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Depression and anxiety disorders treatment of psychological Second Hospital of Sanming City Department Chen Meiying
Second Hospital of Sanming City, Fujian Province, deputy director of clinical psychologist Dr Chen Meiying
Depression and anxiety disorders are common diseases in general hospitals, has become a high incidence of low recognition and diagnosis, not treatment is high, endangering the public health, cause serious impairment and social burden of the disease. The study data show that nearly 1 / 4 of the general hospital patients with depression / anxiety symptoms. Therefore, it is necessary to improve the overall hospital doctors diagnosis and treatment of depression and anxiety disorders capabilities.Depression is a mental illness or mood affective disorder, a type, is also a common mental illness. To clinical depression, a sense of lack of interest and pleasure as the main feature of the depressive episode. Mainly for depression, pessimism, despair, decreased energy, decreased interest, persistent fatigue, slow thinking, lack of initiative, self-blame from the offense, diet, poor sleep, worry about suffering from various diseases, many feel that the body does not seriously, accompanied by suicidal thoughts or suicidal behavior.
Patients with depression worldwide 3.4 billion, about 5% prevalence rate, it is common psychiatric is a high prevalence, high self-mutilation disease, is also a high recurrence of disease, high mortality disease, about 15% o


f depressed patients eventually die of suicide. It is not a self-recovery soon, "emotional problems", but a chronic illness will affect the whole body, has become the global burden of disease to humans poses a major burden in the second most important diseases on patients and their families suffering caused by the loss to society is unmatched by other diseases, and only less than 10% of patients with major depression receive adequate treatment.
That situation is mainly due to lack of proper community awareness of depression, prejudice so that patients do not want to go to the hospital treatment of psychiatric or psychological subjects.
In addition to the causes of depression caused by biological factors, mainly caused by psychological reasons, the main factors are: 1. Personality factors: emotional high and low recurring, as well as easy-compulsive personality and anxiety associated with depression who. 2. Adverse childhood experiences: childhood, lack of affection, or over-indulgence will affect the child's social skills, character formation of their children will have a negative impact. 3. The impact of unexpected events of life: depression, stress and more time in the disease, within 6 months have a significant negative life events of people, depression, increased risk of disease 6 times higher risk of suicide 7 times. 4. Lack of social support: a supportive, the lack of adverse social environment to stimulate and pressure relief of depression is essential.
Depression, women constitute the majority. Harvard University, according to the latest statistics: Worldwide, women suffer from depression, distress were twice as likely. Women of the World, about 1 in every 8 people in a female at some stage in their lives suffer depression problems.
The majority of depressed patients, their first psychiatric treatment is not medical institutions, but the general hospital. One reason is: the one hand, social and cultural factors, people worried about being labeled "depressed", "weak" or "mental illness" label, taboo, a psychiatrist; and partly because symptoms of depression and physical disease were made co-exist, as well as symptoms of mental depression, "hidden", and somatic symptoms "highlights", and therefore doctors general hospital identification and treatment of depression as the first line of doctors.
Clinically, when the physician or a reception like that is difficult to specify unexplained physical symptoms such as fatigue, chronic pain (especially headache, abdominal pain, pelvic pain, etc.), sexual dysfunction, tinnitus, sleep or function of ( intestinal bowel syndrome) and organic (peptic ulcer) gastrointestinal tract as the main clinical manifestations of SARS patients should be alert to the patient may suffer from depression. In addition, when physicians are admissions of patients with high risk factors following a number of features, the even more attention should be paid: 1, past history of depressive episodes; 2 family members in patients with depression; 3, there should be shock life events; 4, lack of social support; 5, in the past history of anxiety attacks; 6, currently at post-natal period; 7, there is substance abuse (tobacco and alcohol, drugs); 8, there is a serious physical disease.
Second, the diagnosis of depression
China to use more Chinese classification and diagnostic criteria for mental impairment (third edition) diagnostic criteria, namely, the diagnosis of CCMD-3, its clinical performance standards are as follows:
Dominated by low mood, is not commensurate with their position, can be depressed to grief, or even stupor. In severe cases, there may be hallucinations, delusions and other psychotic symptoms. Some cases of Anxiety, agitation is significant.
