Treatment for generalized anxiety disorder

Anxiety itself is common to most of us. Feelings of anxiety and restlessness in psychology are a normal state and are considered as an adaptation mechanism that helps us overcome various stressful situations. But as soon as anxiety acquires irrational forms of a pathological nature, it begins to be classified as a neurotic disease. However, anxiety is by far the most common problem, with about 40% of the population experiencing it to one degree or another.

So, anxiety disorder, as a diagnosis, is a neurotic syndrome, accompanied by a permanent feeling of anxiety in the patient regarding everything that surrounds him, and significantly reducing the quality and richness of his life. Often manifests itself in combination with other psychopathic diseases.

Previously, anxiety disorders were called neuroses, and it was believed that they were caused exclusively by childhood psychotrauma. Modern psychiatry does not share this belief and considers psychotrauma only an accompanying trigger mechanism.

How to distinguish causeless anxiety from a justified feeling of anxiety, which helps a person to look at situations sensibly, avoid real dangers and overcome difficulties?

Specific signs of an anxiety disorder

How to understand that this is neurosis?

Unlike the norm, pathological anxiety is characterized by the following symptoms:

• there is no real threat causing alarm;
• the person’s reaction is not adequate to the situation;
• accompanied by a total feeling of helplessness, fear of death, a feeling of catastrophe, and a permanent physically debilitating expectation of trouble;
• anxiety is actively repressed at the conscious level;
• significantly disrupts a person’s quality of life;
• long and intense;
• manifests itself in the form of specific psychopathological symptoms.

Generalized anxiety disorder - GAD

If you constantly feel anxious, you may have generalized anxiety disorder (GAD).

GAD is a long-term mental disorder that makes you feel restless (anxiety, panic) in a wide range of situations and problems, and not just in the situation of one specific event, and is a “non-fixed” and not tied to a specific place or event condition. In many cases, one can say about GAD that one is constantly worried about everything and for every reason.

Generalized anxiety disorder, in English version

Generalized Anxiety Disorder, literally translated as - generalized

anxiety disorder.

According to the syndromic diagnostic index ICD-10 (which is currently used in Russia) it is encrypted as F41.1.

People with generalized anxiety disorder spend much of their time worrying, trying to remember the last time they felt free from anxiety.

In generalized anxiety disorder, both psychological (mental) and physical symptoms may appear, which are often mixed and manifest as psychosomatic disorders. These manifestations vary depending on the personality type, upbringing, education, physical condition and characteristics of human development. GAD may involve feelings of irritability or restlessness and often include difficulty concentrating and/or sleep disturbances.

Generalized anxiety disorder is very debilitating for patients, both mentally and physically. Symptoms of an anxiety disorder exhaust a person, “eat up” vital energy, interfere with sleep, and reduce appetite. In most cases, people with GAD are unable to engage in full-time work, study and adapt to new conditions. With anxiety disorders, patients are unable to free themselves from this chronic worry and calm their anxiety.

Causes of Anxiety Disorder

The etiology of the disease is not fully understood, but at the moment the scientific community is considering the following reasons:

• chronic diseases;
• taking medications, drug or alcohol addiction;
• brain injuries;
• prolonged stress;
• melancholic constitutional portrait of the personality;
• psychotrauma in childhood or adulthood (post-traumatic syndrome);
• Concomitant neurotic conditions (neurasthenia, depression, hysteria) or psychopathies (schizophrenia, paranoia, mania).

To look at the mechanism of triggering and developing anxiety a little deeper, let's look at the main predispositions that provoke the onset of the disease.

Features of mental disorder

It has been observed that generalized anxiety disorder does not develop in childhood or adolescence. Its manifestations become noticeable only after 30-35 years, sometimes earlier. And if the reasons for its formation go back to childhood, then the failure occurs only at a conscious age.

In general, we can distinguish three areas of fear that so worry a person suffering from chronic anxiety.

1. Fear of one's own physical death or that of relatives or loved ones. In principle, each individual tries to avoid potentially life-threatening factors. However, a person with GAD sees this threat everywhere, even in the most harmless things. His imagination gives him such scenarios for the development of events that horror movie directors would envy.
2. Fear of social inferiority. It lies in the fact that a person is afraid of becoming unnecessary to others, ineffective for society.
3. Fear of going crazy. Admitting that you have any mental disorder is very difficult. Therefore, the prospect of losing the ability to reason sensibly and make decisions independently can frighten any person.
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GAD is approximately twice as common in women as in men. What is this connected with? To understand the reason, you need to delve into history. Since ancient times, a woman, as the keeper of the hearth, was responsible for almost everything: order in the house, the availability of food, the health of children, etc. Simply put, there was nothing to worry about.

Millennia have passed, but, in fact, little has changed: representatives of the fairer sex are much more susceptible to chronic anxiety than men. And the reasons for this have only increased. But under certain circumstances, a malfunction in the functioning of the psyche occurs, and the exciting state takes on a pathological character.

Pathogenesis of anxiety disorder

Organic component of anxiety

Most often it has an organic pathagonesis, expressed in hormonal disorders caused by a malfunction of the thyroid gland; problems with the cardiovascular system, brain tumors. Thus, by analogy with panic attacks, diagnosis is carried out by a complete examination and exclusion of the somatic component. Somatics and organics are considered as the root causes of this type of neurosis.

Genetic determinant

The child may inherit a reaction to a stimulus, which causes the transfer of anxious biology from the parents.

Intrauterine pathology

Due to a disrupted biological base during the prenatal period, the child could be born with increased anxiety. Such trauma in itself is rarely a clear trigger, but the social situation in the family and parenting style can provoke the development of an anxiety disorder if the initial prerequisites are present.

