Anxiety

Anxiety, also known as anxiety neurosis, is one of the most common types of neurotic disorders, characterized primarily by the experience of anxiety. It can be divided into two main forms: chronic anxiety, known as generalized anxiety, and acute anxiety, known as a panic attack.

The main manifestations include: tension and worry without a clear objective cause, restlessness, and symptoms of autonomic nervous system dysfunction such as heart palpitations, hand tremors, sweating, and frequent urination, as well as motor restlessness. It is important to distinguish this from normal anxious feelings. If the severity of the anxiety is clearly disproportionate to the objective situation or if it persists for too long, it may be pathological anxiety.

Causes

The exact cause is not yet clear, but it is likely related to a combination of factors including genetics, personality traits, cognitive processes, adverse life events, biochemical factors, and physical illnesses.

Clinical Manifestations

Chronic Anxiety (Generalized Anxiety Disorder – GAD)

1. Emotional Symptoms: Without any obvious trigger, the patient frequently experiences excessive worry and tension that is inconsistent with the actual situation. This nervousness and fear often have no specific object or content. The patient feels as if they are in a constant state of tension, apprehension, fear, and dread.

2. Autonomic Nervous System Symptoms: Physical symptoms such as dizziness, chest tightness, heart palpitations, shortness of breath, dry mouth, frequent or urgent urination, sweating, and trembling.

3. Motor Restlessness: An inability to sit still, feeling restless and agitated, and finding it very difficult to calm down.

Acute Anxiety (Panic Attack)

1. Feeling of Impending Doom or Loss of Control: In normal daily life, the patient may appear almost completely normal. However, when an attack occurs (sometimes triggered by specific situations, like enclosed spaces), the patient suddenly experiences extreme fear, accompanied by a sense of impending doom or a feeling of losing control.

2. Simultaneous Autonomic Nervous System Symptoms: These include chest tightness, heart palpitations, difficulty breathing, sweating, and trembling throughout the body.

3. Duration: Attacks typically last from a few minutes to several hours. The onset is sudden, and the individual remains conscious and aware during the attack.

4. High Potential for Misdiagnosis: During an attack, patients often call for emergency medical help and are seen in the emergency room for cardiac issues. Although the symptoms appear severe, medical tests are usually normal, leading to an unclear diagnosis. After the attack, the patient remains extremely fearful of another one, often visiting multiple hospitals and specialists for various tests, which can delay proper treatment and waste medical resources.

Diagnosis

Diagnosis is made by a specialist based on the patient’s medical history, family history, clinical symptoms, course of the illness, physical examination, rating scales, and laboratory tests. The most critical elements are the clinical symptoms and the duration of the illness.

For early screening or self-assessment, simple tools like the Self-Rating Anxiety Scale (SAS) can be used. If the score is high, it is recommended to seek further evaluation from a psychiatrist or psychologist.

Diagnostic Criteria for Panic Attack (Acute Anxiety):
In addition to the general characteristics of a neurosis, a panic attack must be the primary clinical feature. It must be distinguished from panic attacks secondary to other mental disorders (like phobias or depression) or physical conditions (like epilepsy, heart attack, or hyperthyroidism). For a mild diagnosis, the first four points must be met; a severe diagnosis includes the fifth point:

1. Attacks occur without obvious triggers or specific situations and are unpredictable.

2. Between attacks, there are no significant symptoms other than the fear of having another one.

3. The attack involves intense fear, anxiety, and significant autonomic symptoms, often with distressing experiences like a fear of dying or losing control.

4. The onset is sudden, reaches a peak quickly, and the person is conscious throughout and can recall the event afterward.

5. The patient experiences significant distress as the feeling is unbearable and they feel unable to escape it.

• Course Criterion: At least three such attacks within one month, or persistent anxiety about having another attack for at least one month after the first one.

Diagnostic Criteria for Generalized Anxiety (Chronic Anxiety):
In addition to the features of a neurosis, the primary clinical feature must be persistent, generalized anxiety. It must be distinguished from anxiety secondary to physical conditions (like hyperthyroidism or heart disease) or substance use/withdrawal. For a mild diagnosis, the first two points apply; a severe diagnosis includes the third point:

1. Frequent or persistent fear or apprehension without a clear object or fixed content.

2. Accompanied by autonomic symptoms or motor restlessness.

3. Social functioning is impaired, and the patient feels significant distress because the feeling is hard to tolerate and inescapable.

• Course Criterion: The above symptoms must be present for at least six months.

Treatment

Anxiety disorders are among the more treatable neurotic conditions with a relatively good prognosis. Treatment typically involves a combination of psychotherapy and medication.

Drug Therapy

The choice of medication depends on the patient’s condition, physical health, and financial situation. It is generally recommended to continue medication for 1-2 years. Adjusting the dose or stopping the medication should only be done under a doctor’s guidance.

1. Benzodiazepines (e.g., Diazepam-type drugs):

   • Advantages: They work quickly (usually within 30-60 minutes), have a proven anti-anxiety effect, and are relatively inexpensive.

   • Disadvantages: Their effects are short-lived, they are not suitable for long-term, high-dose use, and they carry a risk of dependence.

   • Commonly used: Lorazepam, Alprazolam.

   • Principles of use: Use intermittently for severe anxiety rather than continuously; use the lowest effective dose; if long-term use is necessary, consider rotating to a different benzodiazepine every 3-4 weeks to minimize dependence.

2. Antidepressants:
   Anxiety can disrupt the body’s neuro-endocrine system and cause an imbalance of neurotransmitters. Antidepressants help to rebalance these neurotransmitters, thereby alleviating anxiety symptoms.

   • For Generalized Anxiety: Commonly used drugs include Paroxetine, Escitalopram, and Venlafaxine.

   • For Panic Attacks: Paroxetine, Escitalopram, and Clomipramine are often prescribed.

3. Combination Therapy:
   Antidepressants are effective for long-term management and are not addictive, but they take 2-3 weeks to start working. Therefore, a short-term course of benzodiazepines is often prescribed alongside them at the beginning of treatment.

Psychotherapy

Psychotherapy involves a therapist using verbal and non-verbal communication to establish a good therapeutic relationship and guide the patient in changing behaviors, habits, and cognitive coping mechanisms. While medication can treat the symptoms, psychotherapy addresses the root causes. Both are often necessary for effective treatment.

Other therapies suitable for anxiety include biofeedback and relaxation therapy.

Prevention

1. Maintain a Good Mindset: Avoid dwelling on the past and blaming yourself. Try to maintain emotional stability, avoiding extreme highs and lows. Cultivate a broad-minded perspective and adapt your thinking to objective reality.

2. Practice Self-Guidance: When you feel anxious, acknowledge it without letting it control your actions. Build confidence in your ability to overcome it. A common technique is to shift your attention to a new activity or thought, which can replace the feeling of anxiety.

3. Avoid Excessive Worry About the Future: People with anxiety often worry about uncertain future events. The best approach is to focus your thoughts on the present moment and enjoy what is happening now, rather than creating unnecessary stress about things that haven’t occurred.

4. Use Music to Relieve Emotions: Music can induce relaxation and positively alter physiological and psychological rhythms. When you feel anxious, listening to calming music can be very soothing and help dissipate the symptoms.

5. Engage in Moderate Exercise: Physical activity can help eliminate some of the stress chemicals that cause anxiety, leading to a relaxed and pleasant mental state. When you feel anxious, activities like jogging, swimming, or playing a sport can be an effective way to relieve tension and boost your energy.