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Introduction In neurology clinics and wards, patients with significant anxiety symptoms are quite common, including patients secondary to neurological diseases (such as stroke, Parkinson’s disease, epilepsy), and various physical discomforts (such as insomnia, headaches) , Dizziness) patients with primary anxiety who are the chief complaint
.
Some neurologists believe that anxiety is just a transient "worry and fear", and can even be regarded as a "normal response" after suffering from a neurological disease, which does not require attention and treatment
.
However, this is definitely not the case
.
Foresight, standardized medication, and extinguishing the "flame" of anxiety in neurology patients will help prevent the spread of "fire", reduce the impact of anxiety on the patient's physical condition, quality of life and functional level, and ultimately improve the overall outcome of the patient
.
In this context, the sixth issue of "Interview with Big Coffee" specially invited Huang Chaoyang, deputy chief physician of the Department of Neurology, Xuanwu Hospital of Capital Medical University, to share his views on the optimization of diagnosis and treatment of neurology patients' anxiety
.
This period expert Huang Chaoyang, deputy chief physician, Department of Neurology, Xuanwu Hospital, Capital Medical University ➤ Postdoctoral, Department of Neurology, Harvard University Massachusetts General Hospital
.
Engaged in epilepsy, sleep disorders, neuroelectrophysiology, cognitive neuroscience and other clinical and research work for more than ten years
.
So far, he has presided over 1 National Natural Science Foundation project and 1 provincial and ministerial level project
.
Involved in a number of national and provincial projects, including key national research and development program, the National High Technology Research and Development Program (863 Program) and so on
.
More than 30 scientific research papers in both Chinese and English have been published
.
➤Main social positions: Member of the Electromyography and Clinical Neuroelectrophysiology Group of the Neurology Branch of the Chinese Medical Association, Deputy Chairman of the Youth Committee of the Department of Neurology of Capital Medical University, Standing Committee Member of the Medical Education Committee of the Chinese Sleep Research Society, Sleep Physiology of the Chinese Sleep Research Society And members of the Pharmacology Professional Committee
.
The following is a transcript of the interview-based on your observations, what percentage of neurology outpatients and inpatients have significant anxiety? Xuanwu Hospital of Capital Medical University is a comprehensive Grade-A hospital with neurological characteristics, which can represent the overall situation of domestic hospitals as well as its own characteristics
.
For example, there are a large number of neurological patients in our hospital, many of whom come from the grassroots, who have encountered difficulties in diagnosis and treatment in local hospitals, or come to our hospital after they have not been diagnosed for a long time
.
The proportion of these patients with anxiety symptoms is very high
.
Specifically, it is very common for patients with common neurological diseases such as dementia, Parkinson's disease, and epilepsy to accompany anxiety
.
Data show that the proportion of patients with epilepsy who are accompanied by anxiety is about 30%; however, based on clinical observations, the true proportion may exceed 50%
.
In addition, more than half of the patients with Parkinson's disease have significant anxiety
.
The anxiety of these patients is more prominent, especially that they are very worried about their physical discomfort and fear that they will suffer from a serious illness
.
Many patients come to the neurology department with complaints of headache and insomnia
.
The proportion of these patients with anxiety is also very high, about 30%-50%
.
As we all know, the clinical manifestations of anxiety are complex and diverse, and many patients show various physical discomforts; the neurology department of insomnia, headache, dizziness, outpatient work is busy, and the number of patients is large, many of which belong to primary anxiety
.
Some neurologists believe that compared with the neurological disease itself, the anxiety associated with the patient is not important, and even belongs to the "normal response" after the illness
.
Do you agree with this view? In recent years, the importance of anxiety, depression, and insomnia has been increasing in China
.
Regarding such problems in neurology patients, we should pay attention to and actively deal with them, no matter from the perspective of the neurological disease itself or the patient's quality of life
.
First of all, it is very common for neurology patients to experience anxiety after illness
.
For example, stroke patients often have a certain degree of sequelae and it is difficult to fully recover; even if they receive high-quality rehabilitation treatment, the ideal result is only to recover to 80%-90% of the pre-morbidity
.
In this case, the patient will almost certainly have some anxiety about future life, work, and family
.
Second, anxiety itself can damage the nervous system
.
For example, pathological anxiety can lead to neuroendocrine system dysfunction, damage the hippocampus structure, and may also adversely affect the function of the prefrontal cortex
.
Third, psychological problems such as anxiety and depression have a great impact on the quality of life and functional level of some patients, even exceeding the primary disease of the nervous system
.