Social component

Lifestyle also greatly influences the development of this type of neurosis and the transition of accentuation into real neurosis. A sedentary lifestyle, excessive exposure to news, taking drugs of a certain cluster, a toxic environment - all these factors are also of great provocative significance.

As for the etiology of psychological development, today there are three main theories:

1. Psychoanalytic
   The appearance of destruction occurs due to frustration, or in other words due to the repression of unfulfilled desires and needs. Often the psyche reacts to censorship and multiple social prohibitions in a neurotic way.
2. Behavioristic
   Here, the emergence of pathology is the result of a gap between the external situation and the mental reaction to it, thus anxiety arises for no reason.
3. Cognitive
   Considers anxiety disorder as a distorted perception of reality by the individual’s consciousness.

What is generalized anxiety disorder

History of GTR Valeria

Valeria has always been restless, but this has never interfered with her life before. Lately, however, she had been feeling edgy all the time throughout the day. She felt an omnipresent sense of fear, paralyzed by constant influxes of thoughts about the future. All her efforts to get rid of this anxiety and concentrate on work were to no avail. When she returned home, she could not relax.

Valeria also had difficulty sleeping, tossing and turning for several hours before falling asleep. In addition, she felt frequent stomach cramps and diarrhea, and tension in the neck muscles. Valeria even began to feel like she was going crazy.

Generalized anxiety disorder (GAD) is a common disorder that involves chronic anxiety, nervousness, and tension. Unlike a phobia, where fear is associated with a specific object or situation, the anxiety of generalized anxiety disorder is somewhat vague, not attached to an object. This anxiety is less intense than panic attacks, but much more persistent, making normal life debilitating and impossible to relax. With panic attacks, as a rule, the state remains normal between panic attacks, but with GAD, anxiety continues in a constant background.

If you have generalized anxiety disorder

If you have GAD, you may worry about the same things that other people worry about: health issues, money, family problems, or difficulties at work, etc.

But you take these worries to a new level.

An employee's careless comment on economics becomes a vision of imminent dismissal; A phone call to a friend who does not return immediately raises strong concerns that something bad has happened. Sometimes just thinking about the events of the day leads to anxiety.

The thought of one's own work is filled with exaggerated anxiety and tension, even when there are no problems or there are minor preconditions that could provoke a problem. Therefore, there are very significant features of the treatment of generalized anxiety disorder with modern inpatient replacement techniques.

Anxiety in GAD is more intense than the situation requires, and this anxiety no longer performs a protective function, does not protect you (after all, for a healthy person, anxiety is just a defensive reaction, a normal reflex). With GAD, you can't turn off your anxious thoughts. They continue to work beyond the reach of your will and desires, endlessly repeating themselves.

Doesn't remind you of anything?

• “I can’t control my thoughts to… it’s driving me crazy!”
• “He's late, he should have been here 20 minutes ago! My God, he must have had an accident! "
• "I can't sleep - I just feel some kind of fear (anxiety) ... and I don't know why!"

The Difference Between “Normal” Anxiety and GAD

Worries, doubts, and fears are a normal part of life. It's natural to worry about your upcoming exam, your finances, your situation at work, your family, etc. The difference between “normal” anxiety and generalized anxiety disorder is that the anxiety in GAD can be described as:

• excessive
• obsessive
• permanent
• exhausting

It has been scientifically proven, for example, that after watching a report about a terrorist attack in the Middle East, a person may feel a temporary feeling of anxiety and anxiety for several minutes. If you have GAD, a person may feel anxious about this all night and still worry about the worst-case scenario for several days, imagining that your hometown will become a target of terrorism, and you or your relatives (relatives, acquaintances) may become victims of this terrorist attack.

The main differences between normal and generalized anxiety in self-diagnosis.

"Normal" Anxiety

• Your anxiety does not stand in the way of your daily activities and responsibilities.
• You are able to control your anxiety.
• Your worries and troubles do not cause significant feelings of distress.
• Your concerns are limited to a small number of specific real problems.
• Your anxiety attacks occur for a short period of time.

Generalized anxiety disorder

• Your significant concern disrupts your work rhythm, activities, and social life.
• Your anxiety is uncontrollable.
• Your worries are very upsetting, make you tense, and are perceived as a disaster.
• You worry about all sorts of things that may not directly concern you or your family and, as a rule, expect the worst.
• Worry almost every day for at least six months.

Symptoms of Anxiety Disorders

It is known that any psychopathic disorder is accompanied by a complex of symptoms, both psycho-emotional and somatic (vegetative) in nature.

The following symptoms are common to all types of anxiety disorders:

• intense tension and panic anxiety;
• sudden, causeless mood swings;
• sleep disorders of various types;
• increased conflict;
• deconcentration, slowness.

At the physiological level, the following may be observed:

Tremor of the limbs, sweating, tachycardia, headaches, nausea, pain in various parts of the body, osteochondrosis.

Main symptoms of the disease

The main and fundamental symptom of generalized anxiety disorder is fear that does not have a specific focus. This distinguishes it from various phobias that are focused on a specific object. The patient is worried about absolutely everything: from boiling water in the kettle to an alien invasion. Any event can be turned in such a way that its ending will be frightening.

GAD can manifest itself in different ways: in the form of periodic attacks or constantly. A panic attack occurs at the moment when the understanding comes that the situation cannot be controlled or its outcome depends on someone else.

Generalized anxiety disorder often manifests itself with somatic symptoms such as:

• headache;
• dizziness;
• sweating
• pain in the muscles, convulsive spasms;
• increased fatigue, general weakness;
• sleep problems;
• fussiness, restlessness;
• disturbances in the movements of the facial muscles;
• constant pressure.

