In general hospitals, whether in outpatient clinics or in wards, we encounter many patients who have persistent or phased anxiety, fear and tension that do not correspond to the reality, often accompanied by motor restlessness and various symptoms of physical discomfort such as chest tightness, chest pain, palpitations, etc., but no organic disease or primary organic disease can be found in accordance with the symptoms after various corresponding examinations. However, no organic disease or primary organic disease can be found in the examination, and the self-symptoms do not match the severity of the disease. Patients often consult the emergency department, neurology, cardiovascular department, gastroenterology department, etc. in general hospitals at the first sign of discomfort or with other physical symptoms. Due to the lack of understanding of the disease by most doctors, the disease is mostly treated as a physical disease, and is often misdiagnosed as acute myocardial infarction, myocarditis, coronary angina, hypertension, chronic gastritis, gastric neurosis, hyperthyroidism, cervical spondylosis, cerebral insufficiency, etc.
Extreme fear and tension, it turns out to be anxiety disorder
Mr. Wang, 37, is a department manager of a joint venture, under the influence of the financial crisis, due to poor sales performance, his psychological pressure increased sharply, irritable mood, and often insomnia. One night more than a month ago, he woke up suddenly in the middle of the night feeling extremely fearful, nervous, sweating profusely accompanied by obvious chest tightness, shortness of breath, choking sensation, dizziness, heart pain, pressure sensation in the chest area, rapid heartbeat, trembling, near-death fear and a sense of loss of control, and other painful experiences. 120 out to the hospital emergency department, the application of nitrates, aspirin and other drugs, the treatment is not effective, still have more frequent attacks, but the attacks He was treated with nitrates, aspirin and other medications, which were not effective, but he still had more frequent attacks, but his mental and physical strength were basically normal during the interval. There were no abnormal findings after multiple examinations such as electrocardiogram, complete set of blood biochemical items, blood and urine routine, chest X-ray and cardiac Doppler ultrasound. Since then, he has been depressed, with recurrent significant chest pain and episodes of chest tightness, and had three panic attacks within a month, rushing to the emergency department and cardiology department for each attack. He felt very painful because he could not stand it and could not get rid of it. He was always afraid of having another attack and repeatedly went to the hospital for various examinations without finding any problem. He was diagnosed as having panic attacks and was given anti-anxiety treatment. After the treatment, his symptoms subsided significantly and his condition stabilized.
What kind of disorder is anxiety disorder?
Anxiety disorders are commonly referred to as anxiety states, known as anxiety neurosis. It is a brain dysfunction with persistent anxiety, fear, tension and impaired vegetative activity, often accompanied by motor agitation and somatic discomfort.
The most prominent symptom of anxiety disorder is anxiety, which is a neurological disorder with anxiety as the main clinical phase, and this disease is very common abroad. A significant proportion of the neurological disorders diagnosed in China are also diagnosed as anxiety disorders in Western countries. The onset of the disease is in young adulthood, with the onset being more common before the age of 40.
In anxiety states, people tend to be irritable, nervous and restless, have a sense of fear, lack of concentration, memory loss, difficulty sleeping and insomnia; accompanied by physical symptoms, dizziness, chest tightness, palpitations, shortness of breath, pain, sweating, indigestion and gastrointestinal disorders. Anxiety is a psychological phenomenon, and moderate anxiety is beneficial while excessive anxiety can become a disease.
What is generally considered anxiety can be broken down into different disorders such as panic disorder, social anxiety, post-traumatic stress disorder, generalized anxiety, and obsessive-compulsive disorder, but they all have some of the same symptoms. Anxiety is generally classified into two types: acute anxiety, also known as panic attacks, and chronic anxiety, also known as generalized anxiety disorder. Their clinical manifestations are not consistent.
In acute anxiety, the onset is sudden and the patient has an unspoken sense of inner tension and fear. The main manifestations of the attack are extreme fear, nervousness, with vegetative dysfunction, dilated pupils, profuse sweating, dizziness and fainting, difficulty in breathing, chest tightness, chest pain, palpitations, a violent heartbeat and even a feeling of “heart jumping into the throat”, a sense of urgency in urination and defecation, numbness in the limbs, and even uncontrollable shivering and sweating. The patient is terrified, as if “a great disaster” or “death is coming”, “loss of self-control” experience, with a sense of near death. It usually peaks in 10 minutes and lasts 20 to 30 minutes. It often occurs suddenly and resolves on its own. Patients have at least three panic attacks in a month, or the first attack is followed by a month of anxiety for fear of another attack.