For example, some patients with epilepsy think that they are "different" from others due to long-term illness; even if their symptoms are well controlled, they have only one minor seizure per month, and they are reluctant to go to work, resulting in complete loss of work ability
.
There are also some patients who have poor compliance with treatment due to emotional problems and are unwilling to cooperate with treatment, which affects the recovery of the disease and has long-term low functional level and quality of life
.
In the busy clinical work of neurology department, since the patient enters the clinic or rounds, how can you effectively identify the anxiety problem in the limited time? Regardless of ward rounds or outpatient clinics, for an experienced neurologist, many patients’ anxiety problems can often be identified through observation and listening
.
For example, after some patients enter the consulting room and sit down, their nervous emotions will be quickly expressed through facial expressions; other patients will have a lot of small movements, speak very fast, and have a lot of emotional content in the conversation
.
All of the above suggest the possibility of anxiety
.
In addition, some patients' symptoms show certain characteristics, which can be used as a clue to identify anxiety
.
For example, some patients complained of "pains everywhere" all over the body, which is difficult to explain with medicine
.
After questioning, it was found that there were obvious socio-psychological factors in the patient's pain symptoms, which was judged to be physical anxiety
.
Once it is found that the patient is suspected of being anxious, some simple screening scales can also help clarify the nature of the symptoms
.
In your opinion, what principles should be followed in the medical treatment of anxiety patients in neurology? Does the faster the drug works, the better? An important principle of anti-anxiety therapy in neurology is to balance short-term efficacy and long-term treatment needs, and the balance should be individualized according to the actual situation of the patient
.
Anxious patients tend to have a strong desire for treatment and have high expectations for drugs
.
From this perspective, drugs with rapid onset and definite curative effect can better meet the needs of patients
.
Moreover, the rapid onset of action of the drug can increase the patient’s trust in the drug, and this trust in turn is conducive to the improvement of the disease; if the drug does not work for a long time, some patients will suspect that the drug you prescribe is "inappropriate" or even Disable it yourself
.
For patients with situational anxiety, such as those who have no history of anxiety in the past and who have had acute anxiety after recent emergencies, it may be reasonable to focus on short-term effects and try to withdraw the drug after the symptoms improve
.
However, for more patients, the treatment of anxiety disorders is undoubtedly a long-term process, and it is not uncommon for the disease to fluctuate or even relapse due to premature withdrawal
.
In order to strive for a more ideal long-term outcome, acute anti-anxiety treatment should fully consider the needs of long-term treatment, take into account future symptom control and functional recovery, and choose drugs suitable for long-term use.
For example, it can improve anxiety without inducing excessive sedation, high safety factor, well tolerated, and no risk of dependence and other addictions
.
In recent years, the 5-HT1A receptor partial agonist represented by the original research tandospirone has been used more and more widely in clinical practice due to its advantages of good efficacy and safety, and suitable for long-term use
.
Can you briefly share your experience of using such drugs? First of all, for office workers with mild anxiety symptoms, I personally often use tandospirone, and patients can usually get ideal symptoms and functional outcomes after taking the medication
.
Take a patient I have diagnosed and treated as an example: this patient has been under a lot of work pressure for a long time, and his position has high requirements for work ability
.
However, anxiety caused the patient to have obvious feelings of restlessness, including restlessness; this feeling made him very uncomfortable and also affected his work
.
After using tandospirone, the patient’s subjective perception was significantly improved, and the medication did not interfere with daily work; in fact, the patient believed that his working condition after tandospirone was even better than before the illness
.
After about half a year of treatment, the patient gradually stopped tandospirone and was in good condition
.
In addition, depression with anxiety is very common in clinical practice; although antidepressants are also the first-line drugs for anxiety disorders, when antidepressants are used alone to treat patients with such comorbidities, patients often have residual anxiety symptoms.
Clinical observation and evidence-based The academic evidence is consistent on this point
.
While some patients were taking antidepressants, their depressive symptoms gradually improved, but anxiety symptoms gradually showed up; the problem is that patients have a strong willingness to stop antidepressants, and it is not realistic to increase the amount of antidepressants again
.
In this case, the combined use of tandospirone is an effective and safe option
.
In addition, some antidepressants can aggravate anxiety in the early stage of treatment.
At this time, the combined use of tandospirone is also expected to enhance the efficacy and reduce side effects
.
Compared with traditional benzodiazepines and other anti-anxiety drugs, 5-HT1A receptor partial agonists such as tandospirone are increasingly used in clinical practice, reflecting the doctors and patients’ preference for more ideal anti-anxiety treatments.