Low self-esteem inspires confidence that everything is bad and will get worse. Any situation whose outcome is unknown in advance is considered potentially dangerous for a person with generalized anxiety disorder. He must control the situation; uncertainty frightens him very much.

Types of Anxiety Disorders

There are a huge number of varieties of this type of disease. The cluster of anxiety states includes obsessive-compulsive and panic attacks, phobic neuroses (Agarophobia, social phobia), post-traumatic stress disorder, hypochondriacal, personality disorder and many others.

Based on the duration of the affective episode, anxiety states are also divided into long-term and short-term . This aspect takes into account the period of time during which a person is unable to adequately respond to what is happening. Let's look at the most common forms:

Generalized anxiety disorder

It is a classic variation of neurosis and represents a type of chaotic anxiety, that is, without any logical direction. It is formed spontaneously and in response to everything, or more precisely, to events that attract the patient’s attention. The sick mind in this case is itself concentrated on finding and solving problems that actually do not exist (work, health, future, relationships). Such a person lives, in principle, with the question “What if?”, and overcoming one far-fetched problem, he comes up with the next one. Anxiety is localized primarily in thoughts (“mental chewing gum”), which is also characteristic of obsessive-compulsive disorder. Mostly the symptoms appear at night and prevent you from falling asleep deeply and for a long time.

At the everyday level, a person avoids everything new: for example, he walks the same road, flies to the same hotel (if he decides to fly in general). It seems to the patient that anxiety provides him with security, allowing him to be on alert, and he cannot be “caught by surprise.” Positive information and good events are leveled out and devalued by an anxious person. They are not happy with gifts and compliments.

Anxiety-hypochondriacal disorder

The main focus and experiences of the patient lie in the plane of his health. A person has constant anxiety regarding signals from his body, which he interprets as deadly. Hypochondria is also accompanied by a tendency to absorb specific and essentially unnecessary information. Most often, this type is combined with conversion and depressive pathologies.

Mixed and anxiety-depressive disorder

This type got its name due to a combination of symptoms defined as the “triad of depressive syndrome,” which includes: low mood, low motor activity and inhibition of mental processes combined with a high level of anxiety. Moreover, in a mixed form, increased anxiety in a patient may prevail over depression, or may correspond. The Hospital Anxiety and Depression Scale is used to assess the prevailing syndrome. The main psycho-emotional symptom, in addition to anxiety, is a lack of interest in life and loved ones, accompanied by vegetative pathology.

Paroxysmal anxiety (anxiety-vegetative) disorder

Paroxysmal, in fact, is another name for anxiety-panic disorder, or in simple words panic attacks, which we discussed in detail earlier. A panic attack is an acute attack of fear accompanied by mental and physiological symptoms.

Typically manifests itself with the following symptoms:

At the physiological level: increased blood pressure, shortness of breath, increased temperature, convulsions, palpitations, hyperhidrosis, tremors of the limbs, nausea and dizziness, insomnia. At the mental level, a person experiences a terrifying feeling of deconcentration and depersonalization (as if everything that is happening is unreal).

The intensity of a panic attack ranges from mild (anxiety and tension in the body) to severe (fear of imminent death). In general, it lasts from 15 to 30 minutes and can occur from 3 times a day to 1 time a month.

Anxiety-asthenic disorder

Another name for it is “anancastic” state of anxiety. Figuratively speaking, psychopathy manifests itself in a patient in the absence of order. As soon as the usual order of things is disrupted, or something new appears in the patient’s life, he falls into a feeling of uncontrollable anxiety. Those suffering from anancastic neurosis have a persistent desire to show perfectionism. In addition to the general characteristic symptoms, it is worth noting increased fatigue in the aspect of asthenic anxiety.

Organic anxiety disorder

Most often it appears against the background of somatic diseases, in connection with this, in patients, in addition to anxiety, dysfunctions of the body of various pathogenesis are observed in parallel (migraines, amnesia, deconcentration, disturbances in the functioning of the heart, thyroid or pancreas, liver).

Phobic disorders

This cluster is quite diverse and includes various types of phobias.

A phobia is an exaggerated, often unreasonable fear of some phenomenon, situation, object, which is often not so dangerous. The most common are social phobia (fear of any contact with people) and agoraphobia (fear of crowded places and open spaces). Phobias also include fear of snakes, spiders, airplane flights, heights, independent travel, and long-distance travel.

Regimen for the treatment of anxiety disorder

Anxiety disorders need to be treated in two ways, they are as follows: psychotherapy and medication.

1. Psychotherapeutic treatment uses cognitive behavioral therapy as the main method. This treatment takes place in the format of conversations between a psychiatrist and his patients. The basis of this method is to change your vision of a stressful situation, to teach you to direct the flow of thoughts in a different direction. The essence of anxiety disorders is that it is not the situation that prevents a person from living, but his vision of this very situation. Thus, by changing your attitude towards the situation, you can get rid of the problem. The therapist will help you understand yourself, understand which thoughts do not want to leave you alone and why. You will be able to change stable thinking patterns and look at the world from different angles. The therapist will tell you how to control yourself using proper breathing and relaxation techniques. You will need to complete a course consisting of an average of fifteen to twenty lessons. You will be taught skills and knowledge that will help you gradually get rid of anxiety and panic attacks.
2. Medicinal treatment methods involve taking various drugs. Usually they start with antidepressants, they affect the level of serotonin and norepinephrine in the body, affect the suppression of anxiety and fear, and eliminate depression. A dose of medication will need to be taken every day for everything to work effectively. If you have started taking a course of pills, you cannot interrupt the treatment yourself. During treatment, doctors will prohibit the use of alcohol.

