Health Worlds

Generalized anxiety disorder (Figure 1) the genetic etiology of Noyes et al (1987) reported a wide range of anxiety disorders in relatives of patients with the risk of the disease was 19.5%, while the relatives of the control group risk of generalized anxiety disorder was 3.5% . Torgersen (1983) failed to find Twin Study of generalized anxiety disorder MZ-DZ with the disease rates were significantly different. Kendler et al (1992) reported generalized anxiety disorder in a group of female twins, the heritability of the disease is about 30%. Some studies suggest that genetic predisposition of the disease was significantly better than panic disorder. Biochemical benzodiazepine class based on commonly used in the treatment of generalized anxiety disorder to achieve good results, suggesting that the brain benzodiazepine receptor system abnormalities may be the biological basis of anxiety. Benzodiazepine receptor concentration in the occipital lobe is the highest, suggesting that generalized anxiety disorder may have occipital lobe dysfunction. Some brain imaging studies found that the occipital lobe in patients with abnormal existence. Pre-clinical and clinical brain imaging shows that all types of anxiety and stress response also involves limbic, basal ganglia and prefrontal cortex. Non-benzodiazepine class of anti-anxiety agent buspirone to 5-HT1A agonist, effective treatment of generalized anxiety disorder, suggesting that 5 - HT system with generalized anxiety disorder ha


ve an important role in pathogenesis. Psychological anxiety that Freud is a physiological state of tension, originated in the unresolved unconscious conflicts. The use of effective self-defense mechanisms can not, it will lead to pathological anxiety. Aeron Beck's cognitive theory is that anxiety is a risk of a reaction. Distortion of information processing led to a lasting danger of misunderstanding and anxiety experiences. Pathological anxiety and selective information processing of threat related. Anxiety patients also feel powerless to deal with his threat. Can not control the environment is to continue the important factors of anxiety. David Barlow to distinguish between anxiety and fear that the generalized anxiety disorder is characterized by feelings of loss of control rather than the threat of fear. Noyes et al (1987) report, about 1 / 3 of patients with generalized anxiety disorder associated with personality disorder, most common for the dependent personality disorder. Pathogenesis of risk factors 1234
Generalized anxiety disorder (Figure 2) genetic: in anxiety disorders, the genetic susceptibility is an important factor. According to the research, in monozygotic twins (MZ) in the incidence of all anxiety disorders than dizygotic twins consistency (DZ) high. However, most studies have not found genetic disease in various anxiety disorders differ, so the genetic generalized anxiety disorder do not know the specific role. childhood experiences: are generally considered susceptible to generalized anxiety disorder is one of the factors, however, currently no definitive evidence. Anxiety is a common mood disorders of children, but most of the anxiety that children grow into healthy people, and anxious adults are not all from the anxiety of the children. personality: anxiety-related personality and anxiety disorders, other personality characteristics may also interfere with their effective response to stress events. Trigger for the occurrence of generalized anxiety disorder and life stress events often associated, especially those threatening events such as interpersonal problems, physical illness, and work problems. Sustained life stress factors can lead to the persistence of events of generalized anxiety disorder chronic; same stubborn way of thinking of the symptoms can also, as noted its fear of others, anxiety, or fear of anxiety will affect their performance. Similar concerns will produce a vicious cycle in which symptoms of a serious and stubborn. Neurobiological cerebral blood flow, metabolism and hemispheric activity: the normal function of the subjects were imaging studies suggest that anxiety is mainly the increase in cerebral blood flow and metabolism, but hyperventilation and increased vascular tone causes vasoconstriction when the decreased cerebral blood flow was induced anxiety. Therefore, the anxiety state of the cerebral blood flow but not in a straight line was like "U"-shaped curve-type changes. EEG study found that the majority of