Pursuit has its rationality
.
(Final) Approval Number: DSPC-NP-SED-21-09-0015
.
Some neurologists believe that anxiety is just a transient "worry and fear", and can even be regarded as a "normal response" after suffering from a neurological disease, which does not require attention and treatment
.
However, this is definitely not the case
.
Foresight, standardized medication, and extinguishing the "flame" of anxiety in neurology patients will help prevent the spread of "fire", reduce the impact of anxiety on the patient's physical condition, quality of life and functional level, and ultimately improve the overall outcome of the patient
.
In this context, the sixth issue of "Interview with Big Coffee" specially invited Huang Chaoyang, deputy chief physician of the Department of Neurology, Xuanwu Hospital of Capital Medical University, to share his views on the optimization of diagnosis and treatment of neurology patients' anxiety
.
This period expert Huang Chaoyang, deputy chief physician, Department of Neurology, Xuanwu Hospital, Capital Medical University ➤ Postdoctoral, Department of Neurology, Harvard University Massachusetts General Hospital
.
Engaged in epilepsy, sleep disorders, neuroelectrophysiology, cognitive neuroscience and other clinical and research work for more than ten years
.
So far, he has presided over 1 National Natural Science Foundation project and 1 provincial and ministerial level project
.
Involved in a number of national and provincial projects, including key national research and development program, the National High Technology Research and Development Program (863 Program) and so on
.
More than 30 scientific research papers in both Chinese and English have been published
.
➤Main social positions: Member of the Electromyography and Clinical Neuroelectrophysiology Group of the Neurology Branch of the Chinese Medical Association, Deputy Chairman of the Youth Committee of the Department of Neurology of Capital Medical University, Standing Committee Member of the Medical Education Committee of the Chinese Sleep Research Society, Sleep Physiology of the Chinese Sleep Research Society And members of the Pharmacology Professional Committee
.
The following is a transcript of the interview-based on your observations, what percentage of neurology outpatients and inpatients have significant anxiety? Xuanwu Hospital of Capital Medical University is a comprehensive Grade-A hospital with neurological characteristics, which can represent the overall situation of domestic hospitals as well as its own characteristics
.
For example, there are a large number of neurological patients in our hospital, many of whom come from the grassroots, who have encountered difficulties in diagnosis and treatment in local hospitals, or come to our hospital after they have not been diagnosed for a long time
.
The proportion of these patients with anxiety symptoms is very high
.
Specifically, it is very common for patients with common neurological diseases such as dementia, Parkinson's disease, and epilepsy to accompany anxiety
.
Data show that the proportion of patients with epilepsy who are accompanied by anxiety is about 30%; however, based on clinical observations, the true proportion may exceed 50%
.
In addition, more than half of the patients with Parkinson's disease have significant anxiety
.
The anxiety of these patients is more prominent, especially that they are very worried about their physical discomfort and fear that they will suffer from a serious illness
.
Many patients come to the neurology department with complaints of headache and insomnia
.
The proportion of these patients with anxiety is also very high, about 30%-50%
.
As we all know, the clinical manifestations of anxiety are complex and diverse, and many patients show various physical discomforts; the neurology department of insomnia, headache, dizziness, outpatient work is busy, and the number of patients is large, many of which belong to primary anxiety
.
Some neurologists believe that compared with the neurological disease itself, the anxiety associated with the patient is not important, and even belongs to the "normal response" after the illness
.
Do you agree with this view? In recent years, the importance of anxiety, depression, and insomnia has been increasing in China
.
Regarding such problems in neurology patients, we should pay attention to and actively deal with them, no matter from the perspective of the neurological disease itself or the patient's quality of life
.
First of all, it is very common for neurology patients to experience anxiety after illness
.
For example, stroke patients often have a certain degree of sequelae and it is difficult to fully recover; even if they receive high-quality rehabilitation treatment, the ideal result is only to recover to 80%-90% of the pre-morbidity
.
In this case, the patient will almost certainly have some anxiety about future life, work, and family
.
Second, anxiety itself can damage the nervous system
.
For example, pathological anxiety can lead to neuroendocrine system dysfunction, damage the hippocampus structure, and may also adversely affect the function of the prefrontal cortex
.
Third, psychological problems such as anxiety and depression have a great impact on the quality of life and functional level of some patients, even exceeding the primary disease of the nervous system
.
For example, some patients with epilepsy think that they are "different" from others due to long-term illness; even if their symptoms are well controlled, they have only one minor seizure per month, and they are reluctant to go to work, resulting in complete loss of work ability
.