Anxiety disorders often cause insomnia; to restore a healthy sleep pattern, the patient is prescribed sleeping pills. Sleeping pills act for their intended purpose: they speed up falling asleep and prolong sleep.

One of the medications used to treat anxiety is sleeping pills. Sleep pills will have such effects that they will reduce the feeling of fear and anxiety. These drugs multiply the effect of gamma-aminobutyric acid, which in turn produces an inhibitory effect on brain cells and thereby calms. It also relaxes muscles and helps relieve tension.

For patients whose anxiety disorders go away along with manifestations of violence, due to clouding of the mind, a dose of tranquilizers is also administered in small doses.

How to treat anxiety

Treatment of this disease, as well as other neurotic conditions, is based on three approaches:

Social

It implies a correct lifestyle and adherence to established regulations. Maintaining a daily routine, balanced nutrition, sports activities, activity, stress prevention.

Medication

In certain cases, the patient may be prescribed drug therapy, including drugs of a different spectrum: sedatives to tranquilizers and antidepressants. It is important to consider that medications are prescribed only if psychotherapeutic practice does not bring the desired result.

Psychotherapeutic

Includes many techniques: (cognitive, behavioral, rational, psychoanalytic) therapy.

As in the case of panic or any other type of disorder, psychotherapeutic techniques aimed at finding the cause of fear and changing the initial reflexes, as well as the patient’s value system, come to the fore.

How can these reflexes be changed?

First of all, clinical psychology recommends exposure and cognitive behavioral therapy methods. But what can a person do to help himself? Developing a new reflex and, accordingly, a new physiological reaction is the task of the patient himself. In this vein, the Visualization Method is good, which implies a certain separation of oneself from one’s inner child. Any new “seemingly dangerous” event, deliberately, through affirmations, should eventually begin to be perceived by a person as the happiest event that can happen. The technique of internal dialogue is independently applied - “It’s great that we will fly on an airplane,” the patient says to himself and convinces his inner child of this.

Scarlett technique

Or “I’ll think about it tomorrow.” The technique involves setting aside a certain amount of time for worry. For example, a person sets aside an “anxious hour” for himself from 15 to 16 and only at this time allows himself to worry from the bottom of his heart.

Speaking technique

As soon as an exciting moment arises, it is important to tell someone close to you about it in detail. Moreover, it is important to note that only “active listening” is required from the other person without advice or reassurance. As a last resort, you can even record the problem on a voice recorder; the main thing is to express yourself as much as possible regarding all the nuances that are troubling.

Body-oriented practices and aerobic exercise

Pilates, yoga, and spa treatments are known to have a relaxing and stabilizing effect. It is also worth paying attention to cardio and aerobic training, which should only be done in the first half of the day. Sports activities before bedtime can lead an anxious person, on the contrary, to overexcitation.

Diagnosis of Anxious Personality Disorder

Treatment of anxiety personality disorder in Moscow at Dr. Isaev’s clinic is carried out only after an accurate diagnosis has been established. To do this, the doctor conducts a conversation with the patient and then evaluates the results of psychological testing. The following identified signs are considered diagnostic criteria in this case:

• constant pressure;
• confidence in one's low value to society;
• constant worry about the opinions of others;
• rejection of criticism;
• reluctance to enter into a relationship when there is no confidence in the person’s sympathy;
• the presence of restrictions in professional and social work.

Identification of an anxiety disorder is carried out after receiving all the examination data and making a differential diagnosis with other mental disorders. Similar symptoms are observed in the following diseases:

• social phobia;
• dependent disorder;
• psychopathy of schizoid type;
• histrionic or borderline personality disorder.

Treatment of social phobia is carried out when a person is not afraid of communicating with another person, but simply cannot tolerate certain social situations. Treatment of psychopathy is carried out under the condition of fear of approaching strangers due to fear of loss of identity. Dependent disorder is characterized by the presence of a phobia of separation, rather than the contact and criticism itself. If a person's behavior is marked by attempts at manipulation and a violent reaction to a negative attitude, then this phenomenon is not considered anxiety, and treatment for hysteria or borderline disorder is carried out.

How to get rid of anxiety and worry on your own

General techniques for reducing anxiety that a person can use independently.

First of all, you need to come to the realization that worrying does not mean thinking and does not mean deciding! That is why the patient’s main task is to move from the experiencing mode to the decision mode. And in order for a solution to come, it is enough to simply write down the problem and deal with it piece by piece.

Next, you should remember and remember well the advice of the Eastern sages, who suggest limiting yourself only to the framework of the current moment, that is, shifting the focus exclusively “to the here and now.” Directing attention to the plane of the moment, including anxiety in the body, is achieved through meditative and breathing practices. In general, Understanding the existentiality of being and accepting the idea of ​​death is a general recommendation for people suffering from any neuroses.

Treatment of generalized anxiety disorder (GAD)

The core symptom of generalized anxiety disorder is chronic anxiety. It is important to understand what is the “trigger mechanism” in the body for this massive anxiety, since these mechanisms play a huge role in triggering and maintaining GAD. Therefore, first of all, a complete and high-quality diagnosis is required that will answer this basic question and determine success in the treatment of generalized anxiety disorder.

The main, most effective method in the treatment of GAD has been and remains complex therapy, which should simultaneously include several mandatory components.

Neurometabolic treatment of generalized anxiety disorder

Neurometabolic therapy, which helps the body quickly cope with the general background of mood, relieves obsessive thoughts, normalizes sleep and gives the brain the ability to self-heal with the help of additional substances that are introduced into the body.