normal anxiety and neurotic anxiety in patients with reduced wave activity exists , wave frequency increases, and wave activity increased. In addition, anxiety was also observed in , and slow form of slow-wave activity. Of blood and EEG studies suggest that the right prefrontal cortex may be in the negative mood and anxiety perception and reaction play a more important role, Davion found in normal volunteers, the left frontal area than the right front area of the classical conditioning of disgust reactions subside faster and more effective suppression of the defense reflex. Carter found that fear - anxiety and cognitive performance, a high degree of activity throughout the cortex, particularly left hemisphere. Concern is not only a manifestation of anxiety, but also through verbal and logical reasoning to reduce, in order to explain the role of left hemisphere of the high activity. neuroanatomical areas and their functions: high awareness play an important role in anxiety, which can lead to wake up and insomnia. Moderate wake-up can improve attention and thus improve the behavior. The wake is highly enhanced reflex, causing complex learning and behavior disorders. Anxiety, shallow and less people sleep, various sleep disorders can be found in anxiety patients, but in general, the main time for sleep latency (sleep time is reduced), reduction of slow wave sleep, wake up and wake up easily increased. Arousal level is largely controlled by the brain stem, it is the biology of anxiety has an important role. Including the noradrenergic locus coeruleus ,5-HT in the raphe nuclei and adjacent to giant nuclei. Early biological theory of anxiety that anxiety occurred in the locus coeruleus plays a central role. Yohimbine ( -2 noradrenergic receptor antagonist own), to increase locus coeruleus activity and induced anxiety. Clonidine ( -receptor agonist) to reduce locus coeruleus activity and reduce anxiety. Anxiolytic effects of other drugs can reduce the locus coeruleus of activities, such as benzodiazepines and opioids class.
Generalized anxiety disorder (Figure 3) Some researchers have simply too much anxiety and wake-up equal to the same, and the strength and avoidance of conflict from the perspective of all of the acts described. Wake-up should not be equated anxiety because of the increased arousal level accompanied by positive and negative emotional response. Is a wake-up level of anxiety increased, it is associated with negative emotional characteristics. However, relative to the brainstem nuclei, the emotional characteristics of the production is more likely to come from the limbic system and prefrontal. Limbic system by the amygdala, hippocampus, septal nucleus and hypothalamus form, it may be primarily of emotional site. In learning and memory also play an important role. Gray according to data from animal studies to establish a theory that every system of the hippocampus has a central role in anxiety. That the system is the induction and regulation of anxiety is important, it is by norepinephrine and 5-HT input to produce effects. From the prefrontal and cingulate cortex area separated from the hippocampus to stimulate the system to provide information and produce forecasts of expected events, then these predictions and compare with the actual events. Aversion to predict events or endogenous incongruity with the event can activate a putative behavioral inhibition system to wake up, pay attention and anxiety response. But LeDoux found that the amygdala may be more involved in Bi Haima fear response, that is, the amygdala and the emotional (including anxiety-related) in access memory. Case study found that patients with amygdala resection can confirm face, but can not identify the expression of emotions. The right side of the left prefrontal cortex more than in the emotional response of the left prefrontal cortex, solely on the spoken and written language, in order to process information, and the role of inhibition of the amygdala. EEG and imaging studies suggest the presence of at least as perceived constituents, anxiety can activate the right prefrontal cortex. Recent studies suggest the function of the cerebellum in the frontal lobe, and adjust the anxiety reaction. In animal experiments, the middle cerebellar damage can be observed fear reactions after the disappearance of aggressive behavior decreased. In imaging studies, anxiety disorder patients and forced cerebellar vermis vermis and adjacent to the increase in metabolic activity of the Ministry. neurotransmitters: the current study found that there are a variety of nervous system neurotransmitter, which benzodiazepine-GABA can, norepinephrine and 5-HT neurotransmitter systems and corticotropin-releasing hormone pathway and anxiety directly related to biology. These transmitters not only of anxiety, maintain and eliminate in importance, but also through the neuroendocrine response may cause some physiological changes. Anxiety by these physiological changes on the role of this sentiment to some extent, thus changing the impact of anxiety on the individual. 