Overview: It is a mental disorder with anxiety as the main clinical manifestation. Patients often have unexplained fear and nervousness, as well as significant symptoms of autonomic nervous system dysfunction, muscle tension and movement uneasiness. They realize that these worries are excessive and unnecessary. Appropriate, but uncontrollable and painful

Causes: 1. Heredity: obvious family aggregation 2. Neurobiological factors: (1) Neuroimaging: increased volume of the amygdala and dorsomedial prefrontal cortex (2) Neurobiochemistry: γ-amino acid butyric acid, 5-hydroxytryptamine, Norepinephrine 3. Psychological related factors

Clinical manifestations: 1. Mental anxiety: Excessive mental worry is the core of anxiety symptoms. It manifests as constant worry about some unpredictable danger or unfortunate event that may occur in the future --- (1) Free-floating anxiety: not clearly aware of the object or content of the worry, but just a feeling of fear and uneasiness. Strong inner experience (2) Anticipatory anxiety: Worry about things that may happen in real life, but the level of worry and anxiety is far out of proportion to reality (3) Increased alertness: sensitivity, startling, difficulty concentrating, insomnia, and easy Irritation 2. Somatic anxiety: manifested as motor restlessness and muscle tension --- (1) Motor restlessness: rubbing hands and feet, being unable to sit still, walking back and forth, and many small movements (2) Muscle tension: subjective Uncomfortable tension in one or more groups of muscles, and in severe cases, muscle soreness, mostly seen in the chest, neck, shoulder and back muscles (3) Tension headache (4) Limb tremor (5) Voice tremor 3. Autonomic nervous system disorder: heartbeat Excessive speed, shortness of breath and chest tightness, dizziness and headache, skin flushing, sweating or paleness, dry mouth, swallowing infarction, etc. can involve various organ systems. 4. Other symptoms: (1) Often combined with fatigue, depression, obsessive-compulsive, fear, panic attacks and Depersonalization, etc., but are often not the main clinical phase of the disease (2) Some include anxious faces, elevated blood pressure, increased heart rate, limb tremors, active tendon reflexes, etc. (3) HAMA ≥ 14 points

Diagnosis: Primary symptoms of anxiety must be present most of the time for at least 6 months, and should include the following elements: 1. Excessive worry and anxiety 2. Motor tension 3. Hyperautonomic nervous activity

Differential diagnosis: 1. Anxiety related to physical diseases: hyperthyroidism, hypoglycemia, SLE, pheochromocytoma, metabolic syndrome, hypertension, diabetes, etc. 2. Anxiety related to mental disorders: depressive disorder, other anxiety disorders, schizophrenia 3. Drug-induced anxiety: long-term use of drugs, overdose, poisoning, and withdrawal. eg. Methylphenidate, thyroxine, steroids, theophylline, antipsychotic drug (overdose) use, alcohol, sedative-hypnotic drug withdrawal.

Treatment: 1. Drug treatment: Acute phase goals [relieve or eliminate symptoms and accompanying symptoms, improve clinical cure rate, restore social functions, and improve quality of life] --- (1) Anti-anxiety depressants: SSRIs and SNRIs-- -eg. Paroxetine, venlafaxine, duloxetine, escitalopram, tricyclic antidepressants (2) Benzodiazepines: early use, 2-4w (3) Other drugs: Partial agonists of 5-HT1A receptors such as buspirone, tandocyclone, and beta-adrenergic receptor blockers. (4) Flupentixol and Melitracen: not suitable for long-term use, as it may induce PD in the elderly (5) Course of treatment: ① Acute phase: 3 months ② Consolidation treatment: 2-6 months ③ Maintenance treatment: at least 12 months 2 , Psychotherapy: health education, cognitive behavioral therapy

Overview: Its main characteristics are sudden attacks, unpredictable, recurring, and intense panic experiences, usually lasting 5-20 minutes, accompanied by a sense of near-death or loss of control. Patients often experience fear and fear of approaching a catastrophic outcome. accompanied by symptoms of autonomic nervous system dysfunction

Causes: 1. Heredity 2. Neurobiological factors: CO2 hypersensitivity theory, г-aminobutyric acid, NE and 5-HT system, neuroimaging research 3. Psychosocial factors

Clinical manifestations: 1. Panic attack: without special fear situation --- (1) Sudden severe autonomic nerve dysfunction (2) Sudden onset and rapid termination, usually lasting 20-30 minutes (3) Consciousness throughout the attack Clarity 2. Anticipatory anxiety: There is still lingering fear in the intermission period after the attack, worrying about recurrence or the consequences of the attack, weakness, and it takes hours to days to recover. 3. Avoidance behavior: persistent anxiety and concern about another attack --- ( 1) Avoiding work or study places, etc., is called agoraphobia (2) Leaving home alone, queuing, crossing bridges, taking transportation, etc., is called agoraphobia

