Treatment of Anxiety Disorders. Table 1.4. Treatment of Anxiety Disorders.

1.5.3. Classification of anxiety disorders.

The classification of anxiety disorders according to DSM-IV-TR includes:

- Generalized anxiety disorder (GAD).

- Panic disorder (with or without agoraphobia).

- Specific phobias and social phobias.

- Obsessive-compulsive disorder (AABB).

- Post-traumatic stress disorder (PTSD).

- Acute stress disorder (SC).

The diagnoses of anxiety disorder due to a physical illness or substance-induced anxiety disorder are used if the physical illness or substance use or withdrawal is the primary cause of these anxiety symptoms.

Anxiety disorders are distinguished from one another by the presence or absence of a distinct environmental stressor (present in phobias, SSCT, and SC; absent in panic disorder, AABB, and LATT) as well as the pattern of symptom onset and remission (eg, acute in panic disorder, chronic in LATT).

1.5.4. Causes of anxiety disorders.

Anxiety disorders are among the most commonly treated mental health problems. Both psychosocial and biological factors are implicated in their etiology. Psychosocial factors include maladaptive learning to fear a harmless object or situation and exposure to a major trauma. Biological factors include genetics and gender. Anxiety disorders are more common in family members of affected individuals than in the general population, and their concordance rate is higher in monozygotic twins than in dizygotic twins. Compared with men, women are two to three times more likely to have panic disorder, twice as likely to develop SSCT when exposed to a major trauma, and slightly more likely to have LATT (55% to 60% vs. 40% to 45%).

Neurophysiological implications. Altered neurotransmission is associated with anxiety symptoms; specifically, decreased serotonin and gamma-aminobutyric acid (GABA) activity; decreased GABA-benzodiazepine receptor binding [67]; and increased norepinephrine activity. Neuroanatomically, the nucleus accumbens, the site of noradrenergic neurons; the putamen, the site of serotonergic neurons; the temporal cortex; the frontal cortex; and the caudate nucleus (especially in the AABB) have been implicated in the development of anxiety disorders.

Organic causes of anxiety symptoms include excessive caffeine intake, substance abuse and withdrawal, hyperthyroidism, vitamin B12 deficiency, hypoglycemia or hyperglycemia, anemia, and pheochromocytoma, a tumor of the adrenal medulla that secretes epinephrine. Because anxiety symptoms (shortness of breath, chest discomfort, tachycardia, and sweating) also occur in cardiovascular disorders such as arrhythmias and respiratory disorders such as chronic obstructive pulmonary disease, these disorders must be excluded.

Anxiety is seen in many patients with depression, and patients with anxiety disorders often have major depressive disorder and dysthymic disorder. Therefore, it can be difficult to distinguish between anxiety disorders and depression. The close biological relationship between these groups of disorders is supported by studies showing similar neuroendocrine abnormalities and sleep electroencephalographic changes in patients with AABB and major depressive disorder.

Anxiety disorders must be distinguished from the prodromal and psychotic phases of schizophrenia, in which anxiety is often prominent, and hypochondriasis, in which there is significant distress without evidence of serious organic illness.

1.5.5. Treatment of anxiety disorders. Table 1.4. Treatment of anxiety disorders .

CLASSIFY

PHARMACEUTICAL CHEMISTRY

MENTALITY

Panic disorder with or without agoraphobia

Emergency treatment: fast-acting BZD Long-term treatment: SSRI

Combination of SSRI and BZD

Intermediate- or long-acting BZD

Beta-adrenergic antagonists (eg,

propranolol [Inderal]) for vegetative symptoms

Systemic desensitization and cognitive behavioral therapy useful in combination with pharmacotherapy

Specific phobia

No good pharmacological treatment Beta-adrenergic antagonists

Cognitive behavioral therapy Systemic desensitization

Other behavioral therapies (eg, flooding and explosion;

Hypnosis, family therapy and psychotherapy

Social phobia

SSRIs (eg, paroxetine [Paxil]) or venlafaxine (Effexor)

MAOIs (eg, phenelzine [Nadril]) Beta-adrenergic antagonists

Assertiveness Training Group Therapy

Obsessive disorder

binding photo

SSRIs (eg, fluvoxamine [Luvox])

Clomipramine (Anafranil)

Behavioral therapy

Supportive psychotherapy

Generalized anxiety disorder

Buspirone (BuSpar) Venlafaxine Doxepin (Adapin)

Intermediate-acting BZDs (eg, lorazepam [Ativan])

Beta-adrenergic antagonist

Cognitive behavioral therapy and other psychotherapies are helpful for chronic symptoms.

Disorder

post-traumatic stress

SSRIs (eg, sertraline [Zoloft])

Anticonvulsants (eg, carbamazepine [Tegretrol])

Antipsychotics (eg, olanzapine [Zyprexa])

Beta-adrenergic antagonist

Support groups as survivor groups

Psychotherapy

BZD: benzodiazepine; MAOI: monoamine oxidase inhibitor; SSRI: serotonin reuptake inhibitor

selective serotonin reuptake inhibitors, treatments (in descending order of utility for each classification).

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1.6. PSYCHOLOGICAL DISORDERS IN STUDENTS.