15 Summary of generalized anxiety disorder symptoms are frequent or continuous, comprehensive, no clear or fixed content object nervous and is characterized by excessive anxiety. The anxiety surrounding the situation is not any particular relationship, which is generally caused by excessive concern. Typical performance is often in real life some of the issues, or worry too much about, such as relatives or as concerned about their illness or accident, abnormal fear of economic conditions, too much about work or social skills. The nervous, worried or upset is not commensurate with reality, so that patients feel unbearable, but can not escape; often accompanied by autonomic hyperactivity, motor tension and excessive vigilance. In general, GAD anxiety symptoms in patients with diverse, there may be a series of physiological and psychological symptoms. Anxiety and worry
Generalized anxiety disorder (Figure 4) showed that may occur in the future, it is difficult to predict a dangerous or unfortunate incidents often worry. Fear of looking forward to (fearful anticipation), irritability, sensitivity to noise, restlessness, decreased attention, worried. If the patient can not clearly aware of his or content of the object of fear, but rather a nervous, anxious for a strong inner experience are known as free-floating anxiety (free-floating anxiety). But often it may be a concern, two non-real threat, or may occur in the life of his own relatives or friends of the unfortunate incident. For example, worry that their children go out an accident and so on. The extent of such anxiety and worry are not commensurate with reality, as fear of waiting (apprehensive expectation), is the core of a wide range of anxiety symptoms. Such patients often have a feeling of panic, upset all day, feel restless, worried, as if misfortune is about to come in their own or their loved ones in the head. Difficulty concentrating, their daily loss of interest in the things in life, so that learning and work has been severely affected. Such anxiety and worry is different from the so-called "anticipatory anxiety" (anticipatory anxiety), such as patients with panic disorder panic attack again, worried that patients with social phobia was troubled to speak in public, repeated hand washing OCD patients contaminated fear, and body weight in patients with anorexia nervosa surge in distressed and so on. Need to explain that patients complain about lack of concentration due to memory loss, anxiety disorder, but does not exist in real memory damage. If you find that its existence must be carefully checked to exclude organic disease. Characteristics of generalized anxiety disorder is a recurring worry about sexual performance, its content, including the concern of disease, worried about the safety of others and social anxiety. Exercise performance of hand-wringing anxiety stamp their feet, back and forth, nervous, unable to sit still, we can see the eyelids, facial or finger tremor, or trembling in patients with self-inductance. Some patients frown, facial and limb muscle tension, pain, or feel the muscle twitching often feel tired and weak. The performance of the body Digestive System: dry mouth, difficulty swallowing a sense of infarction, esophageal foreign body sensation, excessive exhaust, increase or decrease peristalsis, stomach discomfort, nausea, abdominal pain, diarrhea. Respiratory: chest pressure, breathing difficulties, shortness of breath and choking sensations, excessive breathing. cardiovascular system: heart palpitations, precordial discomfort, irregular heartbeat. genitourinary system: urinary urgency, erectile dysfunction, dysmenorrhea, amenorrhea. nervous system: tremor, tingling, tinnitus, dizziness, headache, muscle pain. sleep disorders: insomnia, night terrors. Other symptoms: depression, obsessions, depersonalization. autonomic nervous excitement: sweating, pale face, redness or other symptoms.
