What Is Clinical Anxiety?

Anxiety, also known as anxiety neurosis, is the most common type of neurosis, and is characterized by anxiety and emotional experience. Can be divided into two forms of chronic anxiety (generalized anxiety) and acute anxiety (panic attack). The main manifestations are: nervousness without a clear objective object, restlessness, and symptoms of autonomic dysfunction, such as palpitations, hand tremors, sweating, frequent urination, and motor restlessness. Pay attention to distinguish normal anxiety emotions. If the severity of anxiety is clearly inconsistent with objective facts or situations, or if the duration is too long, it may be pathological anxiety.

Basic Information

English name

anxiety disorders

Visiting department

Psychiatry

Common causes

Related to heredity, personality, and adverse events.

Common symptoms

Nervousness, restlessness, palpitations, tremors, frequent urination, etc.

Causes of anxiety

At present, the etiology is not clear, and it may be related to genetic factors, personality characteristics, cognitive processes, adverse life events, biochemistry, and physical diseases.

Clinical manifestations of anxiety disorder

1. Chronic Anxiety (Generalized Anxiety)

(1) Emotional symptoms In the absence of obvious incentives, patients often appear excessively worried, nervous and afraid of being inconsistent with the actual situation. Such nervousness and fear often have no clear object and content. The patient feels that he has been in an inner experience of nervousness, anxiety, fear, fear, and anxiety.

(2) Autonomic symptoms Dizziness, chest tightness, palpitation, shortness of breath, dry mouth, frequent urination, urgency, sweating, tremor and other physical symptoms.

(3) Exercise restlessness, restlessness, restlessness, restlessness, and difficulty in calming down.

2. Acute anxiety (panic attack)

(1) Near death or out of control In normal daily life, patients are almost the same as normal people. Once the attack occurs (some have specific triggering situations, such as closed spaces, etc.), the patient suddenly appears extremely fearful and experiences a sense of dying or out of control.

(2) Simultaneous occurrence of autonomic nervous system symptoms such as chest tightness, palpitation, dyspnea, sweating, and whole body trembling.

(3) It usually lasts a few minutes to several hours. The attack starts suddenly and the consciousness is clear.

(4) Easily misdiagnosed When an attack occurs, patients often call the "120" emergency phone to see the emergency department of cardiology. Although the patient appears to be very symptomatic, most of the relevant test results are normal, so the diagnosis is often unclear. After the attack, the patient is still extremely scared and worried about his condition. He often goes to various departments in major hospitals and performs various tests, but the diagnosis cannot be confirmed. Both delay treatment and waste of medical resources.

Anxiety diagnosis

It is mainly diagnosed by a specialist based on medical history, family history, clinical symptoms, course and physical examination, scale test and laboratory-assisted examination. The most important of these are clinical symptoms and disease course.

Early screening or self-diagnosis can use some simple anxiety self-assessment scale (SAS) assessment. If the score is high, it is recommended to go to the psychiatric or psychological department for further examination.

According to the 3rd Edition Chinese Classification and Diagnostic Standard of Mental Disorders (CCMD-3), a subtype of anxiety neurosis must first meet the characteristics of neurosis, that is, it has a certain personality foundation, and its onset is often affected by psychosocial factors The symptoms are not based on a verifiable organic lesion, which is not commensurate with the actual situation of the patient, but the patient is painful and powerless about the existing symptoms, has complete self-knowledge, and has a prolonged course.

Panic attack (acute anxiety)

In addition to the characteristics of neurosis, panic attacks must be the main clinical phase. Eliminate secondary panic attacks such as phobias, depression, or somatic disorders; exclude secondary panic attacks such as epilepsy, heart attack, pheochromocytoma, hyperthyroidism, or spontaneous hypoglycemia. The characteristics of mild symptoms meet the following 4 points, plus severe symptoms plus point 5:

(1) There is no obvious cause of the attack, and there is no relevant specific scenario, and the attack is unpredictable;

(2) In the intermission period, there are no obvious symptoms except for fear of recurrence;

(3) Strong onset of fear, anxiety, and obvious autonomic symptoms at the onset, and often have painful experiences such as dying fear and sense of loss of control;

(4) The attack begins suddenly and reaches its peak quickly. The consciousness is clear during the attack and can be recalled afterwards.

(5) The patient feels pain because it is unbearable and cannot be relieved. The standard duration of the disease is at least 3 episodes within 1 month, or the anxiety of fear of recurrence after the first episode lasts for 1 month.

