How Effective Is Clonidine for Anxiety?

Generalized anxiety disorder, referred to as generalized anxiety disorder, is a chronic anxiety disorder characterized by persistent significant nervousness, accompanied by autonomic nervous function excitement and excessive alertness.

Generalized anxiety

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Generalized anxiety disorder, referred to as generalized anxiety disorder, is a chronic anxiety disorder characterized by persistent significant nervousness, accompanied by autonomic nervous function excitement and excessive alertness.

Generalized anxiety (GAD) patients often have characteristic appearances, such as twisted facial muscles, frowns, tight postures, restlessness, and even trembling, pale skin, sweaty hands, feet, and armpits. It is worth noting that although patients are prone to crying, they are a reflection of widespread anxiety and do not indicate depression.

Generalized anxiety is a chronic disorder. It can gradually develop and fluctuate. The course of the disease can be stable or intensified, or it can be aggravated or remissioned. Most patients have symptoms most of the time since onset, but a quarter of patients with GAD may have a remission period (without symptoms for 3 months or longer). Anxiety and concerns that generalize anxiety can be exacerbated by stress. Generally, generalized anxiety can be diagnosed only after symptoms persist for several months (eg, DSM-IV specifies 6 months). Without intervention, about 80% of patients can have symptoms for 3 years. The prognosis is worse if symptoms are severe or accompanied by agitation, loss of realism, switching symptoms, and suicidal perceptions. Some patients with chronic generalized anxiety may have short-term depressive episodes, and they usually seek medical attention during a certain episode.

The first step in treating generalized anxiety is to rule out depressive disorders, because patients with chronic conditions often have depression, and patients with depressive disorders can also show symptoms of anxiety. Including two parts of medication and psychotherapy.

Generalized anxiety

generalized anxiety disorder

Generalized anxiety disorder; generalized anxiety disorder; generalized anxiety disorder; generalized anxiety disorder

Psychiatry> Neurosis

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Generalized anxiety is one of the most common anxiety disorders, accounting for 2% to 8% of the population. It is also one of the most common diagnoses in primary care. The age of onset of generalized anxiety varies widely, ranging from 20 to 40 years. Both men and women suffer from generalized anxiety, but there is no clear comparative study of the prevalence of men and women.

Blazer et. Wittchen et al. (1994) reported that the prevalence of this disease in the US population aged 15-45 years is 3.1% and the lifetime prevalence rate is 5.1%. About 90% of patients have other mental disorders during their lifetime.

The research on generalized anxiety is far less intensive than panic disorder, but it has also accumulated some data.

Generalized anxiety is characterized by frequent or persistent, comprehensive, uneasy and overwhelming anxiety with no clear target or fixed content. This anxiety has nothing to do with any particular situation around it, but is usually caused by excessive worry. The typical manifestation is often too much worry or annoyance about some problems in real life, such as worrying about yourself or relatives getting sick or having an accident, abnormally worrying about economic conditions, and excessively worrying about work or social ability. This kind of nervousness, anxiety or worry is very out of step with the reality, which makes the patient feel unbearable, but unable to get rid of it; often accompanied by hyperautonomic nervous system, exercise tension and excessive vigilance. Generally speaking, anxiety symptoms in patients with GAD are variable, and a series of physical and psychological symptoms can occur.

Patients with generalized anxiety disorder often have other anxiety or affective disorders at the same time. According to Sanderson and Barlow (1990) analysis of the symptoms of 22 patients with generalized anxiety that met the DSM-III diagnostic criteria, 20 (91%) could make at least two diagnoses at the same time. 13 (59%) also had social phobia; 6 (27%) were also diagnosed with panic disorder; another 6 were also diagnosed with poor mood (depressive neurosis); and some also suffered from simple fear Disease (23%), obsessive-compulsive disorder (9%), and major depression (14%), and 73% had panic attacks during the course of the disease. Wittchen et al. (1991) also observed that in patients with anxiety disorder, 69% of the epidemiologically investigated cases, and 95% of clinical cases have two or more anxiety or depressive diseases coexisting (Comorbidity).

