Anxiety disorders, also known as anxiety neurosis, are the most common of the broad category of neurological disorders and are characterized by the experience of anxious emotions. It can be divided into two forms: chronic anxiety (generalized anxiety) and acute anxiety attacks (panic disorder). The main manifestations are: nervous worry without a clear objective object, fidgeting, and vegetative symptoms (palpitations, hand tremors, sweating, frequent urination, etc.).
Clinical manifestations
Chronic anxiety (generalized anxiety)
(1) Emotional symptoms without obvious triggers, patients often have excessive worry, nervousness and fear that do not match the reality of the situation, and this kind of nervousness and fear often has no clear object or content. Patients feel that they are in a constant state of nervousness, anxiety, fear, dread and apprehension.
(2) Vegetative symptoms: dizziness, chest tightness, panic, shortness of breath, dry mouth, urinary frequency, urinary urgency, sweating, tremor, and other physical symptoms.
(3) Motor restlessness fidgeting, restlessness, irritability, and difficulty in quieting the mind.
Acute anxiety attack (panic attack, panic disorder)
(1) A sense of near-death or loss of control In normal daily life, the patient is almost like a normal person. Once the attack occurs (some have specific trigger situations, such as enclosed spaces), the patient suddenly appears extremely fearful and experiences a sense of near-death or loss of control.
(2) The symptoms of the vegetative nervous system appear simultaneously, such as chest tightness, panic, dyspnea, sweating, and general shaking.
(3) The seizure usually lasts for a few minutes to a few hours and starts abruptly, with clear consciousness during the seizure.
(4) It is very easy to misdiagnose the attack, and patients often call “120” emergency number and go to the emergency department of cardiology. Although the patient appears to have severe symptoms, most of the relevant tests are normal, so the diagnosis is often unclear. After an attack, patients are still extremely fearful and worried about their condition, so they often go to various departments of major hospitals and undergo various tests, but the diagnosis cannot be confirmed. Both delayed treatment and caused a waste of medical resources.
Phobias (including social phobia, place phobia, and specific phobias)
The core manifestation of phobias is the same as acute anxiety attacks, which are panic attacks. The difference is that anxiety attacks in phobias are caused by certain specific places or situations that do not cause anxiety when the patient is not in those specific places or situations. Examples include fear of social situations or human interaction, or fear of certain 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.
Treatment
Anxiety disorders are among the neurological disorders that are relatively well treated and have a good prognosis. Psychotherapy and medication are usually used.
Medication
Doctors usually consider a combination of factors such as the patient’s condition, physical condition, and economic situation. It is generally recommended to take medication for about 1 to 2 years. Please consult your doctor for discontinuation and dosage increase, and do not adjust your medication regimen on your own. While taking the medication, pay attention to keep in touch with your doctor and address any side effects or other problems in a timely manner.
(1) Benzodiazepines (also known as tranquilizers)
(1) Advantages: fast onset of action, mostly within 30 to 60 minutes; positive anti-anxiety effect; cheaper.
②Disadvantages short duration of effect, not suitable for long-term use in large quantities; may produce dependence. Commonly used drugs: lorazepam (lorazepam), alprazolam, 2 to 3 times a day. Belong to the short and medium-acting tranquilizers, anxiolytic effect is good, sedative effect is relatively weak, the impact on daytime work is small. The principles of use: the principle of intermittent medication, temporary oral when anxiety is severe, should not be taken for a long time in large quantities; the principle of small doses, a small dose works without a large dose; the principle of regular drug changes, if the condition requires long-term use, 3 to 4 weeks to replace another kind of tranquilizer, can effectively avoid the emergence of dependence; when changing medication, the original drug slowly reduce, the new plus slowly add the drug. If the patient is older, the dose is not too large and the efficacy is good, the medication can be changed without changing. As long as the dose of Valium does not increase, within the normal range, and the efficacy does not diminish, it can be considered that there is no dependence.
(2) Antidepressants are used because the cause of anxiety can lead to disorders in the body’s neuroendocrine system and imbalance of neurotransmitters, while antidepressants can normalize the imbalanced neurotransmitters, so that the anxiety symptoms disappear and the mood returns to normal.
① Commonly used treatment drugs for generalized anxiety are paroxetine (Celerity), escitalopram (Lysop), venlafaxine (Boloxin, Enoxil), Dexedrine, etc.
(2) The drugs commonly used to treat panic attacks are paroxetine (Celerity), escitalopram, clomipramine, etc.
(3) The characteristics of these drugs are: positive anxiolytic effect, fundamental improvement of anxiety, non-addictive, suitable for long-term use, slow onset of anxiolytic effect, 2-3 weeks after the onset of effect, often need to be combined with short-term use of tranquilizers, expensive.
Psychotherapy
Psychotherapy means that clinicians establish a good doctor-patient relationship through verbal or non-verbal communication, and apply professional knowledge about psychology and medicine to guide and help patients change their behavior and cognitive coping styles. Medication is the symptom, and psychotherapy is the root of the problem, one cannot be without the other.
There are also psychotherapy biofeedback therapy and relaxation therapy suitable for patients with anxiety disorders, etc.
The earlier the diagnosis and the earlier the treatment, the better the prognosis of anxiety disorders. After specialized treatment, most patients will recover clinically and regain their happy mood.
It should be especially emphasized that after the symptoms are relieved, it is still necessary to insist on taking antidepressant medication for 1 to 2 years; to stop or reduce the medication, it is necessary to consult a specialist, and never adjust the medication treatment plan without authorization.