1, the symptom criteria: the state of mind down the main, and at least the following four, in line with the standard symptom criteria and severity of at least 2 weeks:
(1) loss of interest, no pleasant feeling; (2) decreased energy or a sense of fatigue; (3) psychomotor retardation or agitation; (4) low self-evaluation, self-blame, or guilt; (5) Lenovo difficult or perceived decline in thinking ability; (6) recurrent thoughts of death or to commit suicide, self-injurious behaviors; (7) sleep disorders such as insomnia, early awakening, or sleeping too much; (8) loss of appetite or significant weight loss; (9), loss of libido. To
2, severe criteria: social dysfunction, or give me cause pain or adverse effects.
3, duration criteria: 1. Meet the symptom criteria and severity criteria at least 2 weeks.
2. Can exist some of the disruptive symptoms, but do not meet the diagnosis of schizophrenia. If the symptoms of schizophrenia also meet the standards in the relief of symptoms after the split, to meet the standards of a depressive episode at least 2 weeks.
4, the exclusion criteria: exclude organic mental disorder, or psychoactive substances and non-addictive substance due to depression.
Third, depressive episode in the rapid identification and diagnosis
Rapid recognition and diagnosis of depression is important. The patient can understand the feelings of seeking eager, but many patients are often repeated in the subjects inside and outside inspection, diagnosis and treatment of poorly had just consider the effect of depression. Clinical show that about half of cases of depression was not timely identification and treatment, the mean duration from March to June before being diagnosed. Other antidepressants in the treatment of general 2 - 4 weeks before an effective, invisible in the making of depressed patients receiving antidepressant treatment can not quickly see the hope of rehabilitation and cure more easily a firm awareness of their inappropriate prejudice, negative and pessimistic and desperate, therefore, rapid identification, diagnosis and treatment of depression is important, if we can quickly ease the symptoms of depression, we can restore the patient's self-confidence, to see the dawn of recovery or cure and prevention of suicide.
Depressive episode of rapid identification, diagnosis, follow these steps:
INSTRUCTIONS: Please talk to you, you are every day in the last two weeks, and most of the time in the day, all of the following conditions (in asking about symptoms need to repeat this guidance language.)
A, core symptoms asked of law: depressive mood, diminished interest and pleasure, or loss of a sense of
1, depressive mood: Do you spend most of time does not always feel happy, or unhappy, or even feel the pain. 2, a sense of diminished interest and pleasure, or loss of: (if necessary, suggest the so-called interest in the project.)
(1) you usually have hobbies, activities or things of interest are still, as usual willingness to do daily or regularly,
To attend? In these activities, whether the same degree as in the past are pleased and happy?
(2) as some people describe a sense of pleasure is unclear, but also the following questions:
If some acquaintance with the talk about a funny thing, we all laughed, you were also present to hear, whether you like the last one
Plots happy laugh without feeling forced or had to Peixiao; or even completely do not feel funny or happy.
Note: If the patient or with one of the two, it should be considered highly likely to suffer from depression, symptom criteria should continue to ask the other seven additional symptoms (see B), such as having four or more, and has been going on for two weeks that meet the diagnostic criteria for depressive episode. If the two do not have any core symptoms, then patients with no depression, no longer have to ask the other seven symptoms.
B, at least four associated with the following additional symptoms:
1, significant weight loss (not dieting) or weight gain (weight change within a month more than 5% of original body weight), or the almost daily loss of appetite or increase; Note: Children should increase body weight was not reached.
2, insomnia or sleepiness almost every day.
3, nearly every day psychomotor agitation or retardation (observable by others the situation is not only the subjective experience restlessness or slow down.)
4, almost daily fatigue weakness or lack of energy.
5 am almost every day of life has no value, or excessive inappropriate guilt from the sins (which may be delusional level, not just blame myself sick.)
6 am almost every day the ability to think or concentrate with the decline, or undecided (or for self-experience, or for another person observation).
7, repeated thoughts of death (not just fear of death), think of no special plans suicidal ideation or a suicide attempt or thought of a special program to implement suicide.