Generalized anxiety disorder (Fig. 5) somatic symptoms of generalized anxiety disorder from excessive sympathetic nervous system activity and increased muscle tension. The specific symptoms than the rich, can be categorized according to the system. Such as hyperventilation from swallowing air; anxiety caused by breathing difficulties and asthma can be differentiated from the difficulties of breath; over a range of physical symptoms caused by breathing. Symptoms in the nervous system, dizziness was a sense of instability rather than spinning. In addition, some patients reflects a blurred vision, but examination showed normal vision. Often has a sense of headache pain or tightening, mostly bilateral, occipital and frontal common. Pain are more common, more in the upper body. It is worth noting that patients often not the chief complaint of somatic symptoms of anxiety, and these physical symptoms are also caused by physical disease. Therefore, the above situation in the differential diagnosis must be fully taken into account. Vigilance over the performance of the fear, easily frightened, and prone to startle response to external stimuli; difficult to focus attention; sometimes feel a blank mind; it difficult to sleep and easy to awaken; and irritability and so on. 678 disease surveillance is currently no specific laboratory disease indicators. Anxiety state of the cerebral blood flow but not in a straight line was like "U"-shaped curve-type changes. EEG study found that the majority of normal anxiety and neurotic anxiety in patients with reduced wave activity exists , wave frequency increases, and wave activity increased. In addition, anxiety was also observed in , and slow form of slow-wave activity. 9 clinical diagnosis based on ICD-10, diagnosis of GAD must be at least a few weeks most of the symptoms of anxiety, usually has lasted more than 6 months of anxiety symptoms include: worry: If concerned about the future, was "nervous" attention difficulties, frequent worry too much about, and there is nervousness, irritability, etc.; Movement tension, fatigue, poor sleep, anxiety, headache, tremor, can not relax; other high-alert symptoms: such as sweating, heart rate speed up, dry mouth, stomach discomfort, dizziness, dizziness and the like symptoms can be diagnosed the disease. The main point is consistent with the diagnosis of GAD criteria were always easy to trouble themselves as people seeking and not so much concern to the treatment, rather, is to make them worried about the avoidance of doubt, such as children's health, the significance of a symptom. Due to these complaints, or tension headaches or other anxiety performance of repeated examination of patients to the hospital, doctors should consider whether there is excessive concern. These two categories of anxiety disorders are primary, not secondary to organic diseases, schizophrenia, affective disorder and other types of neurological signs. 6 Differential diagnosis
Generalized anxiety disorder (Fig. 6) According to the general characteristics of clinical diagnosis and symptoms is not difficult. In the diagnosis of panic disorder, attention should be excluded from physical organic problems such as frequent seizures, coupled with anticipatory anxiety, there may be misdiagnosed as generalized anxiety disorder; certain physical diseases such as mitral valve prolapse may have a similar panic attack symptoms, care should be identified. In the diagnosis of generalized anxiety, hyperthyroidism should be excluded, hypertension, coronary heart disease and other physical illness or drug addiction withdrawal reactions caused by secondary anxiety. and normal anxiety in the stress response when the phase identification. Anxiety disorders that have a strong emotional experience, there is autonomic nervous symptoms and exercise-induced anxiety, while the extent and duration of anxiety and realistic "stimulus" did not match. Not completely normal anxiety reaction has the above characteristics. specific physical diseases can be expressed as similar symptoms. In any case, this possibility must be fully considered, especially in its psychological anxiety symptoms without reasonable explanation. Hyperthyroidism, can lead to irritability, restlessness, tremor, and tachycardia. At this point, physical examination can be found goiter, fine tremor, and exophthalmos, if necessary, feasible and thyroid function tests. Pheochromocytoma and episodes of low blood sugar can cause anxiety. Other more physical illness caused by anxiety and psychological mechanisms, such as fear of the disease in patients with fatal consequences. When patients have a special reason to fear serious consequences of frequent occurrence of such circumstances, such as relatives of patients due to similar clinical symptoms and progression and death. Therefore, in clinical work necessary to ask whether the patient understanding of other people with similar symptoms. When generalized anxiety disorder with physical symptoms as the main performance, it is easy to be misdiagnosed as other diseases. At this point, negative laboratory findings in patients with increased anxiety rather than alleviate, because these results can not explain the severe clinical symptoms. If physicians take into account the diversity of anxiety symptoms, recognizing that heart