Anxiety and Anxiety Disorders
Anxiety is an internal disturbance or unfounded fear that lacks an obvious objective cause, and is a normal emotional response that occurs when people encounter certain things such as challenges, difficulties or dangers.
When the severity of anxiety does not clearly match the objective event or situation, or lasts too long, this is pathological anxiety, called anxiety symptoms, and can be diagnosed as anxiety disorder when the relevant diagnostic criteria are met.
Anxiety disorder, also known as anxiety neurosis, is a mood disorder characterized by persistent tension, worry, fear or episodes of panic, accompanied by behavioral features such as symptoms of the vegetative nervous system and motor disturbances. It can be divided into two categories: generalized anxiety and panic attacks.
Anxiety disorders are the most common mood disorder in the population, with WHO studies showing a lifetime prevalence of 13.6%-28.8% in the population, with 90% of patients developing the disorder before the age of 35, often more in women than men. Although the prevalence of anxiety disorders is not low, the intervention rate is low, with only 6.1% of patients with anxiety disorders in China receiving proper treatment.
Classification and characteristics of anxiety disorders
Some patients with anxiety or depression may present with symptoms such as chest pain and palpitations, and are often seen frequently for complaints of cardiovascular disease, with no improvement after multiple treatments and frequent changes of physicians, and do not easily accept negative test results.
Therefore, chest pain (somatic discomfort) is sometimes a somatic manifestation of a mental disorder.
In patients with unexplained chest pain, where examination does not reveal serious pneumatological lesions, physicians must pay attention to screening for psychogenic etiology (Table).
Table Classification and characteristics of anxiety disorders
Typical symptom onset characteristics
Acute anxiety attack (panic attack)
・When the patient is carrying out daily activities (such as reading a book, eating a meal, taking a walk, having a meeting, or doing housework), a strong, unbearable feeling of fear suddenly appears, accompanied by palpitations, chest tightness, a feeling of pressure in the anterior chest area, or a manifestation of dyspnea, throat blockage, and a strong feeling of suffocation;
Patients may scream, call for help, or run outside due to unbearable symptoms, and may experience hyperventilation, dizziness, facial flushing, excessive sweating, unsteady gait, tremor, numbness of hands and feet, gastrointestinal discomfort, and other vegetative symptoms, as well as motor restlessness;
The attack usually lasts 5 to 20 min and can resolve on its own. After the relief, the patient feels normal, but it can suddenly recur soon.
The attack is very similar to coronary artery disease, and the patient often calls “120” for emergency treatment due to a strong sense of fear, and is seen in the emergency department of cardiology;
Although patients seem to have severe symptoms, most of the relevant tests are normal, so the diagnosis is often unclear, resulting in a high rate of misdiagnosis of acute anxiety attacks;
Because of the unpredictability of the attack, most patients are anxious about having another attack during the interval and show symptoms of hyperactive vegetative nerves. 60% of these patients actively avoid certain activities (refusing to go out alone, going to crowded places, traveling by car, or having to be accompanied by others when going out, etc.) because of the fear of not getting help during an attack.
Generalized anxiety (GAD)
GAD is a chronic anxiety disorder characterized by persistent and significant tension and anxiety with autonomic arousal and hypervigilance. Patients often have a characteristic appearance, such as distorted facial muscles, frowning, tense posture, fidgeting and even trembling, pale skin, sweaty palms, feet and armpits;
GAD is often accompanied by dizziness, chest tightness, panic, shortness of breath, dry mouth, frequent urination, urgent urination, sweating, and tremor;
GAD is often associated with stressful life events, especially threatening events such as interpersonal problems, physical illness, and work problems.
Motor restlessness: rubbing hands and feet, walking back and forth, nervousness, inability to sit still, tremors of eyelids, facial muscles or fingers, or patients may feel trembling; some patients may have double frowning, facial and limb muscles are tense, painful, or feel muscle twitching, and often feel tired and weak;
Physical manifestations: symptoms are variable and may include hyperventilation, inspiratory difficulties, and a series of physical symptoms caused by hyperventilation; vertigo is a feeling of instability rather than spinning; some patients report blurred vision, but physical examination reveals normal vision; anxiety headache is often distended or tight, mostly bilateral, with occipital and frontal lobes more common; in addition, shoulder and back pain is also more common.
Phobia (social phobia, place phobia, specific phobia) ・ refers to a type of psychological disorder in which the patient has intense fear when exposed to a specific thing or situation, resulting in avoidance behavior, and is accompanied by anxiety symptoms and vegetative neurological dysfunction.
The core manifestation of phobias is panic attacks like acute anxiety attacks; the difference is that anxiety attacks in phobias are caused by certain specific places or situations, and they do not cause anxiety when not in those specific places or situations;
The onset of anxiety in phobias is often predictable, and patients tend to adopt avoidance behaviors to avoid anxiety attacks.
Prognosis of the disease
The prognosis for anxiety disorders is often good, and the majority of patients will recover after treatment.
General practitioners should pay more attention in their work, refer patients with difficult conditions and suspected psychiatric etiology to mental health centers for consultation and treatment, and strengthen the follow-up of patients after consultation and treatment to improve patient compliance with treatment.