There are also some patients who have poor compliance with treatment due to emotional problems and are unwilling to cooperate with treatment, which affects the recovery of the disease and has long-term low functional level and quality of life
.
In the busy clinical work of neurology department, since the patient enters the clinic or rounds, how can you effectively identify the anxiety problem in the limited time? Regardless of ward rounds or outpatient clinics, for an experienced neurologist, many patients’ anxiety problems can often be identified through observation and listening
.
For example, after some patients enter the consulting room and sit down, their nervous emotions will be quickly expressed through facial expressions; other patients will have a lot of small movements, speak very fast, and have a lot of emotional content in the conversation
.
All of the above suggest the possibility of anxiety
.
In addition, some patients' symptoms show certain characteristics, which can be used as a clue to identify anxiety
.
For example, some patients complained of "pains everywhere" all over the body, which is difficult to explain with medicine
.
After questioning, it was found that there were obvious socio-psychological factors in the patient's pain symptoms, which was judged to be physical anxiety
.
Once it is found that the patient is suspected of being anxious, some simple screening scales can also help clarify the nature of the symptoms
.
In your opinion, what principles should be followed in the medical treatment of anxiety patients in neurology? Does the faster the drug works, the better? An important principle of anti-anxiety therapy in neurology is to balance short-term efficacy and long-term treatment needs, and the balance should be individualized according to the actual situation of the patient
.
Anxious patients tend to have a strong desire for treatment and have high expectations for drugs
.
From this perspective, drugs with rapid onset and definite curative effect can better meet the needs of patients
.
Moreover, the rapid onset of action of the drug can increase the patient’s trust in the drug, and this trust in turn is conducive to the improvement of the disease; if the drug does not work for a long time, some patients will suspect that the drug you prescribe is "inappropriate" or even Disable it yourself
.
For patients with situational anxiety, such as those who have no history of anxiety in the past and who have had acute anxiety after recent emergencies, it may be reasonable to focus on short-term effects and try to withdraw the drug after the symptoms improve
.
However, for more patients, the treatment of anxiety disorders is undoubtedly a long-term process, and it is not uncommon for the disease to fluctuate or even relapse due to premature withdrawal
.
In order to strive for a more ideal long-term outcome, acute anti-anxiety treatment should fully consider the needs of long-term treatment, take into account future symptom control and functional recovery, and choose drugs suitable for long-term use.
For example, it can improve anxiety without inducing excessive sedation, high safety factor, well tolerated, and no risk of dependence and other addictions
.
In recent years, the 5-HT1A receptor partial agonist represented by the original research tandospirone has been used more and more widely in clinical practice due to its advantages of good efficacy and safety, and suitable for long-term use
.
Can you briefly share your experience of using such drugs? First of all, for office workers with mild anxiety symptoms, I personally often use tandospirone, and patients can usually get ideal symptoms and functional outcomes after taking the medication
.
Take a patient I have diagnosed and treated as an example: this patient has been under a lot of work pressure for a long time, and his position has high requirements for work ability
.
However, anxiety caused the patient to have obvious feelings of restlessness, including restlessness; this feeling made him very uncomfortable and also affected his work
.
After using tandospirone, the patient’s subjective perception was significantly improved, and the medication did not interfere with daily work; in fact, the patient believed that his working condition after tandospirone was even better than before the illness
.
After about half a year of treatment, the patient gradually stopped tandospirone and was in good condition
.
In addition, depression with anxiety is very common in clinical practice; although antidepressants are also the first-line drugs for anxiety disorders, when antidepressants are used alone to treat patients with such comorbidities, patients often have residual anxiety symptoms.
Clinical observation and evidence-based The academic evidence is consistent on this point
.
While some patients were taking antidepressants, their depressive symptoms gradually improved, but anxiety symptoms gradually showed up; the problem is that patients have a strong willingness to stop antidepressants, and it is not realistic to increase the amount of antidepressants again
.
In this case, the combined use of tandospirone is an effective and safe option
.
In addition, some antidepressants can aggravate anxiety in the early stage of treatment.
At this time, the combined use of tandospirone is also expected to enhance the efficacy and reduce side effects
.
Compared with traditional benzodiazepines and other anti-anxiety drugs, 5-HT1A receptor partial agonists such as tandospirone are increasingly used in clinical practice, reflecting the doctors and patients’ preference for more ideal anti-anxiety treatments.
Pursuit has its rationality
.
(Final) Approval Number: DSPC-NP-SED-21-09-0015