Psychotherapy for generalized anxiety disorder

Rational psychotherapy, which gives a person a critical attitude and awareness of the true causes of this anxiety and intrusive thoughts. Provides insight into what is counterproductively draining your mental and emotional energy without leading to resolution of any specific tasks or actions. How to distinguish between productive and unproductive anxiety.

Autogenic training in the treatment of generalized anxiety disorder

Relaxation training makes it possible to learn how to resist anxiety and anxious thoughts. When you are relaxed, your heart rate slows, you breathe slower and deeper, your muscles relax, and your blood pressure stabilizes. It is the opposite of anxiety and worry, which strengthens your body's relaxation responses. This is a powerful impetus for relieving symptoms. Regular practice is necessary. Your nervous system will become less reactive and you will be less vulnerable to anxiety and stress. Over time, the relaxation response will become easier and easier until it comes naturally.

Group therapy for GAD

Communication within group psychotherapy. Generalized anxiety disorder gets worse when you feel powerless alone. It is better to overcome this condition together with those who experience the same problems. The more connected you are to other people, the less vulnerable you will feel.

Anxiety disorders with adaptation disorders and methods of their treatment

CM. Vinichuk, V.Yu. Krylov, National Medical University named after A.A. Bogomolets; S.V. Rogoza, Central City Clinical Hospital, Kyiv

Summary

The purpose of the study was to evaluate the therapeutic efficacy and safety of the drug Stresam (etifoxine) produced (France) in the treatment of adaptation disorder caused by anxiety disorders. The drug Stresam was used in complex therapy of 62 patients (main group) with anxiety disorders and adaptation disorders; 28 of them were diagnosed with panic disorders, 17 with somatoform autonomic dysfunction, and another 17 with anxiety-neurotic disorders. The control group consisted of 62 patients who were comparable to the main group in terms of demographic characteristics and severity of anxiety disorders; they were treated with alpha- and beta-adrenergic receptor blockers. The use of the drug Stresam significantly improved indicators of general condition, reduced the frequency of panic paroxysms, the severity of anxiety disorders, cardiovascular and respiratory dysregulation. Similar dynamics were not observed in the control group. The data obtained give grounds to recommend the drug Stresam for the treatment of patients with adaptation disorders caused by anxiety, which will undoubtedly help improve their social rehabilitation.

Keywords

anxiety disorders, panic attacks, adaptation disorders, treatment, Strezam.

Anxiety disorders are a common borderline psychoneurological pathology. In the population, pathological anxiety is detected in 20-25% of cases, and among patients visiting neurologists and therapists in the clinic - in 30-40% [9, 15]. At the same time, anxiety disorders among women are detected 3-4 times more often than among men, and in many cases they are combined with depression and psychosomatic diseases. Unfortunately, they are not always recognized in a timely manner and receive adequate therapy. People of working age are especially susceptible to anxiety disorders, which leads to disruption of adaptation in everyday life and significant economic losses. Despite the fact that anxiety is considered a pathological state associated with the experience of stress, in a physiological context it also plays a positive role. In particular, it can be considered a signal of trouble emanating from the external environment or the inner world of a person. In such a situation, anxiety mobilizes the subject to action and restoration of impaired adaptation.

It is believed that anxiety directed towards the future is a negative emotion; it is accompanied by a feeling of vague threat, the main purpose of which is to prepare the body for the “fight or flight” response. Different criteria for anxiety are considered: mental - anxiety, self-doubt, feeling of impending danger; psychomotor - characteristic facial expressions and gestures, excitement or depression; vegetative - increased activity of adrenergic structures of the brain with increased blood pressure, increased heart rate, dilated pupils, pale skin, sweating, dry mouth [10, 12, 23]. The causes of anxiety are different: objective situations that arose in extreme conditions, placing increased demands on the human psyche, with uncertainty in achieving the intended goal; subjective - high personal assessment of the upcoming event. If the anxiety is causeless and is expressed by vague anxiety, they speak of generalized “vital”, “floating” (“free floating”) anxiety [11]. Sometimes the patient feels a feeling of internal trembling, anxiety without certain specific reasons or explanations. In most cases, there is comorbidity between anxiety and depression. In patients with depressive disorders, 96% of cases show one or more signs of anxiety. On the other hand, 75% of patients with anxiety disorders, especially the elderly, show signs of concomitant depression [14].

Be that as it may, adaptation disorders caused by anxiety or depression have common somatovegetative symptoms, which include: sleep disturbances, changes in appetite, nonspecific complaints from the cardiovascular system and gastrointestinal tract, difficulty concentrating, irritability, increased exhaustion, fatigue. Anxiety disorders are characterized by a complex psychopathological structure, including both acute manifestations of anxiety - panic attacks with their inherent vegetative disorders and fear of death, and avoidant behavior, that is, the desire to avoid situations that provoke a recurrence of panic paroxysms. Most anxiety disorders are characterized by a chronic course precisely due to the formation of pronounced avoidance behavior. For example, with agoraphobia, the patient fears moving independently, based on the exclusion of situations where the patient may be left without help; with claustrophobia - fear of closed spaces; Nosophobia is an unreasonable fear of somatic illness. In the case of social phobias, the patient tends to avoid social contacts. Chronic anxiety disorders lead to severe social maladaptation of the patient, up to permanent disability.