Fourth, the treatment of depression
Although common and serious depression, but is not a disease so that doctors were helpless. If the diagnosis is correct, the treatment time ,80-90% of patients will get faster, better outcomes. It is because doctors in general hospitals for depression diagnosis and treatment of the primary gatekeeper, the general hospital doctors an accurate grasp of depression, specific treatment, will greatly improve the prognosis of patients and improve their quality of life.
(A) of the principal means of treatment of depression: psychotherapy and drug treatment
1, psychological treatment: psychological treatment can be general, that the actual situation based on the patient and to carry out a reasonable explanation, consolation, encouragement, guaranteed. Throughout the course of treatment with the drug treatment simultaneously.
2, drug treatment: antidepressant drugs can eliminate the patient's symptoms, greatly shorten the course to improve the situation of the social function of patients, reducing mortality and morbidity of depression.
For patients with mild depression, psychological treatment and drug therapy to be effective. For moderate and severe depression patients, psychotherapy is a subsidiary of drug treatment in an effective manner. However, for patients with more severe symptoms, especially in patients with suicidal tendencies, severe depression and patients who have drug interactions and refractory patients should be referred to a psychiatrist.
Treatment of depression issues that need attention: mission adhere to the patient the need for medication. Because antidepressants take 1-2 weeks before the general onset, the patient during this time, probably because no significant effect of withdrawal on their own. In the maintenance treatment phase, patients may stop taking medicine, antidepressant drug treatment systems, sufficient amount of agent, the full course of treatment is to ensure that the basis for achieving this purpose. According to statistics, in the treatment of depression in general hospital patients, more than a third of antidepressant drug treatment gained less than one month, while three-fifths of the dose used by patients is also lower than the effective dose. General Hospital in the treatment of antidepressant drugs usually takes 6 - 8 weeks, the other, depending on the conditions necessary to maintain treatment.
(B) of the main categories of antidepressants:
Current clinical practice at home and abroad, we recommend antidepressants as first-line medications:
1, the selective 5 - HT reuptake inhibitors SSRIs (eg paroxetine);
2,5 - serotonin - norepinephrine reuptake inhibitor dual SNRI (eg venlafaxine);
3, norepinephrine, and the specificity of 5 - HT antidepressants NaSSA (such as mirtazapine);
4, tricyclic antidepressants TCAs (eg amitriptyline).
(C) antidepressants in the treatment of the basic principles:
The diagnosis must be correct; specific circumstances, specific treatment (such as based on symptoms, age, physical status, duration and compliance, etc.); dose must be gradually increased to improve compliance; preferred single drug treatment, if invalid, may consider merging dressing treatment.
(D) different periods of treatment of depression:
Including the treatment of depression during the acute phase of consolidation and maintenance phase. Treatment of major depressive episode called acute phase of treatment, to alleviate and eliminate the symptoms of depression. Relief from symptoms within a period of consolidation, continued from April to June, during which the patient's condition unstable. Maintenance phase of treatment aimed at preventing recurrence.
General Hospital of the more common onset of depression phase (ie acute phase), treatment aims to alleviate and eliminate the symptoms of depression, it is recommended adequate antidepressant treatment and adequate medical treatment, the general course of 6-8 weeks.
The end of the acute phase treatment should be discussed with the patient consolidation therapy measures, clinical recovery were to continue to consolidate the treatment should also be considered, such as the temerity to withdrawal will lead to the rapid resurgence of depressive symptoms.
Depression may be primary, and it can be secondary to some other circumstances, such as stressful life events, such as suffering from physical disease. Secondary depression is more common in the general hospital, the general does not require maintenance therapy. Recurrence of primary depression, the characteristics of those susceptible to the need to maintain and relapse prevention therapy, in general, for the first time after the onset of acute primary depression, maintenance treatment for 6 months, then gradually reduce the dose. If the re-emergence of symptoms, maintenance therapy should be extended from 3 - 6 months.
(E) to improve treatment of depression variable follow-up program:
Treatment effect in patients with obvious treatment processing includes adjustments (dose adjustment, medication, concomitant medications, etc.), selected patients were recommended to the psychiatrist for further diagnosis and treatment at.
(F) use of antidepressants for:
1, according to different mechanisms for different antidepressants, TCAs such as switching to SSRIs.