With the transformation and development of society, the intensification of competition and the accelerated pace of people’s lives, it is easy to develop anxiety under pressure due to uncertainty about the future. If you have a sensitive personality and pay too much attention to your own changes, you are especially prone to “acute anxiety”, which has been growing rapidly in recent years, mostly in young and middle-aged people.
The symptoms of acute anxiety are similar to those of heart block and angina pectoris, and the patient feels inexplicable fear during the attack. It is often misdiagnosed as an acute physical illness such as heart disease. If a patient often has sudden heart pain, sweating all over the body, or even extreme fear, nervousness, difficulty in breathing, or even a very fast heartbeat or even a feeling of “heart beating in the throat”, but the heart is fine when examined in the hospital, we should consider the “high pressure” caused by Acute anxiety.
Chronic anxiety, which is more common than acute anxiety, is a disproportionate nervousness, fear and panic, accompanied by autonomic symptoms of somatic discomfort or motor anxiety, and is a kind of fear or anxiety that cannot be controlled by oneself, often or continuously without a clear object or fixed content. The patient’s social functioning is often impaired, and the duration of the illness has been at least 6 months because it is unbearable and cannot be relieved.
Patients with mild anxiety disorder often cannot face various social situations losing friends and easily losing opportunities for study, work and promotion. Severe cases can affect family relationships and can even lead to functional disability.
What diseases need to be distinguished from anxiety disorders?
1, heart disease: chest pain, palpitations and sweating that occur during panic attacks are easily misdiagnosed as acute myocardial infarction, which can be identified by physical examination, attack time, triggering factors and electrocardiogram examination. It is worth noting that mitral valve prolapse can be accompanied by panic attacks.
2, hyperthyroidism: anxiety symptoms associated with hyperthyroidism, after treatment, anxiety symptoms improve with the recovery of thyroid function. Persistent anxiety should be considered as chronic anxiety disorder.
3, dysthymia: emotional attacks of dysthymia are easily confused with panic attacks, the former with strong emotional color, crying and laughing unpredictably and variable emotions; the latter with strong and uncontrollable anxiety and tension as the main characteristics.
4, depression: often accompanied by anxiety. Depression is characterized by low mood, low interest, poor self-esteem, low self-esteem, reduced ability and negative perceptions; anxiety disorders are characterized by a premonition of future misfortune or a threat that does not exist and tension and fear.
Anxiety disorders are easily misdiagnosed as: (1) myocarditis: but no change in myocardial enzyme profile; (2) paroxysmal tachycardia: the cause is unknown; (3) cardiac neurosis; (4) chronic gastritis and gastric neurosis; (5) menopausal syndrome; (6) phytonadic disorders: including cardiac and gastric neurosis and neurosis of various organs; (7) neurasthenia.
How should anxiety disorders be treated?
The most effective treatment for anxiety disorders is currently recognized as medication, mainly anti-anxiety drugs (such as benzodiazepines) and antidepressants (such as paroxetine). The traditional anti-anxiety medications are benzodiazepines such as lorazepam and alprazolam. Although benzodiazepines are commonly used in the treatment of anxiety, they are no longer used as first-line drugs because they can cause excessive sedation, addiction, withdrawal symptoms and psychomotor impairment, etc. They are replaced by newer antidepressants with better safety profiles, namely 5-hydroxytryptamine reuptake inhibitors (SSRIs) and 5-hydroxytryptamine and norepinephrine reuptake inhibitors (SNRIs). (SNRIs). Antidepressants that have both antidepressant and anxiolytic effects, such as Dextran, may also be used.
Treatment of anxiety disorders can also be actively supplemented with psychotherapy. The main treatment is supportive psychotherapy. We should care for patients with sympathy, explain the nature of the disease scientifically, make patients understand the nature of the disease, relieve their psychological burden, and enhance their confidence in treatment. ②Psychoanalytic treatment: Because psychoanalysis attributes the cause of anxiety disorders to repressed unconscious conflicts, psychoanalytic treatment of anxiety disorders is to help patients comprehend the root cause of their inner psychological conflicts. ③Behavioral therapy: such as relaxation training and systematic desensitization techniques. ④Cognitive therapy: change the patient’s cognitive style. ⑤ Encourage patients to actively participate in cultural and physical activities, including listening to relaxing music, playing ball, and dancing, which can quickly reduce anxiety.
