Classification of disorders
Anxiety disorders can be of many types, and according to the patient's clinical manifestations, anxiety is often classified as:
1) Generalized anxiety: in the absence of obvious triggers, patients often appear to be excessively worried, nervous and afraid, but the nervousness and fear often do not have a clear object and content. In addition, patients are often accompanied by dizziness, chest tightness, panic, shortness of breath, dry mouth, frequent urination, urinary urgency, sweating, tremor and other somatic symptoms, and this kind of anxiety usually lasts for several months.
2) Acute anxiety attack (also known as panic attack): In a normal daily life environment, there is no fearful situation, the patient suddenly develops extreme fear of tension, accompanied by a sense of near death or a sense of loss of control, and at the same time, there are obvious symptoms of the vegetative nervous system, such as tightness in the chest, panic attacks, shortness of breath, sweating, and generalized trembling, which usually lasts from a few minutes to a few hours. The attack starts suddenly and peaks quickly, and the person is conscious during the attack. Attention! The onset of this type of anxiety is episodic and unpredictable. Because the clinical presentation of an acute anxiety attack is very similar to that of a coronary heart attack, patients often call "120" and go to the emergency department of cardiology. Although patients seem to have severe symptoms, most of the relevant test results are normal, so the diagnosis is often unclear, making the misdiagnosis rate of acute anxiety attacks higher, which both delayed treatment and caused a waste of medical resources.
3) Phobias (including social phobia, place phobia, and specific phobias): The core manifestation of phobias is a panic attack, just like acute anxiety 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. Examples include fear of social situations or human interaction, or fear of certain 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 just afraid to take the subway or bus, as long as she takes the above transportation, she will have an anxiety attack, extremely painful, in order to avoid anxiety attacks, she took a cab to and from work, because by cab she is fine.
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 a **** same point, that is, anxiety symptoms are prominent. [2-4]
Clinical manifestations of the most common population
Anxiety disorders can be said to be the most common mood disorders in the population, the World Health Organization's research shows that the lifetime prevalence of anxiety disorders in the population is 13.6%-28.8%, 90% of patients with anxiety disorders develop before the age of 35 years old, and there tend to be more women than men. China's lack of national survey information on anxiety disorders, Hebei, Zhejiang and several other provinces, the survey shows: the prevalence of anxiety disorders in 5% -7%, according to which it is estimated that there are about 50 million or more people with anxiety disorders in the country.
Disease Symptoms
First of all, the definition of anxiety disorder. Anxiety is an unpleasant, distressing emotional state accompanied by a somatic experience of discomfort. Anxiety disorders are a group of mood disorders in which anxiety symptoms are the main clinical phase, and often contain two sets of symptoms:
1) Emotional symptoms The patient feels that he or she is in a kind of nervousness, uneasiness, trepidation, fear, fear, apprehension of the inner experience. What is the tension and fear? Some people may clearly state the object of fear, and some people may not be able to say what to be afraid of, but just feel afraid;
(2) physical symptoms The patient's nervousness is often accompanied by autonomic hyperfunctioning manifestations, such as panic, shortness of breath, dry mouth, sweating, trembling, flushing, and so on, and sometimes there is a sense of imminent death, the heart is very difficult to feel that he is going to die, and when there is a sense of loss of control, there is a sense of loss of control of the seriousness. It is not a good idea to have a sense of loss of control.
Disease Hazard
If you don't get timely and correct diagnosis and treatment, anxiety patients will repeatedly visit the doctor, seriously affecting the patient's normal life and work, but also cause a huge waste of health care resources, some studies show that the medical cost of anxiety patients is nine times that of the general population. One patient, who had an acute anxiety attack, repeatedly dialed "120" emergency because the performance of anxiety attacks and coronary heart disease is extremely similar to the anxiety attack patients were mistaken for a coronary heart attack, and cardiography. It can be said that anxiety disorders bring great pain and burden to both individuals and families.
Are anxiety disorders treated well? Unfortunately, due to a general lack of common knowledge about mental health, including anxiety disorders, the vast majority of people with anxiety disorders do not receive timely and correct treatment. Research by the World Health Organization shows that only 6.1% of anxiety disorder patients in China receive proper treatment, while the treatment rate in the United States is 42%. Being a psychiatrist is a big responsibility. [1][5][4]
Diagnosis
The psychiatrist's diagnosis of anxiety disorders is based on the patient's medical history provided by the family (duration of illness, bad behavior, etc.), psychiatric examination (results of the examination are obtained by talking to the patient), physical examination, scale measurements, and laboratory ancillary tests.
Diagnosing an anxiety disorder 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 a psychiatrist for a systematic examination. Of course, there will be some error in the psychological test, this test is considered as a screening, high scores do not necessarily mean anxiety, but more than moderate anxiety, it is recommended that you go to the doctor to see a differential diagnosis is better.
