or disaster is imminent, or run, scream, or call for help, with autonomic symptoms such as chest tightness, tachycardia, irregular heartbeat, dyspnea or hyperventilation, headache, dizziness, vertigo, numbness and abnormal sensation in the extremities, sweating, flesh jumping, general shaking or general weakness. Panic attacks usually have a rapid onset and termination, usually lasting 5-20 minutes and rarely more than an hour, but can soon recur suddenly. The patient’s anxiety is no longer prominent, but is replaced by a weakness that takes several hours to several days to recover. 60% of patients develop avoidance behavior due to fear of not getting help during the attack, such as not daring to go out alone and not daring to go to crowded places, developing into place phobia.
IV. Diagnosis of anxiety disorders
The diagnostic criteria for CCMD-3 generalized anxiety and panic attacks are as follows.
1.Generalized anxiety
(1) Meet the diagnostic criteria of neuropositive.
(2) Predominantly persistent primary anxiety symptoms that meet both of the following.
(1) Frequent or persistent fear or panic attacks without clear objects and fixed contents.
(ii) Accompanied by autonomic symptoms and motor restlessness.
(3) Impaired social functioning, where the patient is distressed by unbearable but unrelieved symptoms.
(4) Meeting the symptom criteria for at least 6 months.
(5) Excluded: anxiety secondary to physical diseases such as hyperthyroidism, hypertension, coronary artery disease; anxiety associated with euphoric drug overdose and drug dependence withdrawal; anxiety associated with other types of mental illness or neurosis.
2.Panic disorder
(1) Meet the diagnostic criteria of neurosis.
(2) Panic attacks must meet the following four items.
(i) No obvious trigger for the attack: no relevant specific context, and the attack is unpredictable.
(ii) No obvious symptoms during the interictal period, except for fear of further seizures.
(iii) The seizure manifests intense fear, anxiety and obvious autonomic symptoms, and is often accompanied by painful experiences such as depersonalization, dissolution of reality, near-death fear, or a sense of loss of control.
(4) The seizure is sudden, reaches its peak rapidly, is conscious during the seizure, and can be recalled afterwards.
(3) The patient is in pain because it is unbearable but cannot be relieved.
(4) At least 3 panic attacks in a month, or anxiety secondary to fear of reoccurrence lasting for 1 month after the attack.
(5) Exclusion: panic attacks secondary to other mental disorders: panic attacks secondary to somatic diseases such as epilepsy, heart attack, pheochromocytoma, hyperthyroidism or spontaneous hypoglycemia.
V. Differential diagnosis of anxiety disorders
1. Anxiety due to somatic diseases
Thyroid disease, heart disease, certain neurological diseases such as encephalitis, cerebrovascular disease, cerebral degenerative disease, systemic lupus erythematosus, etc. are prone to anxiety symptoms. Clinically, patients who are first diagnosed, old, without psychological stress factors and with good personality quality before the disease should be highly alert to whether anxiety is secondary to somatic diseases.
2.Pharmacogenic anxiety
Many drugs can cause typical anxiety disorders after intoxication, withdrawal or long-term application. For example, certain sympathomimetic drugs such as amphetamines, cocaine, caffeine, certain hallucinogens and opioids, long-term application of hormones, sedative-hypnotics, antipsychotics and so on. According to the history of taking medication can be identified.
3.Anxiety due to mental illness
Patients with schizophrenia can be accompanied by anxiety, as long as the symptoms of schizophrenia are found, the diagnosis of anxiety is not considered; depression is the disease most often accompanied by anxiety, when depression and anxiety are severely government primary and secondary indistinguishable, the diagnosis of depression should be considered first to prevent delayed treatment of depression and adverse consequences such as suicide; other neurological disorders accompanied by anxiety, anxiety symptoms in these diseases are often not the main clinical phase or are Secondary symptoms.