2, the same class of drugs can also switch to other drugs such as SSRIs for use of SSRIs;
3, the dressing can improve patient compliance, reduce side effects and improve efficacy. But the dressing should pay attention to the possible withdrawal symptoms and effects of different drugs from the time difference.
(Vii) combination therapy: Enzyme should be noted that drug
1, SSRIs should not be within the same joint, should not be combined with high-dose TCAs;
2, SSRIs benzodiazepine class (BZDs);
3, SSRIs maprotiline (NE reuptake antidepressants);
4, SSRIs small amount of mirtazapine (10-15mg/QN) can improve sleep.
(Viii) indications on the referral and consultation:
If the effects are still not satisfied after dressing, you should consider your psychiatrist for consultation or referral.
The indications for consultation or referral:
1, 4-6 weeks of antidepressant treatment ineffective;
2, who have a negative risk of suicide;
3, there were serious adverse drug reactions;
4, severe depression, anxiety symptoms; refused to cooperate with treatment.I. Over
Anxiety Anxiety is commonly referred to, called anxiety neurosis. It is a persistent anxiety, fear, tension and autonomic activity in brain barrier dysfunction, often accompanied by anxiety and physical exercise-induced discomfort.
The most prominent symptoms of anxiety disorder is anxiety, anxiety as the main clinical phase is a neurological disorder, the disease is common in foreign countries. Diagnosis of neurasthenia in China, there are a considerable number of countries in the West was diagnosed with anxiety disorder. Disease in young adults period to onset before the age of 40 is more common. Men and women no significant difference in incidence. Annual rate of 3.5 million newly issued anxiety disorder, accounting for sixth place.
Second, the main type of anxiety disorder and clinical performance:
Anxiety disorders can be divided into two types: the acute anxiety (also known as panic attacks, accounting for 43%) and chronic anxiety (also known as generalized anxiety disorder, accounting for 57%). The clinical manifestations are not consistent.
1, panic attack (acute anxiety)
Sudden onset, the patient has an indescribable inner tension, fear. Attack patients to extreme fear, tension, accompanied by autonomic dysfunction as the main performance, pupil dilation, sweating, dizziness, fainting, difficulty breathing, chest tightness, chest pain, palpitations, severe heart or even feel the "heart jump throats ", urine urgency, and limb numbness, and even can not control the trembling sweating, terrified patients, as" apocalyptic "or" death is approaching, "" loss of self-control "experience, there is a sense of dying. Generally 10 minutes, which peaked at 20 to 30 minutes. Often sudden, self-relief.
Acute anxiety disorders, their symptoms and heart obstruction, like angina, attack patients will feel a vague fear, as also with heart pain, chest choking, dyspnea and other symptoms, often giving a cardiovascular disease attack illusion. Often misdiagnosed as heart disease and other acute physical disorders.
As competition intensifies and the quickening pace of people's lives, young lives in the city, because of the uncertain future, it is easy under the pressure of anxiety. If the character sensitive, and too much emphasis on their changes, are particularly prone to "acute anxiety." In recent years the rapid growth of the disease to young people in the majority.
2, generalized anxiety disorder (chronic anxiety)
Generalized anxiety disorder is more common than acute anxiety, there may be different clinical characteristics. The object is a lack of clear and specific content-based fear and nervous anxiety, and significant autonomic symptoms, exercise-induced muscle tension and anxiety, the patient is unable to escape because of the unbearable pain. Some people expressed as anticipatory anxiety, the patient there is always a fear of foreboding, worried about what their loved ones misfortune and accidents will happen, some changes on their own bodies and feel very sensitive. Patients are in a constant state of anxiety may be several weeks or longer, during which time patients have anxiety or symptoms of light or heavy, as usual for the little things and distress, self-blame, exaggerating the difficulties, often failing at worst sake, often making a fuss, special attention on the physical discomfort.
Psychological symptoms: no object content of fear, tension, fear, fear; of sound, light sensitivity; whole body discomfort (the emotional discomfort); anxiety, irritability, easy temper; concentration, memory decline.
