Anxiety neurosis (referred to as anxiety disorder) is a type of neurosis primarily characterized by anxiety. It manifests as a state of nervousness and fear without factual basis, clear objective triggers, or specific conceptual content, accompanied by autonomic nervous symptoms, muscle tension, and motor restlessness. This disorder is divided into two forms: panic disorder and generalized anxiety disorder.

bubble_chart Diagnosis

1. Symptom Characteristics

(1) Generalized Anxiety Disorder:

Characterized by frequent or persistent tension and unease without a clear object or fixed content, or excessive worry and distress about certain issues in real life. This tension, worry, or distress is disproportionate to reality; often accompanied by hyperactive autonomic nervous function, motor tension, and excessive vigilance.

(2) Panic Attacks:

Characterized by recurrent intense episodes of panic, accompanied by a sense of impending death or loss of control, and may include severe autonomic nervous symptoms.

(3) At least three panic attacks within one month, each lasting no more than two hours, significantly affecting daily activities.

2. Physical Examination Findings

Panic attacks are not caused by physical illnesses and are not associated with schizophrenia, affective disorders, or other neurotic disorders.

3. Differential Diagnosis

The condition needs to be differentiated from hyperthyroidism, stimulant overdose, withdrawal reactions to sedatives or benzodiazepines.

bubble_chart Treatment Measures

Drug therapy has a significant effect on this disease, but psychotherapy can alleviate anxiety. Generally, psychotherapy should be appropriately combined with drug therapy to control anxiety.

(1) Tricyclic antidepressants: Imipramine and clomipramine are more effective. The initial dose should be small. For example, imipramine can start with 12.5mg once at bedtime, increasing by 12.5mg every other day until reaching 300mg. The general treatment dose is 150mg, and some individuals may require more than 300mg.

(2) Benzodiazepines: Alprazolam has the best efficacy; others such as chlordiazepoxide, oxazepam, estazolam, and diazepam also have good effects. Alprazolam can be used at 0.4–0.8mg three times a day.

(3) Beta-adrenergic receptor blockers: Propranolol can be used to reduce the patient's autonomic nervous system hyperactivity symptoms.

(4) Buspirone is effective for generalized anxiety and has no side effects such as drowsiness.

II. Psychotherapy: This is a fundamental method for treating this disease. Commonly used approaches include:

(1) Group psychotherapy;

(2) Small-group psychotherapy;

(3) Individual psychotherapy;

(4) Morita therapy.

Psychotherapy involves the doctor systematically explaining the medical knowledge of the disease to the patient, enabling the patient to fully understand the condition, analyze the causes of their illness, seek solutions, eliminate hypochondriacal thoughts, reduce anxiety and distress, and break the vicious cycle. The treatment methods are also explained to encourage active cooperation from the patient and maximize therapeutic effects. Individual psychotherapy provides psychological guidance tailored to the specific circumstances of individual patients, based on group or small-group therapy. Morita therapy, which advocates acceptance of nature, is one of the effective methods for treating neurasthenia. It can also be selected in hospitals with the necessary conditions.