palpitations, headaches, frequent urination, abdominal discomfort and other symptoms listed in Table 2 may be the clinical presentation of generalized anxiety disorder, can greatly reduce a similar misdiagnosis. schizophrenia chief complaint is sometimes the anxiety without apparent psychotic symptoms, even under direct questioning and even denied. But asked in detail about the causes of symptoms can reduce misdiagnosis, as patients will be exposed to some strange ideas, such as that around the impact of threat. Anxiety symptoms found in a variety of psychiatric disorders, but mental illness is not such a major clinical phase, the content of their anxiety and other symptoms of mental illness, no major internal relations. Note that the phase identification and depression, anxiety and depression may be associated with the existence of both the diagnosis often relies on the occurrence and severity analysis of sequence comparison to determine. Therefore, in the diagnosis of these diseases, we should attach great importance to the collection and its history of symptoms observed. depression relative to anxiety symptoms, more severe depressive symptoms, while the order and the different symptoms in anxiety symptoms in generalized anxiety disorder first appear. Therefore, history taking should also ask patients and their families in order to confirm the diagnosis. Sometimes accompanied by intense episodes of depression may be misdiagnosed as anxiety, but asked in detail about their symptoms of depression can reduce misdiagnosis. Significant anxiety or depression are often agitated, and generalized anxiety patients, nervous due to the long life is not always pleasant, the identification of key points are: first, generalized anxiety disorder patients usually have symptoms of anxiety, illness for a long time and eventually find life unhappy; light Day and night, the mood changes in weight; often unstable and difficult to fall asleep and sleep, waking rare; autonomic nerve symptoms of depression than rich; appetite often affected; more important is that this is not as depressed patients lack of interest in things like disease or happy. But not typical in the differential diagnosis of depression may be more difficult. When depression and anxiety symptoms are apparent, and were consistent with the diagnosis of two standard
Generalized anxiety disorder (Figure 7) on time, the same time under two diagnosis. Also worth noting that the identification of the disease with mental disorders include: somatization disorder, depersonalization disorders. Neurological symptoms in the mixed situation is very common, and you should identify the type of symptoms, can make the appropriate diagnosis. It should be noted symptoms of depression more dangerous, may lead to suicide, it is to master the principle of priority to the diagnosis of depression. Alzheimer dementia and Alzheimer's patients will be such sometimes anxiety chief complaint, clinicians often overlook its associated memory impairment, or put the blame on lack of concentration. psychoactive substances, alcohol or caffeine withdrawal response to the abuse of drugs can cause anxiety, if the patient can often lead to misdiagnosis hide history. If patients report early morning when the anxiety is particularly serious, suggesting alcohol dependence (withdrawal response was often at this time), but sometimes secondary to anxiety and depression during early morning is also obvious. 101,112 concurrent disease with generalized anxiety disorder patients often also associated with other anxiety or affective disorder. According to Sanderson and Barlow (1990) of 22 patients met the diagnostic criteria of DSM- patients with symptoms of generalized anxiety, 20 patients (91%) while at least the next two diagnosis. 13 cases (59%) also suffer from social phobia; 6 cases (27%) were also diagnosed with panic disorder; another 6 patients diagnosed as dysthymic while (depressive neurosis); there are some cases also with pure fear disease (23%), obsessive-compulsive disorder (9%) and heavy depression (14%), in the course of panic attack symptoms in 73%. Wittchen et al (1991) also observed that patients with anxiety disorder, 69% of the epidemiological investigation cases, and 95% of clinical cases with two or more anxiety or depressive disorders co-exist (Comorbidity). 13 Summary of the first treatment of disease to exclude depression, because patients often accompanied by chronic treatment of depression, but depression can also be demonstrated in patients with anxiety symptoms. Including medication and psychotherapy in two parts. Drug treatment because the disease is recurrent, all kinds of treatment should not be shorter than six months of a general; in some cases, medication required to maintain 3 to 5 years to full remission. Drugs commonly used in the following categories. anxiolytics: The main clinical application of current benzodiazepine drugs and buspirone and so on. Panic attack should choose the former; generalized anxiety disorder can choose one of them. Two types of drugs have anxiolytic effects. The amount used: benzodiazepine drugs: such as alprazolam (Jia Jing be), lorazepam, clonazepam (clonazepam) orally, with ease anxiety, enhance sleep, calm, and the role of the drugs can quickly control the anxiety symptoms, but not long-term use