Somatic symptoms: autonomic dysfunction, the sympathetic nerve activity based, such as dry mouth, abdominal discomfort, nausea, dysphagia, flatulence, bowel, diarrhea, chest tightening, difficulty breathing or shortness of breath, palpitations, chest pain, tachycardia, urinary frequency, urgency, sweating, facial flushing, impotence, lack of sex, menstrual cramps, discomfort. Location, nature is not clear, there are changing migration characteristics. In addition, headache, tight, head heavy, the mind is unclear, neck pain, muscle tension, aches, stiff feeling, slightly trembling hands, restlessness, easy fatigue, weakness, difficulty falling asleep, early awakening, nightmares, night terrors, sleep is not deep, wake up after the fear.
Third, the diagnosis of anxiety disorder
China to use more Chinese classification and diagnostic criteria for mental impairment (third edition) diagnostic criteria, namely, the diagnosis of CCMD-3, its clinical performance standards are as follows:
1, acute anxiety disorder (panic attacks) in the diagnosis
(1) symptom criteria: meet the diagnostic criteria of neurosis; acute anxiety disorder must meet the following four: a no incentive to attack, no specific situation related to that attack is not predicted; b in the interval of onset, in addition to fear of re- attack, but no obvious symptoms; c show a strong attack of fear, anxiety, and significant autonomic nervous symptoms, and often personality disintegration, the disintegration of reality, dying of fear, or loss of control painful experience flu; d attack suddenly and quickly reached a peak, a clear sense of attack, and afterwards to recall.
(2) severe criteria: the patient because of intolerable and can not escape, and feel the pain.
(3) course criteria: at least 1 month 3 panic attack, or after the onset of secondary afraid of the first episode of anxiety for 1 month.
(4) Exclusion criteria: rule out physical illness or other mental disorders, such as: fear, depression, or somatoform disorders, panic attacks secondary; exclude physical diseases such as epilepsy, heart attack, mitral valve prolapse, addicted chromaffin cell tumors, hyperthyroidism, or spontaneous hypoglycemia, penicillin allergy.
2, chronic anxiety disorder (GAD) in the diagnosis
(1) symptom criteria: meet the diagnostic criteria of neurosis; to ongoing anxiety symptoms in primary and meet the following two: a recurrent or persistent non-specific and fixed content object of fear or fear; b with autonomic symptoms or exercise-induced anxiety.
(2) severe criteria: social dysfunction, the patient is unable to escape due to unbearable, and feel the pain;
(3) duration standard: the standard symptoms of at least 6 months.
(4) Exclusion criteria: rule out hyperthyroidism, hypertension, coronary heart disease secondary somatic anxiety; eliminate excess stimulant drugs, hypnotic and sedative drugs, or anti-anxiety drug withdrawal symptoms, obsessive-compulsive disorder, phobia , hypochondriasis, neurasthenia, mania, depression, or schizophrenia, etc. associated with anxiety.
Fourth, diagnosis and differential diagnosis based on
1, the diagnosis is based on:
repeated no clear reason, the object or content of the fear, anxiety and other intense emotional experience, accompanied by exercise-induced anxiety and autonomic symptoms of hyperthyroidism and other body; complete insight for treatment; course for 1 month or more; premorbid personality traits, mental factors and the family made a similar diagnosis of help Dengjun; has affected the patient's work, study and life; exclude hysteria, depression, schizophrenia, heart disease and other physical disease associated with mental illness and anxiety state.
2, the differential diagnosis
Anxiety disorders need to be differentiated from the following: heart disease: chest pain that occurs when a panic attack, palpitations, sweating and so often misdiagnosed as acute myocardial infarction, through the examination, onset, predisposing factors, and ECG can be identified. It is noteworthy that can be associated with mitral valve prolapse and panic attacks. Hyperthyroidism: Hyperthyroidism associated with anxiety symptoms after treatment, anxiety symptoms, along with the restoration and improvement of thyroid function. Persistent anxiety, chronic anxiety disorders should be considered. hysteria: the emotional hysteria and panic attack episodes easily confused, the former with a strong emotional colors, laughing and crying impermanence, mood changes; the latter strong and uncontrollable anxiety, tension, as the main feature. Depression: often accompanied by anxiety. Depression to depression, interested in dull, feel bad, low self-evaluation, ability to reduce negative perceptions and the other mainly; anxiety disorder Zeyi premonition of future misfortune or actual threat is approaching and there is no tension, fear.