The changes in cerebral blood flow under anxiety state are not straight but change in a "U" shape. Most EEG studies have found reduced alpha wave activity, increased alpha wave frequency, and increased beta wave activity in patients with normal anxiety and neurotic anxiety. In addition, slow-wave activity in the form of , , and slow was observed in the anxious state.

According to ICD-10, the diagnosis of generalized anxiety must be anxiety symptoms for most of the period of at least several weeks, which usually lasts for more than 6 months. The anxiety symptoms include: Worry: such as worrying about the future, feeling "anxious", attention Difficulty in concentration, often worrying too much, and having nervousness, irritability, etc .; Exercise stress, fatigue, poor sleep, restlessness, headache, tremor, unable to relax; Other high alert symptoms: such as sweating, increased heart rate , Dry mouth, stomach upset, dizziness, dizziness and other symptoms can diagnose the disease.

The main diagnostic point is that patients who meet the generalized anxiety standards always see themselves as annoying people. Seeking medical treatment is not so much to treat doubts, but rather to make them worry about things they worry about, such as children's Health, the significance of a symptom. Doctors should consider whether there are excessive concerns about patients who return to the hospital for these complaints or tension headaches or other manifestations of anxiety.

The above two types of anxiety disorders are primary and not secondary to organic diseases, schizophrenia, affective disorders and other types of neurological signs.

General diagnosis is not difficult based on clinical manifestations and symptoms. In the diagnosis of panic disorder, attention should be paid to the exclusion of physical organic problems, such as frequent attacks and expected anxiety, which may be misdiagnosed as general anxiety disorder; certain physical diseases such as mitral valve prolapse may have similar panic attacks The symptoms should be identified. In the diagnosis of generalized anxiety, secondary anxiety caused by physical disorders such as hyperthyroidism, hypertension, coronary heart disease or withdrawal from addictive drugs should be excluded.

Distinguish from normal people's anxiety response during stress

Anxiety disorder has a strong emotional experience, with autonomic symptoms and motor restlessness. At the same time, the degree and duration of anxiety are extremely disproportionate to the actual "stimulation". The anxiety response of normal people does not fully have the above characteristics.

Specific physical illnesses can show similar symptoms

This possibility must be fully considered in any case, especially if there is no reasonable psychological explanation for its anxiety symptoms. Hyperthyroidism can cause irritability, restlessness, tremor, and tachycardia. At this time, physical examination can reveal goiter, slight tremor, and eyeball protrusion. If necessary, thyroid function tests can be performed. Pheochromocytoma and hypoglycemia can cause episodic anxiety.

Other physical diseases are more likely to cause anxiety through psychological mechanisms, such as patients fearing the fatal consequences of the disease. Such situations often occur when patients have special reasons to fear a serious consequence, such as the death of a patient's relatives due to similar clinical symptoms and progression of the disease. Therefore, it is necessary in clinical work to ask patients if they know other people with similar symptoms.

When generalized anxiety is characterized by physical symptoms, it is easy to be misdiagnosed as other diseases. At this time, negative laboratory test results increased patient anxiety rather than relieved, because these results could not explain serious clinical symptoms. If clinicians consider the diversity of anxiety symptoms and recognize that palpitations, headaches, frequent urination, abdominal discomfort, and other symptoms listed in Table 2 may be clinical manifestations of generalized anxiety, similar misdiagnosis can be greatly reduced.

Schizophrenia

Patients with schizophrenia sometimes complain mainly of anxiety without obvious psychotic symptoms, and even deny it under direct inquiry. But careful questioning about the cause of the symptoms can reduce misdiagnosis, as patients will be exposed to strange ideas such as the perception of threatening effects around them. Anxiety symptoms can be seen in many mental illnesses, but they are not the main clinical phase of this kind of mental illness. The content of anxiety is not intrinsically related to the main symptoms of other mental illnesses. It should be noted that it is different from depression. Anxiety and depression can accompany it. In diagnosis, it is often determined by analysis of the sequence and severity of the two. Therefore, in the diagnosis of these two diseases, we must attach great importance to the collection of medical history and observation of their symptoms.

