Anxiety disorder

Disease Description (Causes and Symptoms)

• Definition: Anxiety disorders refer to a group of conditions in which chronic and excessive worry, tension, and anxiety are the main symptoms and affect daily functioning (including generalized anxiety disorder, panic disorder, specific phobias, and others).
• Main causes (pathophysiology)
  • Genetic predisposition: Similar anxiety disorders are frequently observed among family members.
  • Abnormalities in brain function and structure: Abnormalities in the function of the frontal lobe, limbic system (including the amygdala), and basal ganglia, as well as imbalances in neurotransmitters (serotonin, norepinephrine, GABA, etc.), are involved.
  • Psychosocial factors: Chronic stress, trauma, parenting environment, and cognitive distortions (overestimating danger) contribute to the development of the disorder.
  • Various theories (psychoanalytic and cognitive-behavioral) explain the mechanisms through which symptoms are expressed.
• Main symptoms
  • Psychological: Persistent worry, restlessness, irritability, difficulty concentrating, excessive anxiety (a feeling that something terrible will happen without any basis)
  • Physical: Palpitations, shortness of breath and rapid breathing, muscle tension, fatigue, insomnia, gastrointestinal symptoms (abdominal discomfort and diarrhea), a lump-in-the-throat sensation, frequent urination, a feeling of heat in the face and chest, tingling in the hands and feet, and others
  • Clinical example: Generalized anxiety disorder involves excessive worry lasting at least 6 months, accompanied by at least 3 of the following symptoms: restlessness, easy fatigability, decreased concentration, irritability, muscle tension, and sleep disturbance (1 symptom is sufficient for diagnosis in children).

Treatment Methods

• Medication treatment
  • First-line treatment: Antidepressants (the SSRI class — e.g., sertraline, escitalopram, etc.) and SNRIs (e.g., venlafaxine). It takes several weeks for the effects to appear.
  • Short-term adjunctive treatment: Benzodiazepines (e.g., lorazepam, alprazolam) are useful for relieving acute anxiety, but short-term use is recommended because of the risk of dependence and tolerance.
  • Treatment duration: Even after symptoms improve, maintenance treatment is generally recommended for at least 6 to 12 months (considering the risk of relapse).
• Psychotherapy and non-medication treatment
  • Cognitive behavioral therapy (CBT): Key components include modifying negative automatic thoughts, exposure therapy, and cognitive restructuring; it is an evidence-based treatment.
  • Relaxation techniques, deep-breathing training, muscle relaxation, biofeedback, stress management, and sleep hygiene education.
  • In severe cases or when there is a poor response to medication, consider additional treatment (depth psychotherapy, group therapy, etc.) in consultation with a psychiatrist.
• Lifestyle management and precautions
  • Take medications regularly as directed by your doctor and do not stop them on your own (gradual dose reduction is particularly recommended for SSRIs).
  • Because long-term use of benzodiazepines carries risks of dependence, memory impairment, and falls, use them for the shortest possible period at the lowest effective dose.
  • Be cautious because combining them with alcohol, recreational drugs, or certain sedatives can increase central nervous system depression and side effects.
  • When driving or operating heavy machinery, check whether you are taking medications that cause sedation.
  • If suicidal thoughts, severe functional impairment, or medication side effects (such as severe drowsiness or respiratory depression) occur, immediately visit a medical institution or seek emergency care.

Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)

• Items to prepare (recommended to bring)
  • A list of all medications currently being taken (including prescription drugs, over-the-counter medicines, herbal medicines, and supplements), along with the times and doses taken
  • Previous diagnosis and treatment records (such as previous psychiatric diagnoses, medication records, and psychological test results)
  • A record of recent symptom changes: when symptoms began, their frequency, triggering situations, and factors that worsen or improve symptoms
  • Sleep habits and history of caffeine, alcohol, smoking, and drug use
  • Family history (including any mental illness or suicide attempts)
  • Impact on daily functioning (work, studies, interpersonal relationships, etc.)
• Information to tell the doctor first during the outpatient visit
  • Whether you have thoughts of self-harm or suicide, whether you have had acute panic attacks, and any medication allergies or previous side effects
  • Whether you are pregnant or breastfeeding (this affects medication selection)
• Examples of things to ask yourself during the outpatient visit (initial questions)
  • Organizing the course of symptoms from their onset to the present by date or week can help with diagnosis.

Examples of General Questions to Ask the Doctor

• "When should I expect this medication to start working, and what are its main side effects?"
• "How long should I take this medication? What should I do when stopping it?"
• "What psychotherapy is recommended instead of (or together with) medication treatment, and how long will the treatment take?"
• "What behaviors should I avoid or precautions should I take in daily life?"
• "What preventive management is needed to reduce the risk of relapse?"

Examples of Questions Tailored to Each Condition

• If generalized anxiety disorder is suspected:
  • "How do you determine whether the worry I am experiencing meets the diagnostic criteria for generalized anxiety disorder (at least 6 months, minimum number of symptoms, etc.)?"
• If panic attacks occur frequently:
  • "Please tell me what measures I can take immediately when a panic attack occurs (breathing techniques, criteria for taking medication, etc.) and when I should go to the emergency room in an emergency."

(If you have urgent thoughts of self-harm or severe functional impairment, immediately contact an emergency medical institution or a mental health crisis counseling center.)