Anxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapy

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Chest pain of a non-cardiac nature is one of the extremely significant problems of clinical medicine, which is associated with the widespread prevalence of this condition and the high healthcare costs for diagnosing and treating such patients. Along with neurological, gastroenterological and pulmonological diseases, mental disorders make a major contribution to the formation of chest pain. Moreover, the formation of pain in the chest area can be associated not only with such well-known psychopathological conditions as depression and anxiety disorders, but also with the pathology of the somatoform circle. This review presents data on the frequency of chest pain associated with mental disorders (pain as a symptom of a mental disorder, mental disorders as a consequence of a previous episode of chest pain, etc.), the nature of the relationship between pain symptoms and mental disorders, as well as the clinical picture somatoform disorders manifesting in the form of thoracalgia. Information is summarized on approaches to diagnosing mental disorders in patients with chest pain and the possibilities for their psychopharmacotherapy and psychotherapy. When discussing psychopharmacotherapy, emphasis is placed on the possibilities of using the atypical tranquilizer tofisopam in this category of patients, and a brief description of its effectiveness and safety is given. To illustrate the main points of the review, a clinical case of a patient with chest pain of non-cardiac origin, which manifested itself after a traumatic event, which in turn provoked a myocardial infarction, is also presented. Positive dynamics with subsequent recovery during therapy with tofisopam are described.

Chest pain as an interdisciplinary problem – emphasis on somatoform disorders

Petelin,

Isaeva,

Tolokonin

et al. 2024

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Treatment of functional neurological disorders by example of a patient with cardiac neurosis, tension headache, musculoskeletal pain and insomnia

Golovacheva,

Golovacheva

2024

The article presents a clinical case of a patient with cardioneurosis, frequent episodic tension headaches involving the pericranial muscles, chronic musculoskeletal cervicalgia, thoracalgia, chronic insomnia and increased anxiety. The above disorders are listed among the most common reasons for seeking outpatient care from a neurologist. The majority of patients with these disorders are young people of working and reproductive age. For this reason, it is important to consider an effective, modern approach to the treatment of such patients in outpatient neurological settings. Treatment of this category of patients is quite a challenge that requires the expert knowledge, experience and attentive attitude of the doctor towards the patient. Difficulties in treating such patients are associated with the fact that they have misconceptions about their disease, catastrophic thinking about their symptoms, avoidance behaviours, unhealthy lifestyle and distress for a long time, increased emotional sensitivity to current events, and stressful events that preceded their disease. Despite the increased level of anxiety and the psychosomatic nature of the complaints, many patients refuse to consult a psychiatrist and take antidepressants in real neurological practice. The Sechenov University Clinic of Nervous Diseases offered the patient a comprehensive approach to the treatment that comprises awareness conversations, recommendations on sleep hygiene and lifestyle, the short-term use of Valocordin, cognitive-behavioural therapy, relaxation and mindfulness, and kinesiotherapy. The detailed clinical conversations with the patient and examination data allowed to identify all factors that provoked and supported cardioneurosis, pain syndromes, insomnia that was caused by stressful events in the anamnesis, misconceptions about her condition and treatment methods, catastrophizing of symptoms, erroneous strategies for overcoming pain, anxiety and insomnia, physical inactivity, prolonged static load. The treatment process included therapeutic dealing with all of the listed factors. The complex treatment resulted in a decrease in patient’s pain and cardioneurotic symptoms, improvement of her sleep and emotional state, and returning to her previous active lifestyle.

Anxiety Disorders in Clinical Practice (Clinical Observation and Literature Review)

Petelin,

Sorokina,

Galiautdinova

et al. 2024

Anxiety disorders are the most common group of mental disorders. The high prevalence of anxiety disorders and their negative impact on the functioning and quality of life of patients determines the need for timely diagnosis and therapy. The review presents data on the clinical manifestations of anxiety, as well as on the main forms of anxiety disorders according to current classifications of mental disorders. An analysis is conducted on the relationship between somatic and cognitive manifestations of anxiety, explaining the difficulties in diagnosing and treating patients with a predominance of somatic symptoms. Cognitive features specific to patients with anxiety disorders are described. Approaches to the diagnosis and differential diagnosis of anxiety disorders are provided, along with information on main psychometric scales. The importance of a clinical approach in diagnosing anxiety disorders is justified, and the role of para-clinical methods in establishing a diagnosis is described. According to recent consensus documents and clinical guidelines, the first-line therapies for anxiety disorders are cognitive-behavioral therapy and the use of selective serotonin reuptake inhibitors; the basics of both methods are described. Considering current research, both approaches have drawbacks, which necessitates the use of medication with an alternative mechanism of action. One such medication is the modern multimodal anxiolytic Aviandr, which has demonstrated high effectiveness and safety in treating patients with the most severe form of anxiety disorders – generalized anxiety disorder. The main points of the review are illustrated with a clinical example of the successful use of Aviandr in a patient with generalized anxiety disorder.