of drug dependence, usually used when symptoms worsen. There are many drugs to choose from, in general, can be used estazolam, alprazolam (1.2 ~ 4mg / d or 0.4 ~ 0.8mg, 3 ~ 4 times / d), diazepam (10 ~ 30mg / d), lorazepam (Laura) (2 ~ 4mg / d or 0.5 ~ 1mg, 3 ~ 4 times / d), clonazepam (3 ~ 8mg / d) and so on. The body of generalized anxiety disorder symptoms better effect than other drugs. Long-term large doses can cause a sudden withdrawal of drug dependence and withdrawal symptoms when it is the main drawback of these drugs. Panic attack, immediately injected or sublingual lorazepam (lorazepam) 2 ~ 4mg, or diazepam (stability) 10mg IV slow injection. buspirone: a non-benzodiazepine class of anti-anxiety drugs, but the onset benzodiazepine class than the slower, less drug dependence and withdrawal symptoms. Unlikely to cause drug dependence, and therefore more suitable for long-term use. Effective dose of generalized anxiety disorder is 15 ~ 60mg / d, 2 ~ 3 times a day orally, or 5 ~ 10mg, 3 times / d. antidepressants: not only the antidepressant effect of antidepressants, there are anxiolytic effects, and no dependence; can be used as benzodiazepine class of long-term use of alternative drugs, including tricyclic (TCA), SSRI, SNRI, NaSSA and so on. Tricyclic class of negative mood and cognitive symptoms than the better class of benzodiazepines, but the effect on poor physical symptoms. Commonly used drugs imipramine, the dose 50 ~ 150mg / d. It is noteworthy that, SSRI and SNRI will initially use a transient increase anxiety, so use with caution or start a few days ago with the benzodiazepine class of drugs used in combination. With the exception of clinical Venlafaxine extended release (Effexor) have proven effective in treating GAD, but did not find other drugs which are particularly effective, it can be based on the patient's medication
Generalized anxiety disorder (Figure 8) tolerance of drug use and contraindications and flexible. Clomipramine (clomipramine), imipramine, desipramine (norepinephrine imipramine) is better for all anxiety disorders. The dose start small dose and gradually increase. Imipramine started 12.5mg, 1 ~ 2 times / d, increase 12.5mg, general daily dose of 150mg, 300mg medication to individual patient needs more than a day, depending on the symptom improvement may be. Clomipramine (clomipramine) is similar to the amount and imipramine. In addition, side effects, such as smaller class SSRI fluoxetine, paroxetine, doxepin (doxepin), etc. Ring or other new drugs such as trazodone dose (150 ~ 300mg / d, side effects are more phthalaldehyde N Zhuo class and buspirone ketones more), Man Fala Xin (venlafaxine), tianeptine, the effect is good, while easing the patient's depressive mood can also be used. Amitriptyline, doxepin is a cheap drug, because of its anxiolytic effect produced when the antidepressant effect of the dose when compared with the small, so the corresponding anti-cholinergic side effects rarely cause significant discomfort. Adverse reactions, such as patients with obvious or self-injury tend to be small even if the use of excessive side effects and no obvious adverse reactions taking a new antidepressant drugs. Monoamine oxidase inhibitor (MAOI) has been used in the treatment of chronic anxiety disorders. In the selection of drug therapy is poor. Because of drug interactions with other drugs and the need to disable certain foods, is now less used or to be applied under the guidance of experts, but should strictly abide by the contents of the specification of goods. -receptor blockers: usually used to control severe persistent palpitations, and the symptoms are usually valid for other anti-anxiety drugs. Must pay attention when using the instructions in the Notice of goods and contraindications. Other: Sodium valproate is also effective in the treatment of panic attacks, 200 ~ 600mg / d, 2 ~ 3 times a day orally. Psychotherapy can be applied to interpretative psychotherapy, relaxation therapy, behavior therapy and hypnosis therapy. psychological education: the nature of this disease reported in patients, so that patients have a correct understanding of the disease, the disease has some insight, that, although severe symptoms, feel pain, but only psychological problems, will not affect the good health, being not improve, do not worry, thinking of the patient to lay down the burden on the health of patients can reduce anxiety, increase cooperation in the treatment. While helping to solve or to adapt them to life stress events. cognitive behavioral therapy: anxiety induced by imagination or on-site, and then relaxation training, reduce body stress and anxiety symptoms. Leading to the cognitive component of anxiety, the use of cognitive restructuring, correcting cognitive distortions in patients, including correcting the appearance of these symptoms and the onset of somatic sensory and emotional experience of the unreasonable interpretation of the patient aware of these feelings and Experience is not serious damage to health, to reduce the anxiety, fear and avoidance. biofeedback therapy: the use of bio-feedback relaxation training patients to reduce anxiety, generalized anxiety disorder treatment effective. Relaxation training, if the line of respiratory control hyperventilation. Guidance for anxiety control training.
