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Written by Mark Melchiorre   
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Case Study: Anxiety Neurosis
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SUMMARY OF THE 10 QUESTIONS

  1. Chills and Fever: None.
  2. Perspiration: Cold sweat during anxiety attacks.
  3. Head and Body (pain or dizziness): Heaviness of the head (like a band around the head). Dizziness during anxiety attacks.
  4. Urine and Stool: Urine: Urinary tenesmus. Stool: Alternates between loose and dry.
  5. Diet and Appetite: Appetite generally is good. Anorexia during anxiety attacks. Craves sour foods. Thirst for hot liquids. Note: Bulimic episode 5 years ago.
  6. Chest and Abdomen (sensations): Respiration is fast and superficial during anxiety attacks. Feeling of obstruction in the throat.
  7. Eyes and Ears: Blurred vision during anxiety attacks.
  8. Energy level: Low.
  9. Sleep: Insomnia with dream disturbed sleep (nightmares).
  10. Gynecological/ Obstetric: Menarche at age 15. Cycle is irregular. Flow is heavy. Color is pinkish to dark, with some clots. Breast and abdominal distention 2 days prior to period.

REVIEW OF THE PATIENT'S LIFESTYLE AND MEDICAL HISTORY

Lifestyle: The patient exercises infrequently. A nonsmoker. Does not drink alcohol. Moderate caffeine use. The patient's husband is attending school in a distant city.

Medical History: 1985 Ectopic pregnancy. Salpingectomy (R). 1989 Vaginitis. Cystitis. Yeast Infection.

INITIAL TONGUE AND PULSE READING

Tongue: Pale body. Thin white coat.
Pulse: Thin. Slightly wiry.

WESTERN MEDICAL VIEW OF THE ILLNESS

Etiology:

Emotional stress such as a change in personal relationships, or a fear of losing control of emotional drives (eg. sexual, aggressive, or dependency needs) are common psychological factors. On a physiological level, the signs and symptoms result from the stimulation of the "fight or flight" reaction of the autonomic nervous system by frightening fantasies, impulses, and emotions.

Anatomy and physiology:

Noradrenergic neurotransmitters are important in producing anxiety. The locus ceruleus, located in the 4th ventricle of the brain, with its numerous connecting pathways to the rest of the brain, is thought to be an important mediating center.

Diagnosis:

Anxiety Neurosis (Generalized Anxiety Disorder; Anxiety Reaction).

Because many of the somatic signs and symptoms are cardiorespiratory in nature (eg. tachycardia, palpitations, precordial pain) it is important to rule out Myocardial Infarction in the diagnosis. Also to be ruled out are hyperthyroidism and pheochromocytoma., a tumor of the sympatho-adrenal system that produces norepinephrine and epinepherine as these share similar signs and symptoms eg. palpitation, apprehension and tingling extremities.

Treatment Methods:

Insight psychotherapy; Supportive psychotherapy; Relaxation techniques; Meditation. Minor tranquilizers; tricyclic antidepressants or MAO inhibitors (monoamine oxidase); Alprazolam; Beta-blockers (propanolol, atenolol); The agents of choice are benzodiazepines. Note: Xanax and Ativan are both benzodiazepines

Possible Side Effects: Benzodiazepines can increase the suicidal tendency in people with depression and can enhance the effects of other CNS depressants. Skin rash, nausea, headache, impaired sexual function and vertigo. Also, drowsiness and ataxia. There are reports of paradoxical effects such as increased levels of anxiety, psychotic episodes and suicidal impulses. Withdrawal symptoms can occur after several months of use.



 
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