Diagnosis: 1. The patient has panic attack as the main clinical symptom, accompanied by autonomic nervous system related symptoms. 2. Within 1 month after at least one panic attack, there is ① continuous worry about another attack ② worry about the consequences and possible adverse effects of the attack ③ and Seizure-related behavioral changes 3. Rule out other clinical problems, such as substance use and physical illness causing panic attacks

Differential diagnosis: 1. Cardiovascular diseases: chest tightness, chest pain, difficulty breathing, shortness of breath, paralysis, etc. 2. Panic attacks caused by other physical diseases: hyperthyroidism, epilepsy, hypoglycemia, TIA, pheochromocytoma, rabies, etc. 3. Drug effects or psychoactive substance abuse and withdrawal: methylphenidate, thyroxine, steroids, theophylline, amphetamines, benzodiazepines, alcohol withdrawal, etc. 4. Other mental disorders: social anxiety disorder, specific fear disorder; depressive disorder

Treatment: 1. Drug treatment: (1) Benzodiazepines BZD: fast acting, lorazepam, alprazolam or clonazepam, substance abusers are more likely to develop dependence (2) 5-HT Reuptake inhibitors and 5-HT and NE reuptake inhibitors: broad spectrum of action, no tendency to abuse and dependence, long-term use can significantly reduce the relapse rate (3) Tricyclic antidepressants (TCAs): clomipramine is effective in treatment , but there are many adverse reactions, and a small dose needs to be started. 2. BZDs can be combined with antidepressants in the early stage, and BZDs can be stopped after 4-6 weeks. 3. Duration of treatment: (1) Acute phase: 8-12w (2) Consolidation and maintenance treatment: At least one year 4. Cognitive behavioral therapy

Overview: It is an anxiety and fear disorder in which the object of fear is a specific place or situation, such as a place where it is difficult to escape or where help cannot be obtained during panic attacks and other embarrassing situations, although there is no danger at the time.

Clinical manifestations: 1. Main manifestations: Fear of being trapped, embarrassed or helpless, and feeling fearful and uneasy. Avoid these environments, and may even be unable to leave home at all. 2. Often accompanied by anticipatory anxiety, and continuous fear of the possible occasions and consequences of the next attack. 3. May cause secondary depressive disorder and alcohol abuse.

Differential diagnosis: 1. Normal fear 2. Generalized anxiety disorder 3. Obsessive-compulsive disorder (fear of losing self-control)

Treatment: 1 Psychotherapy: behavioral therapy, cognitive behavioral therapy, supportive psychotherapy 2 Drug therapy: anti-anxiety drugs---alprazolam, lorazepam; anti-depressant drugs---SSRIs

Overview: Persistent nervousness or fear in social situations and social avoidance behavior.

Causes: 1. Heritability: 30-65% 2. Abnormal 5-HT function; abnormal function of dopamine transporter in the striatum 3. Psychosocial factors: over-protection, neglect and abuse in childhood (sexual abuse in childhood) Miss)

Clinical manifestations: 1. Core symptoms: Significant and persistent worry that he may be embarrassed or embarrassed in public, worried that others will laugh at him or evaluate him negatively, and the patient will become more restrained and nervous when others are watching him intentionally or unintentionally. Uneasiness, although the patient realizes that this tension and fear is unreasonable, but still tries to avoid relevant social situations 2. Extreme situations: can lead to self-social isolation, being nervous about necessary and upcoming social interactions, and having troubles when socializing Intense anxiety and pain, blushing and trembling hands, not daring to look at each other, etc., leaving in a hurry after completing necessary social behaviors as much as possible, which can seriously affect the patient's personal life, professional functions and social relationships

Diagnosis: 1. Symptoms: A strong sense of fear in one or more social situations. The focus of worry is that the individual will behave negatively or will be negatively evaluated by others when showing anxiety symptoms. 2. Course criteria: persistent. Less than six months 3. Severity: Prevents the individual from participating in desired activities or causes significant pain during such activities

Differential diagnosis: 1. Normal shyness 2. Body dysmorphic disorder 3. Schizophrenia 4. Place phobia disorder (whether you want someone to accompany you)

Treatment: 1 Cognitive behavioral therapy 2 Drug treatment: antidepressants---SSRIs, SNRIs, BZDs, beta-blockers

Overview: 1. Definition: It is an anxiety and phobia disorder. The patient's fear or avoidance is limited to specific objects, scenes or activities. 2. Object of fear: specific natural environment, animals, injections, situations, infection with certain diseases ( AIDS), etc. 3. Avoidance behavior: adopted to reduce anxiety. Usually what is feared is not the object or situation itself, but the possible consequences. For example, fear of driving is fear of traffic accidents. 4. Characteristics: This fear is excessive , unreasonable and persistent (the boy who is afraid of dogs)

Differential diagnosis: 1. Obsessive-compulsive disorder (fear of losing self-control) 2. Schizophrenia 3. Others: substance use, organic brain diseases

Treatment: 1. Psychotherapy: exposure therapy 2. Drug treatment: antidepressants---BZDs, β-blockers