Anxiety disorder often misdiagnosed as: myocarditis: but there is no change in myocardial enzymes; paroxysmal tachycardia: unexplained; cardiac neurosis; chronic gastritis, gastric neurosis; menopausal syndrome; plants neurological disorders: including heart, stomach neurosis, the organ neurosis; nervous.
Fifth, generalized anxiety disorder of rapid identification, diagnosis, follow these steps:
INSTRUCTIONS: Please talk to you, you in the most recent period almost every day of the following situation? And they are not caused because of objective factors.
A. core symptoms of inquiry: (This is the core symptoms of "mental anxiety")
1. Excessive anxiety: [anxiety, including irritability (irritability) and two kinds of emotional stress]
anxiety: how often have you been, or even every day upset for no reason, even with others (especially family members) impatient with it? nervous: how often do you have recently, virtually every day feel the same mood as the rope pull tight, can not relax, even after hours or when nothing is so?
2. Too much about: Do you feel different from the past, always felt uneasy, as if something bad will happen like it? Do you never worry about some little things are usually afraid of them worry about it (which can prompt)? And they can not control myself not to worry?
Note: If two patients have these symptoms 1,2, should be highly considered for generalized anxiety disorder (GAD). Symptom criteria should continue to ask the other additional symptoms (see B), such as having more than three of them, and continued up to 6 months to be diagnosed with GAD, such as 6 months, however, should consider their suffering from the symptoms of generalized anxiety disorder should also be given treatment.
B. At least three symptoms associated with the following: fatigue; difficult to focus attention or to feel a blank mind; irritability; muscle tension; sleep disorders (difficulty falling asleep and staying asleep, or restless sleep) .
Sixth, the treatment of anxiety disorders
(A) psychological therapy
1, in support of psychotherapy-based, to caring, compassionate mood to patients, the nature of the disease to be a scientific explanation, so that patients understand the disease's nature, to lift the psychological burden, and enhance treatment of confidence.
2, psychoanalytic therapy: Because of psychoanalysis to the causes of anxiety disorders attributed to the repressed unconscious conflicts, therefore, focus
Taking into account the spirit of disease treatment is to help patients receive their inner psychological conflict.
3, behavior therapy: specific symptoms based on different patients, the use of behavioral therapy. Such as relaxation training, systematic desensitization techniques.
4, cognitive therapy: the patients often to change the cognitive style.
5, to encourage patients to actively participate in sports activities, including listening to relaxing music, play, dance, can quickly reduce the anxiety.
(B) drug treatment
Anxiolytics in patients with both emotional stability, but also contribute to psychological treatment. Many drugs are rapidly and safely control the focal
Consideration of the effect. To the most commonly used benzodiazepine, such as Squeak stability 0.4 ~ 0.8mg2 ~ 3 times / d; stability of 2.5 ~ 7.5mg, 3 times / d, orally; estazolam 1 ~ 2mg2 ~ 3 times / d; propranolol 10 ~ 30mg, 3 times / d orally. May choose a dual role of antidepressant and antianxiety antidepressants, such as doxepin 12.5 ~ 25mg2 ~ 3 times / d, maprotiline 12.5 ~ 25mg2 ~ 3 times / d, Deanxit 1 tablet 2 times / d (early, middle).
Acute anxiety attack, slow intravenous saline injection stability 20mg + 20ml to patient symptoms. Other: Small doses of antipsychotic drugs: perphenazine, sulpiride and so on.
Treatment of generalized anxiety disorder mainly anxiolytic drugs (eg, benzodiazepines) and antidepressants (eg paroxetine). Although the benzodiazepine drug commonly used to treat anxiety, but the drug itself may lead to dependency. The treatment of generalized anxiety disorder is antidepressant drug of choice.
As often accompanied by depression and anxiety, so it should be adopted in both the treatment of depression and anxiety drugs. This applies in particular General Hospital, when physicians can not determine whether the patient is first admissions of depression or anxiety time. General Hospital, now the majority of clinicians advocate of choice in patients with depression and anxiety new antidepressant, that is, 5 - serotonin reuptake inhibitors (SSRIs) paroxetine drugs represented a class of antidepressants.