Attachment: Self-Assessment Scale for Anxiety (SAS)
Anxiety is a common mental experience, and those who experience anxiety over a long period of time are prone to develop an anxiety disorder. This scale consists of 20 items rated on a 4-point scale.
Please read the following carefully and click in front of the appropriate number to indicate how you have actually felt in the last week. For self-assessment of current major emotional and somatic symptoms please select according to the level of self-perceived symptoms. All questions are *** with answers, please put a tick under A, B, C and D. Each question is limited to one answer.
Answers:A: none or very little of the time; B: a small amount of the time;
C: quite a lot of the time; D: the vast majority or all of the time
1. I feel and usually am easily tense and anxious A. B. C. D.
2. I feel frightened for no apparent reason A. B. C. D.
3. I am easily disturbed in my mind or feel I feel that I may be going crazy A. B. C. D.
5. I feel that everything is fine A. B. C. D.
6. I have shaking and trembling in my hands and feet A. B. C. D.
7. I suffer from headaches, headache, neck pain, and back pain A. B. C. D.
8. I feel I feel easily weakened and tired A. B. C. D.
9. I feel calm and can sit quietly easily A. B. C. D.
10. I feel that my heart beats fast A. B. C. D.
11. I suffer from bouts of dizziness A. B. C. D.
12. I have episodes of fainting or I feel like I am about to faint A. B. C. D.
12. I have a feeling that I will 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 pains and indigestion A. B. C. D.
16. I often have to pee A. B. C. D.
17. My hands often I often have to urinate A. B. C. D.
17. my hands are wet A. B. C. D.
18. I blush and get hot A. B. C. D.
19. I fall asleep easily and sleep well through the night A. B. C. D.
20. I have nightmares A. B. C. D.
The scoring: Forward-scoring questions A., B., C., and D are scored on a scale of 1, 2, 3, and 4; Reverse-scoring questions A., B, C, D by 4, 3, 2, 1 points, reverse scoring question number: 5, 9, 13, 17, 19. 20 items of the scores add up to the total score, and then multiplied by 1.25 to take the integer, that is, the standard score,
Below 50 points for normal; 50-60 points for mild anxiety; 61-70 points for moderate anxiety, more than 70 points for severe anxiety, moderate or higher anxiety recommended psychiatric consultation. Specialist consultation to rule out anxiety disorders.
Another commonly used anxiety scale is the Hamilton Anxiety Scale, which is measured by a doctor, and the Social Anxiety Scale. [3-4]
Disease Treatment
Anxiety disorders are mood disorders that are better treated and have a good prognosis, so there is no need to be overly concerned even if you are diagnosed with an anxiety disorder. Treatment for anxiety disorders usually includes medication and psychotherapy.
Medication
1. Benzodiazepines (also known as Valium)
1) Advantages: ①Fast-acting, mostly within 30-60 minutes
②Anxiolytic effect is certain
③Generally less expensive
2) Disadvantages: ①Short-lasting effect, unsuitable for long-term large-scale use
②There is a possibility of dependence. Valium drugs anti-anxiety, like a car too fast, with the foot on the brakes, works but is not suitable for common use.
3) commonly used drugs: lorazepam (lorazepam): the common dose is 2-3 times a day, each time 0.5-1.0mg; Jiajingjing Valium (also known as alprazolam): the common dose is 2-3 times a day, each time 0.4mg; oxazepam tablets (also known as Ufi): the common dose is 2-3 times a day, each time 15mg, these three drugs belong to the short-medium-acting stabilizers. These three drugs are short- to medium-acting tranquilizers with good anti-anxiety effects and relatively weak sedative effects, which have less impact on daytime work. In fact, all the valium drugs can be anti-anxiety, only the side effects and the effect is different, the above three drugs are more commonly used.
Small knowledge: where the drug is followed by so-and-so diazepam or so-and-so zolium, are valium drugs.
4) How to use valium drugs:
①The principle of intermittent medication: temporary oral when anxiety is severe, not long-term large quantities.
②Small dosage principle: small dosage works without large dosage
③Principle of regular change of medication: If the condition requires long-term use of Valium anti-anxiety drugs, 3-4 weeks to change to another Valium drug, can effectively avoid dependence on the generation of. Note that when changing medication, the original drug is slowly reduced, and the new drug is added slowly, and after the two drugs have been taken for a period of time, the original drug is withdrawn, and the new drug is added to the therapeutic amount. If the patient's age, the dose of the drug is not big, the efficacy of the better, but also can not change the drug, as long as the dose of Valium drugs do not increase in the normal range, the efficacy of the drug is not weakened, it can be considered that there is no dependence.