The pathogenesis of anxiety disorders is quite complex. Great importance is attached to the effects of chronic stress, especially of a psychosocial nature (manager's syndrome). According to modern concepts, the development of an anxiety state is not the result of dysfunction of any one neurotransmitter system, but reflects the emergence of a systemic regulatory imbalance of various neurotransmitters at various levels of structural and functional organization. The GABAergic system plays a key role in the formation of imbalance. It is the disturbances of GABA-dependent processes in the central nervous system that mediate dysfunction of the serotonin-, catecholamine- and peptidergic systems, predetermining the subsequent development of adaptation disorders caused by anxiety disorder [11, 17].

Quite often in the clinical practice of a doctor, panic disorders or episodic paroxysmal anxiety occur. This condition is characterized by spontaneously recurring panic attacks that occur in the absence of any triggering stimuli or situations. Pan, according to mythology, is the ancient Greek deity of wild nature and herds, the son of Hermes and the nymph Dryope. It was believed that it was dangerous to disturb him, because he could send panic into a person. This is where the phrase “panic attacks” comes from.

The diagnosis of panic disorder is valid if at least two spontaneous panic attacks occur, and at least one of these paroxysms must be accompanied by an anxious expectation of a recurrence of the attack or changes in behavior for at least one month. A panic attack is a well-defined syndrome of intense fear or discomfort, accompanied by a combination of at least four of the following symptoms, which appears suddenly, reaches a peak within 10 minutes and lasts no more than 10-15 minutes [4, 5]. These include: palpitations, sweating, chill-like trembling, a feeling of lack of air, suffocation, pain or discomfort in the chest, paresthesia, nausea, dizziness and instability, manifestations of derealization or depersonalization, fear of loss of control or death, feelings of heat or cold, etc.

Panic disorders affect 1-4% of the population, and among women they occur 2-6 times more often than among men. The debut usually occurs at a young age. About 15% of the population experiences at least one panic attack during their lifetime. In 70% of cases, patients with panic disorders have a number of comorbid conditions [4, 7]. Several theories of the pathogenesis of panic disorders are discussed in the literature [4, 22]. Among them, the leading role is played by:

• respiratory theory, according to which a spontaneous panic attack is considered as a kind of emergency reaction that occurs in response to dysregulation of breathing;
• autonomic theory, which places great emphasis on dysfunction of the autonomic nervous system or disruption of the relationship between the sympathetic and parasympathetic divisions;
• the serotonin concept, which involves the release of increased levels of serotonin, adrenaline and other neurotransmitters into the blood by the central adrenergic systems and adrenal glands;
• conditioned reflex theory, according to which a panic attack is the result of activation of neuronal structures that ensure the development of a conditioned reflex phobic reaction in response to normal fluctuations in physiological parameters, for example, increased blood pressure, changes in breathing.

An important role in the occurrence of panic attacks is played by hereditary predisposition, which may be determined by a decrease in the threshold of excitation of the noradrenergic and serotonergic nuclei of the brain stem, and disruption of neurotransmitter processes in the limbic system [4].

Adaptation disorders are often caused by somatoform autonomic dysfunction, which often predetermines the development or is the main clinical manifestation of many somatic and neurological diseases. This is due to the universal participation of the autonomic nervous system in the processes of adaptation of the body to external environmental factors. The mechanisms of development of somatoform autonomic dysfunction are diverse; it is believed that dysfunction of the central suprasegmental formations of the limbic-hypothalamoreticular complex, responsible for specific disorders of autonomic regulation, is of great importance. Potentially, autonomic dysfunction is manifested by emotional disorders, feelings of fear, anxiety with adaptation disorders.

According to ICD-10, there are other common forms of anxiety disorders. Generalized anxiety disorder is characterized by frequent or persistent fears and worries that arise about real events or circumstances that cause concern to the person, but which are clearly exaggerated in relation to them (unjustified, exaggerated fears). Anxiety in generalized anxiety disorders is more global in nature than in other anxiety disorders and is formed regardless of a specific event, that is, it is not reactive.

Obsessive-compulsive disorder (obsessive-compulsive disorder) is manifested by anxiety, obsessive thoughts and actions in the form of repeated stereotypical behaviors that do not lead to the fulfillment of useful plans, the meaning of which is the supposed prevention of unlikely events that could harm the patient. Obsessions and compulsions reduce the level of his social adaptation.

Post-traumatic stress disorder occurs immediately after a traumatic event and reflects the specifics of trauma, characterized by symptoms that, unlike acute stress disorder, persist for at least a month.

Treatment

Therapy of anxiety disorders for a long time was based on the use of anxiolytics (tranquilizers) of the benzodiazepine series (phenazepam, diazepam, lorazepam, gidazepam, alprazolam), non-benzodiazepine tranquilizers (atarax, adaptol, stresam, buspirone), antidepressants - selective serotonin reuptake inhibitors

(SSRIs) (fevarine, paroxetine, fluoxamine, sertraline), monoamine oxidase inhibitors (MAOIs) (pirazidol, moclobemide), tricyclic antidepressants (amitriptyline, doxepin, melipramine, clomipramine) [12].

For a long time, the basic pathogenetic therapy of anxiety disorders with adaptation disorders was based on the use of GABAergic drugs. In particular, the use of anxiolytics is based on their properties to activate inhibitory mechanisms in the brain through stimulation of GABAergic processes. However, the mechanisms of their action on the GABA receptor complex are different. Most anxiolytics affect the GABA-A receptor complex. This is a rather complex structural and functional formation, including binding sites for GABA-benzodiazepines, barbiturates, etc. Benzodiazepines, by binding to specific benzodiazepine sites, increase the interaction of GABA with GABA-specific sites and thus stimulate GABAergic mediation [6, 7]. However, clinical observations show that the use of benzodiazepine anxiolytics is accompanied by characteristic side effects, such as psychomotor retardation, drowsiness, lethargy, dizziness, muscle relaxation, deterioration of cognitive functions, the development of tolerance and addiction with long-term use, withdrawal syndrome, extensive potential for drug-drug interactions, especially with other neuro- and psychotropic drugs [8, 12]. Drugs in this class are included in the list of psychotropic drugs with corresponding strict requirements for their prescribing, which significantly limits their availability.