Depression

Compared with anxiety symptoms, the symptoms of depression are more serious. At the same time, the sequence of symptoms is different. Anxiety symptoms appear first in generalized anxiety. Therefore, patients and their families should be asked at the same time as the medical history to confirm the diagnosis. Sometimes an agitated depressive episode is misdiagnosed as anxiety, but a careful inquiry into its symptoms can reduce misdiagnosis. Depression often has significant anxiety or agitation, and patients with generalized anxiety often have unpleasant lives due to long-term nervousness. The main point of identification is that patients with generalized anxiety disorder usually have anxiety symptoms first, and gradually feel like life after a long illness Unhappy; no diurnal mood changes; often difficult to fall asleep and sleep instability and rarely wake up early; autonomic symptoms are not as rich as depression; appetite is often not affected; more importantly, patients with this disease are not as depressed Disease like lack of interest or happiness. But the differential diagnosis of atypical depression may be more difficult. When the symptoms of depression and anxiety are obvious and meet the diagnostic criteria of the two diseases, two diagnoses are made at the same time. In addition, it is worth noting that the mental disorders identified with this disease include: somatization disorder, personality disintegration disorder, etc.

Among the symptoms of neurosis, mixed conditions are common. At this time, the type of symptoms should be identified, and the corresponding diagnosis can be made. However, it should be noted that the symptoms of depression are more dangerous and may lead to suicide. Therefore, we must master the principle of giving priority to the diagnosis of depression.

Alzheimer's and Alzheimer's

Sometimes Alzheimer's and Alzheimer's patients will complain mainly of anxiety, and clinicians often ignore their accompanying memory disorders or blame them for lack of concentration. Therefore, when elderly patients are accompanied by anxiety symptoms, their memory function should be carefully evaluated.

Withdrawal of psychoactive substances, alcohol or caffeine

Psychoactive substances, alcohol withdrawal, or caffeine abuse can all cause anxiety, which can often lead to misdiagnosis if patients hide their medical history. If the patient reports that anxiety is particularly severe in the early morning, it is suggestive of alcohol dependence (withdrawal response is often apparent at this time), but sometimes anxiety secondary to depressive disorder is also apparent in the early morning.

Depressive disorders should be ruled out first, because patients with chronic illnesses are often accompanied by depressive disorders, and patients with depressive disorders can also show symptoms of anxiety. Including two parts of medication and psychotherapy.

The onset of panic attacks is sudden and intermittent. Onset of generalized anxiety is slow, and the course of the disease lasts for several years. Often there is no obvious incentive. Many patients often don't remember when they begin to show symptoms, thinking that this has been the case since childhood; they have never been anxious throughout their lives. The duration of panic disorder is longer and less spontaneous. The earlier the age of onset, the more severe the anxiety symptoms and the more impaired social functioning. The research conclusions on the prognosis are quite different, which may be due to different samples. Some people think that the recovery and improvement rate is 75%, and some people think that it is less than 50%. However, although the patient's symptoms persist, it will not lead to mental disability and social loss. It is worth noting that attention should be paid to suicide in anxiety disorder, and some scholars believe that suicide in anxiety disorder is not an isolated phenomenon.

Due to the late development of psychiatry in the entire medical science and the complexity of the basic theory of the profession itself, there are quite a number of common causes and pathogenesis of mental illness that have not yet been elucidated. Coupled with the influence of the old ideas, the cause of mental illness has been neglected for a long time because it is considered mysterious, which hinders the development of mental illness prevention. At present, in some countries, the prevention of mental illness is taking different measures in different organizational forms, combining different social systems and cultures, and national characteristics, and moving towards the goal of preventing mental illness.

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