Experts remind:
In the early treatment of anxiety disorders should be used as soon as possible in sufficient quantities of valium anxiolytics, in order to control anxiety as soon as possible, because antidepressant drugs to play the role of anxiolytics, often need to be 2-3 weeks, if not as soon as possible to control the symptoms of anxiety, if it will be adversely affected by the recovery of the disease. The tranquilizers can be slowly tapered down to discontinuation after 4-6 weeks of taking them.
If you stop taking Valium, slowly reduce the dosage until you stop taking it, do not stop taking it suddenly, otherwise it will easily cause a withdrawal reaction and aggravate your condition.
2. Antidepressants
If you compare anxiety to a car going too fast, then antidepressants are a way of letting off the gas, which can radically improve anxiety, 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, which can alleviate anxiety and radically treat anxiety. The guidelines for the treatment of anxiety disorders in the United States and China clearly state:
1) Generalized anxiety: the first-line treatment drugs are: paroxetine (Seroquel), escitalopram (Lysop), venlafaxine (Bolerxin, Enox). The second-line drug of choice is duloxetine.
2) Panic attack:First line drug is paroxetine (Seroquel), escitalopram, second line drug is clomipramine.
3) Social anxiety (social terror): first-line drugs are paroxetine (Seroquel), buspirone, and second-line drugs are escitalopram, sertraline, and venlafaxine.
First-line drug means the first choice, with clear efficacy; second-line drug means the second choice if the first-line drug is not effective. Through the treatment guidelines, it can be seen that Seroquel is the first line drug for all kinds of anxiety, and it is the drug of choice for all kinds of anxiety. It is followed by escitalopram, duloxetine and venlafaxine, which also work well.
The characteristics of these drugs are:
1) Advantages: ①Anxiolytic effect is certain
2) Improvement of anxiety from the root
3) Non-addictive, suitable for long-term use.
2) Disadvantages: ①Anxiolytic effect is slow, 2-3 weeks after the onset of effect, often need to be combined with short-term valium drugs.
2) Expensive.
Doctors will usually consider the patient's condition, physical condition, and financial situation, depending on which drug is being used.
Experts remind:
1) In the early stages of taking the drug anxiety may worsen, related to the side effects of the drug, usually in 2 weeks after the disappearance. Note that when you start taking the drug, the dose is small, and slowly increase the amount, anxiety is obvious, the timely addition of valium drugs 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 if you want to stop taking the medication or increase the dosage, and do not adjust your medication regimen on your own.
3) Side effects may occur while taking the medication, so don't panic and consult your doctor in a timely manner. 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 program.
4) Individualized differences in psychiatric drugs means that different patients, with the same diagnosis, the same age and gender, and similar physical condition, have significant differences in the effects of drug therapy. The dose of the drug that works, the side effects of the drug will also use a big difference. Patients taking medication, pay attention to keep in touch with the doctor, problems arise in a timely manner, do not be afraid of the side effects of drugs, you can work together to find ways to solve it.
Combined with the clinical experience of medication, review of these drugs:
1) Paroxetine tablets: the trade name of Sailot, Leyou, etc., belonging to the SSRI class of drugs, the role of the 5-HT system, the commonly used dose of 20-60mg / day, a single dose can be used, the anxiolytic effect of the outstanding, is the first choice of drugs for the treatment of all types of anxiety disorders, because it is really good efficacy, especially in the It is the first choice for the treatment of all types of anxiety disorders, because it is really effective, especially in the treatment of anxiety disorders, and when other drugs are not effective, switching to Seroquel can still be effective. Therefore, it is clearly indicated as the drug of choice for all types of anxiety disorders in the guidelines for the treatment of anxiety disorders. A little experience of application: when you start taking Sylocet, take half a tablet at first, and then increase it to 1 tablet after a few days. If you stop taking the drug, slowly reduce the dosage, do not stop taking Sylocet at once. Individual patients have a certain sedative effect after taking the drug, can be put into the evening medication, usually in the morning; individual patients will have a transient high blood pressure, hypertensive patients need to monitor blood pressure.
2) Escitalopram: the commercial name of Lysop, Bai Lote, also belongs to the SSRI class of drugs, the role of the 5-HT system, the common dose is 10-20mg/day. Anti-anxiety effect is good, the side effects are small is its advantages, especially suitable for the elderly and patients with cardiovascular disease, the price is expensive.
3) Venlafaxine: the trade name is Einos, Bolexin, there are extended-release formulations as well as immediate-release formulations. The drug is a dual-receptor action of the drug, the action of 5-HT and NE two neurotransmitters, the common dose is 75-225mg/day . Antidepressant and anxiolytic effects are good. Note that there is a possibility that in the initial period of taking the drug anxiety will worsen, the need to add valium drugs, usually lasts for two weeks most of the disappearance.