The use of tricyclic antidepressants for anxiety disorders is also limited by numerous side effects, among which the most common are dry mucous membranes, diplopia, constipation, dysfunction of the cardiovascular system, transient impairment of cognitive functions, sedation, lethargy, and orthostatic hypotension [18].

The use of selective serotonin reuptake inhibitors for anxiety disorders is based on their ability to inhibit the reuptake of serotonin at presynaptic terminals. Recent studies show that their antidepressant effect is associated with this mechanism [12]. The greatest experience with the use of drugs of the SSRI class has been accumulated in the treatment of panic and obsessive-compulsive disorders. Positive results were noted with the use of fluvoxamine and sertraline in the treatment of patients with manifest manifestations of social phobia [9].

Monoamine oxidase inhibitors are used in the treatment of depressive and anxiety disorders. However, their use is limited due to the occurrence of serious side effects: the development of arterial hypertension provoked by the consumption of tyramine-containing foods or drinks (the so-called cheese reaction). Tyramine is present in many foods and drinks, including commonly consumed ones such as meat, cheese, and wine. The intake of tyramine while taking MAOI drugs provokes the development of a severe hypertensive crisis with possible heart rhythm disturbances. Other side effects when using drugs in this group include orthostatic hypotension, psychomotor agitation, drowsiness, weight gain, and sexual dysfunction. The use of MAOI drugs can provoke a manic episode if the patient has a constitutional predisposition [20].

A promising direction in the treatment of anxiety disorders with adaptation disorders is the creation of new anxiolytic drugs - incomplete agonists of benzodiazepine receptors, capable of causing not all the effects of standard agonists, but only those whose action is associated with the development of paroxysmal anxiety. One of the most effective and original drugs of this class is the drug Stresam (etifoxine) produced (France), which has been used in medical practice since 1979 [21, 26]. The active substance of Stresam, etifoxine (a benzoxazine derivative), has a unique mechanism of action that distinguishes it from all other anxiolytics. Etifoxine also acts on the GABA-A receptor, but it interacts with a fundamentally different site on the postsynaptic membrane, different from the binding sites for GABA itself, benzodiazepines and barbiturates. As a result of the interaction of etifoxine with a specific site on the postsynaptic membrane, the chloride ion channel, one of the most important structural and functional components of the GABA-A receptor, is activated. Stimulation of the intracellular transport of chloride ions promotes the activation of the entire GABA-A receptor complex and, accordingly, the entire GABAergic neurotransmission in the central nervous system. Thus, etifoxine acts as a direct GABA mimetic, different in its mechanism from benzodiazepines [2, 24, 25, 28].

In addition, Stresam is a modulator of GABAergic transmission by activating the synthesis of neurosteroids, recently isolated biologically active substances synthesized in glial cells and increasing the sensitivity of GABA-A receptors to GABA. This provides a longer lasting effect of the drug [28]. Thus, the drug has a two-component effect.

Unlike benzodiazepines, Stresam does not have a sedative effect, does not affect psychomotor and cognitive functions, and does not cause lethargy, drowsiness, or muscle relaxation [2, 19]. The drug improves sleep and normalizes autonomic dysfunction, reduces the severity of neurotic disorders manifested by anxiety and adaptation disorders, stabilizes blood pressure, and does not cause the development of addiction, tolerance, or withdrawal syndrome. The effectiveness and safety of etifoxine was proven in a double-blind, placebo-controlled study in the treatment of adjustment disorders caused by anxiety. By the 28th day of treatment, a significant difference in treatment results was found in favor of etifoxine [26, 27].

Side effects are rare. Sometimes, at the beginning of treatment, dizziness occurs, and occasionally allergic skin reactions occur. Contraindications to taking the drug are individual intolerance, liver dysfunction and renal failure, galactosemia, myasthenia gravis; It is not recommended to prescribe Strezam during pregnancy, lactation and children under 15 years of age.

Thus, at present, Stresam is the drug of choice in the treatment of adaptation disorders caused by anxiety syndrome of various origins. The drug is available in 50 mg capsules. Prescribed 1 capsule 2-3 times a day, the duration of treatment ranges from 2 weeks to 2-3 months.

The purpose of our study is to evaluate the therapeutic efficacy and safety of the drug Stresam (etifoxime) produced (France) in the treatment of adaptation disorder caused by anxiety disorders.

Materials and research methods

The effectiveness and safety of the drug Stresam was studied in the treatment of 62 patients (main group) with anxiety disorders and adaptation disorders. There were 27 men, 35 women, ages ranged from 19 to 63 years (average age: 38.0 ± 1.23 years). In accordance with the ICD-10 classification, 28 patients were diagnosed with panic disorders, 17 with somatoform autonomic dysfunction, and another 17 with anxiety-neurotic disorders (neurasthenia).