Generalized anxiety disorder (Figure 9) other therapies: such as hypnotherapy, biofeedback therapy, music therapy, etc., have adjuvant therapy. If the patient over-breathing, free bag covering the patient's mouth and nose, let the patient inhale more carbon dioxide, to reduce the panic attack, hyperventilation caused by alkaline blood. support measures and social measures: the duration of the patient's symptoms meet diagnostic criteria for the former general has been in general clinical doctor for treatment. Early in the disease, many patients and physicians to ensure the effective discussion. The talks may not be very long, but patients must feel in rapt attention, the problem is put ourselves in being understood. Produced by somatic symptoms of anxiety should be accurate and clear explanations, such as palpitations are a normal reaction to stressful events in patients with excessive attention to heart disease rather than the tips. In addition, to help patients learn to deal with or adapt to maintain and increase the anxiety symptoms of social problems. Such as anxiety is very severe, short-term benzodiazepine taking drugs, but should be noted that less than 3 weeks to prevent the emergence of drug dependence. Improved treatment of Professor Baldwin 1415 University of Southampton Medical School associate professor, Department of Clinical Neuroscience, has long been engaged with mood disorders and anxiety disorders in clinical practice and research, and published several articles on the treatment of anxiety disorders research articles and monographs, clinical practice of doctors have an important role in guiding. April 24, 2009, more than 20 Chinese psychiatrists had the pleasure of Professor Baldwin progress in the treatment of generalized anxiety disorder in-depth discussion. First, GAD treatment options and what factors can predict the effect of drugs. The traditional anti-anxiety drugs benzodiazepines such as lorazepam, alprazolam. A number of studies have evaluated the clinical efficacy of these drugs, and confirmed its remarkable anti-anxiety effect, but because these drugs can cause excessive sedation, addictive, withdrawal symptoms and prone to damage and other spiritual movements, have not as first-line drug use, replaced by a good safety of 5 - HT reuptake inhibitors (SSRIs) and 5 - serotonin and norepinephrine reuptake inhibitors (SNRIs), Baldwin Professor of SSRIs and SNRIs reed the acute phase treatment GAD series of randomized double-blind, placebo-controlled study showed that treatment of these new drugs GAD demonstrated a significant effect, in which the earliest and most in-depth study of the drug is paroxetine. In the treatment of GAD, in the past few references to "clinically cured" of the concept. Professor Baldwin's research evidence through detailed clinical recovery leads to the concept of GAD and standards. The treatment of GAD objectives and other similar mental disorders, not just the symptoms improve, patients should also be concerned about the social function of recovery, including symptoms and quality of life and social function recovery, the equivalent of the Clinical Global Impression Scale improvement rating of 2 subscales points or less, or Hamilton anxiety scale total score 9 points or less, the standard currently used in the GAD began to clinical research and clinical practice. Paroxetine treatment of GAD in a clinical study of acute, 20mg / day and 40mg / day of paroxetine is not only effective in the treatment of patients with core symptoms of anxiety and anxiety, and significantly improved overall social functioning of patients, including the families of patients life, social life and work ability. GAD further confirmed the applicability of the standard clinical recovery. Because the cause of GAD is unknown, there were no sensitive indicators to predict the efficacy and safety of drugs, a study from the patient's clinical features were analyzed and summarized, results suggest that patients with certain clinical features, may indicate better (such as short course) or less (such as past use of benzodiazepine drugs or a longer treatment time) and clinical improvement. Data from these studies in the Post hoc analysis found that treatment for GAD, and