4.Depression
Unlike anxiety disorders, the anxiety of the former is necessarily related to his delusional notions such as suspicion and self-criminality, and melancholy is always present behind the anxiety attacks of such patients; if an anxiety attack occurs suddenly in a person who was originally well-adapted, depression should be considered first after excluding organic factors. When depression and anxiety are seriously indistinguishable in priority, the diagnosis of depression should be considered first to prevent delay in the treatment of depression and the occurrence of adverse consequences such as suicide.
Self-regulation methods of anxiety disorders
1.Maintain a good self-mindedness
The first thing is to be happy and content with your life. The second is to maintain mental stability, not to be overjoyed, to be broad-minded, to think about everything, to make their subjective thoughts constantly adapt to the objective development of reality. Do not try to make objective things into their own subjective thinking track, that is not only impossible, but also very easy to induce anxiety, depression, resentment, sadness, anger and other negative emotions. Again, we must pay attention to “anger”, do not easily lose temper.
2.Increase self-confidence
Self-confidence is the necessary prerequisite for curing nervous anxiety. Some people who do not have self-confidence in themselves are skeptical about their ability to accomplish and cope with things, and exaggerate the possibility of their own failure, thus worrying, stressing and fearing. Therefore, as a person with neurotic anxiety, you must first be confident and reduce your feelings of inferiority. You should believe that every time you increase your self-confidence, your anxiety level will decrease a little bit, and by restoring your self-confidence, you will also be able to finally banish your anxiety.
3.Self-direction
The elimination of mild anxiety relies mainly on the individual. When anxiety occurs, you must first realize that you are an anxious mind, face it squarely, and not use other reasons that you think are reasonable to cover it up. Secondly, you should build up confidence in eliminating the anxiety psychology, fully mobilize your subjective initiative and use the principle of attention shifting to eliminate anxiety in time. When your attention is shifted to something new, the new experience generated psychologically is likely to expel and replace the anxiety psychology, which is a method commonly used by people.
4.Self-relaxation
When you feel anxious and uneasy, you can use the method of self-awareness relaxation to regulate, and use the method of self-relaxation to release from the tension. Specifically, it is a conscious effort to behave in a fast, relaxed and confident manner. For example, you can sit still, close your eyes, and then begin to give yourself the command: “Relax your head, relax your neck,” until your limbs, fingers, and toes relax. Use the power of consciousness to relax your whole body, in a loose and quiet state, with the relaxation of the body, anxiety can slowly be calmed down, you can imagine yourself in the blue waves of the sea or the lake, bathed in warm sunshine, hear the sound of waves lapping the shore rocks, smell the fresh and pleasant air. Let your body and mind to get a comprehensive relaxation, abandon excessive anxiety.
5.Self-reflection
Some neurotic anxiety is due to the patient’s repression of certain emotional experiences or desires, repression to the unintentional, but it does not disappear, still lurking in the unconscious, so it produces the disease. At the onset of the disease, you only know the pain and anxiety, but you do not know the cause. Therefore, in this case, you must do self-reflection and tell the subconscious what is causing the pain. If necessary, you can vent, after venting the symptoms can generally disappear.
6, home remedies for you to regulate anxiety with good results. Liver depression multiplied by the spleen, the spleen is not healthy, the production of dampness gathered phlegm, the appearance of throat obstruction feeling (plum kernel gas):.
(1) the use of food considered to be both smooth and phlegm.
(2) Vegetables such as various bamboo shoots, mao bamboo shoots, winter melon, radish, fishy grass (now eaten as a wild vegetable), etc.
(3) Fruits such as oranges, pomelo, rutabaga, watermelon (including the skin) are good choices.
(4) seafood such as seaweed, sea cabbage, etc.
7, diet taboos
Diet is quite important, avoid cola, fried food, junk food, sugar, white wheat flour products, potato chips and other foods that can easily stimulate the body. Diet needs to be 50%-75% lettuce.
8. Avoid caffeine, cigarettes, alcohol and drugs
Alcohol, drugs may provide temporary relief, but the next day the tension comes back, and these substances themselves are also harmful to health. Therefore, you should learn how to adapt, rather than just rely on escape. When the body and mind face the persecution of tension and anxiety, it is important to eat properly. The right diet will strengthen the body and make the immune system and nervous system in good condition.