Adaptation disorders caused by anxiety in the examined patients appeared during the last 3-4 weeks before admission to the clinic. He had not previously been treated with anxiolytic drugs. The main study group did not include patients with other types of nervous disorders (generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic anxiety disorder, etc.). The control group consisted of 62 patients who were comparable to the main group in terms of demographic characteristics and severity of anxiety disorders. The selection of patients was carried out on the basis of medical history, the results of a general clinical and neurological examination, and scale scores. The Hamilton Rating Scale (HDRS) assesses 14 subjective and objective symptoms. Each of them is assessed according to the degree of severity in gradations from 1 to 5 points. The total score is equal to the sum of all points with a possible range from 0 to 56. A total score from 0 to 7 means the absence of an anxious state, 8-19 means the presence of anxiety symptoms, 20 or more means an anxious state [1, 16]. The Covey anxiety scale (Covy anxieti Scale), as an additional to the Hamilton scale, allows you to assess the state of anxiety and its severity based on two subjective (complaints, behavior) and one objective (somatic manifestations) parameters. Each parameter is assessed according to the severity of symptoms in gradations from 0 to 4. The average total score can take a value from 1 to 12. A total score from 6 to 8 means the presence of an anxiety state [13]. A. Wayne's questionnaire is a unified questionnaire for identifying signs of autonomic dysfunction, which patients evaluate in points. A score > 15 is assessed as the presence of signs of autonomic dysfunction [3].

Patients of the main group were prescribed Stresam for 30 days, 50 mg 3 times a day (150 mg) in combination with symptomatic therapy (vitamins, vasoactive agents) for a month. Patients in the control group were treated for 30 days with vegetotropic drugs (alpha- and beta-adrenergic receptor blockers - anaprilin or pyrroxan) in standard doses along with symptomatic therapy. The condition of the patients during treatment was assessed daily, and data from rating scales were analyzed before and after the course of therapy. When statistically processing the material, a two-level Student's t-test for a quantitative variable was used.

Results and its discussion

Analysis of the results of clinical, neurological and neuropsychological status showed that the background state of anxiety on the Hamilton scale in patients with panic attacks corresponded to 26.3 ± 2.4 points, in patients with somatoform autonomic dysfunction and anxiety-neurotic disorders (neurasthenia), presented in one subgroup - 29.2 ± 3.0 points. The data obtained indicate the presence of personal anxiety in patients. The anxiety of their condition was also confirmed by the results of a psychological examination of patients using the Covey scale: their average total clinical score before treatment exceeded a six-point gradation - 7.2 ± 0.8 and 7.8 ± 0.9 points. Similar indicators were recorded in the control groups. A characteristic and frequent clinical manifestation in patients with panic and anxiety-neurotic disorders was the presence of autonomic dysfunction, as evidenced by a significant increase in the background score of the Wein test (23.2 ± 2.0 and 24.3 ± 1.7 points). Clinically, the autonomic dysfunction syndrome was manifested by emotional disorders, unmotivated anxiety, irritability, and general weakness.

As a result of therapy using the drug Stresam, after 30 days of observation, there was a significant decrease in the parameters that determine the level of anxiety with adaptation disorder on the Hamilton scale: in the group of patients with panic disorders, the effectiveness criterion was 50.2% (p < 0.001), in the comparison group - 21.8% (p > 0.05); in patients with somatoform autonomic dysfunction and anxiety-vegetative disorders - 50.3% (p < 0.001), in the control group - 28.7% (p = 0.1). In patients receiving Stresam, the frequency and severity of panic attacks decreased more significantly compared to patients who were prescribed alpha- and beta-blockers. An interesting fact is that during therapy with Stresam, a positive therapeutic effect occurred after the 7th day of treatment, and especially on the 14th day of observation; in the comparison group, improvement occurred at a later date - from the 21st day, and therapy did not lead to a complete cessation of panic attacks.

The positive results of treatment of adaptation disorder caused by anxiety using the drug Stresam are also confirmed by the data of a neuropsychological examination using the Covey scale: in patients with panic disorders, the level of anxiety decreased by 43.1% (p < 0.01), in controls - by 19, 1% (p = 0.1); in patients with somatoform autonomic dysfunction and anxiety-neurotic disorders - by 37.2% (p < 0.05), in the control group - by 13.9%.

The use of the drug Stresam not only reduced the frequency of vegetative crises, but also reduced the sympathetic direction of autonomic functions, as evidenced by a significant decrease in the A. Wein test scores: in patients with panic disorders from 23.2 ± 2.0 to 18.1 ± 1.6 points (p < 0.05), in the control group they were unreliable - from 24.4 ± 1.9 to 20.4 ± 1.9 points (p > 0.05); in patients with autonomic dysfunction and anxiety-neurotic disorders, from 24.3 ± 1.7 to 18.7 ± 1.9 points, respectively (p < 0.05), in the control group - from 23.8 ± 1.4 to 19 .4 ± 2.2 points (p > 0.05).

Thus, the use of the drug Stresam in the treatment of adaptation disorder caused by anxiety is of great importance for increasing the effectiveness of therapy and social rehabilitation of patients.

conclusions

A clinical and psychological study showed that the use of the drug Stresam in the treatment of adaptation disorders caused by panic disorders, somatoform autonomic dysfunction and anxiety-neurotic disorders significantly improved the general condition of patients, which was manifested by a decrease in the level of anxiety, regression of other subjective disorders, and a decrease in the severity of sympathicotonia and associated anxiety and depressive disorders, cardiovascular and respiratory dysregulation.

The inclusion of the drug Stresam in the treatment program for patients with neurotic disorders, manifested by panic attacks, vegetative crises, anxiety and adaptation disorders, leads to regression of panic paroxysms, weakening of the manifestations of vegetative disorders, and promotes social adaptation of patients.

Stresam is an effective means of rehabilitation of patients with adaptation disorders caused by somatovegetative disorders, situational and personal anxiety. The drug is safe and does not cause addiction or withdrawal symptoms.

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