Fear at every step – What is acute anxiety disorder?

This is the 3165th article of Da Yi Xiao Hu

"Fear at Every Step - Focus on Acute Anxiety Disorder" Panic disorder, also known as acute anxiety disorder, may make people wonder: Isn't anxiety just frequent random thoughts, easy tension and worry, and excessive worry about various things? Why is there a distinction between acute and chronic?

Let’s take a look at the characteristics of panic disorder:

01

“Come and go without a trace”

Panic disorder attacks are often sudden and unpredictable. They can occur in any environment, such as riding a bus, driving, watching TV at home, walking, etc. There is no specific environment or stimulus, so we cannot predict when it will occur. Each attack will be relieved by itself in about 5-20 minutes. Whether it is during the attack or after the relief, it is difficult to find abnormal results in the hospital. It can be said that it "comes and goes without a trace."

02

"I searched for him everywhere"

Panic disorder is extremely hidden and often disguises itself as various physical discomforts, causing most patients to visit various major internal medicine departments to look for the cause. For example, if they have palpitations, rapid heartbeat, and chest pain, they go to the cardiology department; if they have choking, shortness of breath, or a feeling of suffocation, they go to the respiratory department; if they have dizziness, chills and fever, numbness and tingling, sweating, tremors, or shaking, they go to the neurology department. In addition, patients may also experience nausea or abdominal discomfort, a feeling of unreality, fear of losing control, a sense of impending death, etc., but even after many tests, the cause cannot be found. Only after many twists and turns can it be discovered that the physical discomfort is related to panic disorder.

03

"Still feeling scared"

The "悸" here does not refer to "heart palpitations" but to "worry". After a panic attack, the patient will always worry about the recurrence of such intense discomfort and will avoid activities or environments related to the previous attack.

Of course, before diagnosing "panic disorder", we need to rule out diseases with similar symptoms: 1. Acrophobia: This strong discomfort occurs when standing at a height; 2. Claustrophobia: Strong discomfort occurs when in a closed space such as an elevator or subway; 3. Social phobia: Strong discomfort occurs in many places or when socializing is required. In addition, we also need to rule out physical diseases such as mitral valve prolapse, pheochromocytoma, hyperthyroidism, hypoglycemia, etc. through multiple tests.

How to treat panic disorder?

The treatment of panic disorder is mainly based on medication and psychotherapy. Commonly used drugs include benzodiazepines, antidepressants, tandospirone, etc. Among them, benzodiazepines are often used to "treat the symptoms" - quickly relieve the strong physical discomfort during panic attacks, and regular use reduces the number of panic attacks. It is recommended that routine use should not exceed 2-4 weeks. "Treat the root cause" requires the use of antidepressants, tandospirone, etc. Anxiety disorders have a long course of disease, and drug treatment generally needs to be maintained for 1-2 years; anxiety disorders are also prone to relapse, so patients also need long-term follow-up visits.

Psychological or behavioral therapy, including relaxation training, anxiety control training, and targeted exposure therapy, can help relieve anxiety and physical discomfort symptoms.

Panic disorder is not scary. As long as it is diagnosed and treated early, the symptoms of most patients can be effectively controlled, the number of panic attacks will be greatly reduced, or even no longer occur.

Author: Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Department of Psychological Medicine