similar treatment of depression, there is also "predict long-term effect of early onset," the law, in particular, the efficacy of the treatment of 4 weeks can predict the sensitivity After 8 weeks of recovery, therefore, not patients 4 weeks of the onset of the patients, should be considered further increase the dose or through other strategies, to increase efficacy, this can increase the likelihood of recovery of patients. However, these indicators need further clinical research validation. GAD treatment followed by a period of consolidation. GAD long-term treatment on a relatively small research data, Angst J GAD patients to a group of 22 years follow-up study, the results confirmed the GAD for chronic, persistent fluctuations in the course, these data also raised the treatment of GAD require long-term requirements. Studies have evaluated paroxetine, escitalopram, duloxetine and long-term treatment of quetiapine in GAD relapse prevention effects, the results suggested that these active drug maintenance therapy, can effectively prevent the recurrence of GAD. These studies provide a scientific basis for clinical practice. When the GAD patients selected drug treatment fails, you can increase the drug dose, for the cognitive behavioral therapy or other drugs (such as SNRI or quetiapine), combined synergist (such as the antipsychotic olanzapine or interest Pei-ketone), or combination of drugs and psychological treatment of these combined treatment to improve efficacy. The future direction of anti-anxiety drugs may be to other targets of drug development, such as the SSRI plus 5-HT1A and 5-HT1B receptor antagonist, SSRI plus 5-HT2C antagonist, SSRI plus 5-HT1A partial agonist and 5-HT3 antagonist, melatonin receptor agonists, nicotine receptor partial agonist agent and, metabotropic glutamate receptor antagonists, cholecystokinin receptor antagonists, neuropeptide Y agonists, Adenosine A1 and A2A receptor agonists and GABA-A receptor subtype selective agonists and so on. Prognosis of sudden onset of panic attack 16, was intermittent seizures. Slow onset of generalized anxiety disorder, and more protracted course of several years. Often have no obvious incentive. Many patients often can not remember when the symptoms began to appear, that is so small; in their life has never been a time without anxiety. More than the long course of panic disorder, and less spontaneous remission. The earlier age of onset, more severe anxiety symptoms, social function, but also more subject to damage. Quite different conclusions about the prognosis, it may be different samples. Some believe that the cure and improvement rate was 75%, and some that accounted for 50%. However, despite the delayed healing of the patient symptoms, but will not lead to loss of mental disability and social functions. Is worth noting that anxiety disorders should be concerned about suicide, and some scholars believe that anxiety is not an isolated phenomenon of suicide. Since 1417 prevention of psychiatric medicine in the development of late, the profession itself but also because the complexity of the basic theory, a considerable number of common causes of mental illness and pathogenesis has not been elucidated. Together with the old concepts, the cause of mental illness is considered to be a long time, mysterious and neglected, thus impeding the prevention of mental work. Present mental illness prevention in some countries, are different forms of organization, to take different measures, combined with different social systems and cultural and ethnic characteristics, towards the prevention of mental illness with this goal. 18 health-care when patients are at a low ebb, too lazy to move, the following some of the release of tension, increase vitality to try. This well-designed dozens of sport, can stretch your whole body, accelerate blood circulation, regardless of when and where, five minutes can be done. If you are at home, you can also use music to match. Most of the music is not too fast is too slow, you can find about three minutes long and low-key child songs, many of which contain up shot, then adjust the speed of movement with the music melody. 21


Friends Links:Automation Control Blog
Automation Products Order Numbers