2. General anxiety (chronic anxiety)

In addition to the characteristics of neurosis, continuous clinical anxiety must be the main clinical phase. Exclude secondary anxiety of physical diseases such as hyperthyroidism, hypertension, coronary heart disease; Excessive stimulant drugs, hypnotic sedative drugs, or withdrawal from anxiolytic drugs; Exclude obsessive-compulsive disorder, phobia, depression, or schizophrenia, etc. Associated Anxiety. Light performance meets the following 2 points, heavy performance plus point 3:

(1) Frequent or persistent fears or fears without a clear target and fixed content;

(2) With autonomic symptoms or motor disturbances.

(3) The social function is impaired, and the patient suffers because it is difficult to bear and cannot be relieved. The course criteria meet the above symptoms for at least 6 months.

Differential diagnosis of anxiety disorder

Normal tension

Normal tension is different from pathological anxiety, and it shows an emotional response to the objective threat of reality. This emotional response is compatible with the actual threat.

2. Anxiety symptoms associated with physical illness

Anxiety secondary to physical illness should be diagnosed as anxiety syndrome. Anxiety manifests in a variety of medical diseases, especially cardiovascular and endocrine diseases.

3. Anxiety symptoms associated with drugs

Due to the widespread use of hormonal drugs, the symptoms of anxiety caused by drugs are no longer rare, as long as the history of medication is not ignored, identification is not difficult. If the diagnosis is suspicious, the hormone should be reduced or discontinued for observation. Cocaine, cannabis, heroin administration or withdrawal can cause anxiety and autonomic dysfunction, and even typical panic attacks. Antipsychotics can cause anxiety.

4. Anxiety symptoms associated with mental illness

Anxiety can be seen in any mental illness, and this anxiety is one of the symptoms of primary mental illness.

Anxiety Treatment

Anxiety disorder is a disease with relatively good treatment effect and good prognosis in neurosis. Psychotherapy and medication are usually used.

Drug treatment

Comprehensive consideration according to the patient's condition, physical condition, economic situation and other factors. It is generally recommended to take medicine for about 1 to 2 years. Please consult your doctor for withdrawal and dosage. Do not adjust the medication plan yourself. During the medication, pay attention to keep in touch with the doctor, side effects or other problems are resolved in time.

(1) Benzodiazepines (also known as diazepam drugs) Advantages Quick effect, mostly within 30 to 60 minutes; anti-anxiety effect is certainly positive; the price is cheaper. Disadvantages The duration of the effect is short, and it is not suitable for long-term large-scale use; there may be dependence. Commonly used drugs: Laurazepam (Rolla), Alprazolam, 2 to 3 times a day. It belongs to the short- and medium-acting tranquilizers, which has good anti-anxiety effect, relatively weak sedation, and has less impact on daytime work. Principles of use: intermittent medication principle, temporary oral administration when severe anxiety is not suitable for long-term large-scale use; small-dose principle, small-dose does not require large doses; regular drug change principle, if the condition requires long-term use, change another 3 to 4 weeks This kind of stability drugs can effectively avoid the occurrence of dependence; when changing the medicine, the original medicine slowly decreases, and the newly added medicine slowly increases. If the patient is too old, the dosage is not large, and the effect is better, you can not change the drug. As long as the dosage of tranquilizers does not increase, and within the normal range, the efficacy does not decrease, it can be considered that there is no dependence.

(2) Antidepressants Because the cause of anxiety can lead to disorders of the body's neuro-endocrine system and imbalance of neurotransmitters, antidepressants can make the unbalanced neurotransmitters tend to normal, so that anxiety symptoms disappear and emotions return to normal. General anxiety The commonly used drugs for treatment are paroxetine (Xelortex), escitalopram (Raspor), venlafaxine (Bolexin, Yinuosi), Dilixin and so on. Panic attacks Commonly used drugs are paroxetine (Silot), escitalopram, clomipramine and so on.

(3) Combination of long- and short-acting drugs has certain anti-anxiety effects, which can fundamentally improve anxiety, is not addictive, and is suitable for long-term use, but the anti-anxiety effect is slow to take effect, and it takes effect after 2 to 3 weeks, often requiring simultaneous short The combination drugs are expensive.

2. Psychotherapy

Psychotherapy refers to the establishment of a good doctor-patient relationship through verbal or non-verbal communication, the application of professional knowledge about psychology and medicine to guide and help patients to change behavioral habits and cognitive coping styles. Drug therapy is the cure, and psychotherapy is the cure. Both are indispensable.

There are also psychotherapy biological feedback treatment and relaxation treatment suitable for anxiety patients.

Anxiety prognosis

The sooner you diagnose and the sooner you treat, the better the prognosis for anxiety. After specialized treatment, the vast majority of patients will get clinical rehabilitation and return to the happy mood of the past.

In particular, it should be emphasized that after the symptoms are relieved, it is still necessary to take antidepressants for 1 to 2 years; discontinuation and reduction of drugs need to consult a specialist, and never adjust the drug treatment plan without authorization.