With test questions (5 points each)
I. True or false:
1, suicide is a symptom of depression, one of the most dangerous. According to statistics, in the twenty-first century, depression will become the second killer of harm to human health. ()
2, in the minds of many people, depression is not a disease, just to be considered a bad mood, in fact, depression and diabetes, coronary heart disease, hypertension, peptic ulcer is a serious, like the harm to human health diseases. ()
3, depression is a mental illness, a mood disorder, to depression, sadness, disappointment, interest declined, no fun as the main feature, often accompanied by nervousness, insomnia, early awakening, weight loss, vague aches and discomfort and other physical symptoms. ()
4, mild depressive symptoms day and heavy night, especially in the early morning as the most important emotional depression. ()
5, for some patients, severe depression, psychological treatment is not a panacea, first drug treatment or electroconvulsive therapy, and then consider the combined use of psychological methods of treatment. ()
6, anxiety disorders is episodic or persistent feelings of anxiety and tension as the main clinical phase of the neurological disease. Often accompanied by lightheadedness, dizziness, chest tightness, heart palpitations, breathing difficulties, frequent urination, sweating and other obvious physical symptoms. ()
7, anxiety disorder is a persistent anxiety, fear, tension and autonomic activity in brain barrier dysfunction, often accompanied by anxiety and physical exercise-induced discomfort. ()
8, divided into acute anxiety anxiety disorder (also known as panic attacks) and chronic anxiety (also known as generalized anxiety disorder). ()
9, anti-anxiety drugs in patients with both emotional stability, but also contribute to psychological treatment. Many drugs are rapidly and safely control the effects of anxiety to the most commonly used benzodiazepine. ()
10, acute anxiety (panic attacks), its symptoms and heart obstruction, like angina, attack patients will feel a vague fear, as also with heart pain, chest choking, dyspnea and other symptoms, often misdiagnosed as heart diseases such as acute physical disease. ()
Second, the multiple-choice questions:
1, the three main symptoms of depression are ()D. insomnia
2, depression is often what aspects of pathology ()D. somatic symptoms
3, the cause of depression is not very clear so far is generally believed that a number of reasons. Among them, the depressive character neurosis patients showed some common characteristics: ()
A. lack of confidence and self-esteem,
B. over-reliance on others and self-force
C. is not cheerful, good thought-4, the main treatment for depression are the following, but is still the main treatment ()D. light therapy and electroconvulsive therapy, etc.
5, the current clinical practice at home and abroad, we recommend antidepressants as first-line medications:
A. selective 5 - HT reuptake inhibitors SSRIs (eg paroxetine)
B. 5 - serotonin - norepinephrine reuptake inhibitor dual SNRI (eg venlafaxine)
C. Norepinephrine and specificity of 5 - HT antidepressants NaSSA (such as mirtazapine)
D. tricyclic antidepressants TCAs (eg amitriptyline).
6, anxiety disorders cause is unknown, there are different interpretations of different schools of thought is generally believed that a number of reasons. Among them, the occurrence of anxiety disorders play an important role because ()
A. Genetic factors
B. premorbid personality traits7, acute sudden onset anxiety disorder ()
A. Patients with a strange inner tension, fear
B. attack patients to be extreme fear, tension, accompanied by autonomic dysfunction as the main performance
C. generally 10 minutes, which peaked at 20 to 30 minutes
D. often happen suddenly, relieve itself.
8, the standard course of acute anxiety disorder ()
A. within 1 month in at least 3 times a panic attack
B. 1 month at least 4 times a panic attack
C. in 2 months at least 3 times a panic attack
D. In the first episode after the onset of secondary afraid of the anxiety for 1 month
9, chronic anxiety disorder (GAD) of the severe standard ()
A. Social dysfunction
B. the patient is unable to escape because of intolerable
C. pain
D. meet the symptom criteria at least 6 months
10, anxiety disorder often misdiagnosed as ()D. autonomic dysfunctionWith test questions (5 points each)Second, the multiple-choice questions
1, ABC 2, ABCD 3, ABCD 4, AB 5, ABCD
6, A 7, ABCD 8, AD 9, ABC 10, ABCD
(This article published in the "Fujian Medical" No. 5, 2008, as a continuing medical education programs for the province to learn reference)



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