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Anxiety is all around us ……
Anxiety disorders are common in general hospitals and have become a disease with high incidence, low recognition and diagnosis rates, high untreated rates, a public health hazard, and a cause of serious functional impairment and social burden.
Nearly one quarter of patients attending general hospitals present with anxiety/depressive symptoms. This information comes from a survey conducted by Professor Xu Biao at the School of Public Health, Fudan University, titled “A Study on the Prevalence of Depression, Anxiety and Depressive-Combined Anxiety Symptoms in Chinese Urban Non-psychiatric Patients”. By surveying patients in four general departments of neurology, gastroenterology, cardiovascular medicine and obstetrics and gynecology in 12 tertiary general hospitals in Beijing, Chengdu, Guangzhou and Shanghai, the results of the study showed that.
— Anxiety was prevalent among patients in the neurology, cardiovascular, and gastroenterology departments of general hospitals, with 20%-25% of patients experiencing anxiety/depression symptoms, and the prevalence of female patients was higher than that of male patients.
— The rate of anxiety diagnosis and treatment in general hospitals is very low. The rate of correct diagnosis of anxiety disorders is only 0%-5.7% and the rate of anti-anxiety treatment is only 0%-5.7%.
The prevalence of anxiety disorders in general hospitals implies that physicians in general hospitals should adequately consider the presence of anxiety and screen it out in early differential diagnosis, thereby reducing patient suffering and risk of death.
Appendix: Hamilton Anxiety Inventory (HAMA)
The Hamilton Anxiety Inventory (HAMA) is a common anxiety scale used by physicians, which is a good measure of treatment effectiveness, fairly consistent, moderate in length, easy to use, and applicable to adults with anxiety symptoms. It includes 14 items and uses a 5-point scale of 0~4. That is: (0) asymptomatic; (1) mild; (2) moderate; (3) severe; (4) very severe.
1, anxious state of mind: worry, worry, feel that the worst thing is going to happen, easily provoked.
2, tension: tension, easy fatigue, can not relax, easy to cry, trembling, feel uneasy.
3, fear: fear of the dark, strangers, alone, animals, car or travel and crowded occasions.
4.Insomnia: difficulty falling asleep, waking up easily, not sleeping deeply, excessive dreaming, nightmares, night terrors, feeling tired after waking up.
5, cognitive function: inability to concentrate, poor memory, or memory, attention disorders.
6.Depressed mood: loss of interest, lack of pleasure in past hobbies, depression, early awakening, heavy daytime and light nighttime.
7, muscular system symptoms: muscle pain, inflexibility, muscle twitching, limb twitching, teeth chattering, voice trembling.
8.Sensory system symptoms: blurred vision, chills and fever, weakness and tingling.
9.Cardiovascular system symptoms: tachycardia, palpitations, chest pain, vascular throbbing sensation, fainting sensation, heartbeat leakage.
10.Respiratory system symptoms: chest tightness, choking sensation, sighing, difficulty in breathing.
11.Gastrointestinal symptoms: difficulty in swallowing, belching, indigestion (abdominal pain after eating, burning pain in the stomach, bloating, nausea, feeling of fullness in the stomach), intestinal tinnitus, diarrhea, weight loss, constipation.
12. Genitourinary system symptoms: frequent urination, urinary urgency, menopause, sexual frigidity, premature ejaculation, erectile inability, impotence.
13. symptoms of the vegetative nervous system: dry mouth, flushing, pallor, easy sweating, easy to get “goose bumps”, tension headache, hair erection.
14. Behavioral manifestations during the interview: (1) General manifestations: nervousness, inability to relax, apprehension, finger biting, clenched fist, etc. (2) Physiological manifestations: swallowing, beating, rapid heart rate and rapid breathing (more than 20 times/minute) during quiet time, etc.
Analysis of results :
Total score >14, can be considered as having definite anxiety; >7, may have anxiety; <6, no anxiety.