4) Duloxetine: the trade name of Xinbaida, OSPIN, there are slow-release preparations and immediate-release preparations, the same is also the principle of dual-receptor action of the drug, the role of 5-HT and NE two neurotransmitters, the common dose of 60mg/day, the most important characteristic of this drug is the degree of dual-receptor action has its own advantages, antidepressant, anxiolytic effect is relatively good.
Drugs like sertraline, lancet, xipramine, fluoxetine, and clomipramine are often used as second tier drugs.
3. Buspirone, tandospirone
belongs to the 5-HT-1A agonist, good for social anxiety, no dependence, the disadvantage is that the effect is slow, 2-3 weeks to see the effect, if the patient first took the valium class of drugs, and then take buspirone, the effect is more than not ideal, you can be used in conjunction with antidepressants.
4. Other drugs
1) Acute anxiety attacks can be considered to take propranolol (cardioplegia) 10-20mg, temporary use, can improve symptoms.
2) Tricyclic drugs: such as chlorpromazine, amitriptyline, etc., the efficacy of the drug is good, the price is cheaper, but the side effects of the side, is not the first choice of drugs.
3) Derexin: not commonly used in this drug, the efficacy of the general, pharmacological advantage is not much, it is an antipsychotic drug and an antidepressant mixture.
As for which drug is suitable for each patient, it is necessary to take into account the patient's condition, previous experience with the drug, the efficacy of the drug, the patient's tolerance of the drug and side effects, but also consider the patient's financial situation, and make a decision after comprehensive consideration. At the same time, it is also necessary to closely follow up with the patient, adjust the treatment program at any time, so that the patient gradually towards recovery.
Psychotherapy
Psychotherapy is the process by which the clinician establishes a good doctor-patient relationship with the patient through verbal or non-verbal conversation, and applies knowledge of psychology and medicine to guide and help the patient to overcome and correct poor lifestyle, behavioral habits, emotional disorders, cognitive biases, and adaptation problems. Medication and psychotherapy are the two legs to help patients with anxiety disorders recover, medication is the snow, essential; psychotherapy is the icing on the cake, will allow patients to further recovery, but also very important.
So, what is the most appropriate person to seek psychotherapy?
(1) Psychiatrists There are some psychiatrists whose specialty is psychotherapy, and it is most appropriate to find these psychiatrists to do psychotherapy because they are the most competent psychiatrists. Other psychiatrists may not specialize in psychotherapy, but they can also do psychotherapy, like supportive therapy, cognitive therapy, etc.;
(2) Clinical psychologists People who have knowledge of clinical psychology, such as psychotherapists in hospitals.
Psychotherapies suitable for anxiety disorders are: supportive therapy, behavioral therapy, cognitive therapy, biofeedback therapy, and so on.
Here is a relaxation treatment for you:
Relaxation training is to achieve psychological relaxation through physical relaxation, the more simple such as deep breathing: when anxious, close your eyes, slowly inhale through the nose and exhale through the mouth and nose, repeated three to five times. You can also use meditation: that is, consciously think of a happy thing, try to be real and specific. Excessive tension, anxiety, first gently close your eyes, the whole body to relax, do a few even and rhythmic deep breathing, repeated self-suggestion: "do not rush", "relax, relax", after a few minutes, the mood will be smooth. [1-2][5]
Disease prognosis
Anxiety disorders tend to have a better prognosis, and after treatment, the vast majority of patients will recover and regain their old smiles, with special attention to be paid to the fact that, after the symptoms are relieved, it is recommended that medication be taken for about 1-2 years. Various types of anxiety disorders, need to adhere to a period of time to take antidepressants; stop as well as increase or decrease the amount of medication, please consult your doctor, do not adjust the medication regimen on your own to avoid aggravating the condition. [3]
Expert opinion
1, anxiety disorders are the most common mood disorders, which can be treated, prevented and have a good prognosis.
2, anxiety disorders need to be treated with medication under the guidance of a psychiatrist, and after the symptoms are relieved, you still need to stick to the medication for a period of time, and not to stop the medication on your own. With the psychotherapy, for the recovery of anxiety disorders, the effect is better.
3, Sylate is a first-line drug for the treatment of anxiety disorders, excellent efficacy, suitable for all types of anti-anxiety drugs. Escitalopram, duloxetine, venlafaxine are also the most commonly used anti-anxiety drugs. Early coadministration of valium drugs is of greater significance in improving anxiety as quickly as possible.
4, it is recommended that the majority of patients to learn more about a variety of mental health knowledge, to achieve early detection, early diagnosis, early treatment, to reduce the pain, is of great significance.