The student period begins for each person after the age of 18. The majority of Vietnamese students are between the ages of 18 and 25, which is the transitional period from adolescence to adulthood. Therefore, it can be said that students on the one hand still have the characteristics of adolescence, on the other hand have begun to have the characteristics of adulthood. The psychology of students is still somewhat unstable due to adolescence. Especially for first-year students, adapting to changes in the new environment, new friends, new ways of learning... can easily increase psychological and emotional instability.

In addition, students are also people who have a very clear perception and thinking about life goals, about what they have done, are doing and must do. Therefore, students, especially final year students, have a heavy mentality to both complete their studies well and develop good social relationships and gradually complete their future life goals (have a good career, get married...) [45],[46]. In addition to psychological characteristics, economic conditions or living conditions as well as all social relationships also greatly affect the mental health of students. Students who live far from home, have difficult economic conditions and have to both study and work, the pressure of life as well as the pressure from studying are more likely to cause anxiety, depression, and stress. The risk of mental disorders in this group of people may be increasing. According to Facundes VI & Ludermir AB, the prevalence of common mental disorders among health care students is 31.4% and this rate is higher in the group of students who feel overloaded with studying (OR=2.67) and students who have many difficulties in life (OR=2.25). It can be understood that mental health problems are often disorders in emotional states, which hinder people's cognitive, emotional and social abilities.

The study period is 4 to 6 years, in which the first 2 years are for studying basic subjects, which are very heavy. All students in the faculties study these common subjects: internal medicine, surgery, obstetrics, pediatrics, dermatology, health psychology, psychiatry, etc. Then, in the last 2 years, depending on the nature of the field, students will practice in hospitals or the community. During the period of studying specialized subjects, students are equipped with in-depth knowledge, and can write a graduation thesis or take a graduation exam.

Students must practice the skills they have been trained in, such as communication between doctors and patients, examination skills, and decision-making skills. First-year and final-year students mostly face problems with academic pressure, longer study time than other majors, preparing their thesis or graduation exam during their practice in the community. Emotionally, students have to face the suffering of patients every day, between life and death, including the death of a loved one, they must prepare mentally for the stressful situations they have to go through. All the factors of psychology, social relationships or

Living and studying conditions have more or less negatively affected the mental and physical health of students [10]. One of those effects is specifically emotional disorders such as anxiety, stress, sadness, disappointment, fatigue... Some students have to drop out of school because they cannot accept witnessing the death of a patient [7].

1.6.1.Love and work.

By adolescence, most people have a sense of who they are and what their role is in the world. This sense of belonging allows a person to get along with others without feeling like they have lost their identity. Erikson 2010 [45], describes early adolescence as a period of conflict between belonging and isolation, implying that if an individual does not develop love, affection, and sexual relationships with others by this age, they will not be able to do so in later years. Most people develop close relationships with others through marriage or other relationships.

Sigmund Freud said that in addition to love, a good job is also important for the emotional health of adults. This work can be done outside or right inside the home. In the US, most men go out to work and develop their careers at a very young age. Women initially orient their work as housewives or go to work, but when they are over 30, they often choose other paths such as going back to work or continuing to go to school when their children are of school age, or after having had time to develop their careers, they return to full-time or part-time housework.

1.6.2. Sexual activity and pregnancy.

Adolescence is marked not only by cognitive maturation and identity formation, but also by a strong onslaught of sexual feelings. These feelings are expressed through bodily activities and masturbation. Daily masturbation throughout adolescence (and beyond) is a normal occurrence, and heterosexual and homosexual infatuation—feelings of love for someone as unattainable as a rock star—are common. Same-sex experiences can occur throughout puberty and may or may not be the initial expression of a same-sex sexual orientation. And, although parents may become alarmed, such practices are part of normal development [63].

In the United States, the average age of first sexual intercourse is about 16. By age 19, most men and women have had intercourse. Because the average age of first marriage is about 23, premarital sex is the norm in this society. Fewer than half of sexually active teens use contraception consistently. The reasons for this vary, but teens are often convinced that they are “special” and “different” and therefore will not get pregnant or develop a sexually transmitted disease. This conviction is not based on reality. In 2000, the 15- to 19-year-old age group had the highest age-specific gonorrhea rate among women (716 cases per 100,000) and the third highest rate among men (328 cases per 100,000). In fact, chlamydia is more common in adolescent women (2,400 cases per 100,000) than in older women. Other reasons for contraceptive failure in adolescents include lack of access to the child or not knowing which methods are effective. Social and emotional factors that contribute to teen pregnancy include depression, poor school performance, and parental divorce. Although the teen pregnancy rate in the United States is currently declining, in 2000 this age group gave birth to approximately 469,000 babies; at least 8,500 were born to mothers younger than 15. In contrast, pregnancy rates among older mothers, especially those over 40, are increasing. Teen pregnancy can present a challenge to the body because they are at higher risk of obstetric complications than older patients. This is true in part because adolescents are less likely to seek prenatal care than older patients and also because their bodies are not yet mature. Most medical care for adolescents (those under 18) requires parental consent. However, it is often legal and ethical for physicians to provide adolescents with sex and contraceptive counseling without parental consent or knowledge, as well as to treat sexually transmitted diseases, pregnancy-related problems, and drug and alcohol abuse. In studying this age group, Daniel Levinson (2010) found that by the age of 30, people have a definite role to play.

established in society, physically most fully developed and very independent individuals. Usually, at this age, the age considered as the transitional period or the mid-30s crisis, people often self-examine the past stages in their lives [63],[64].

RESEARCH OUTLINE

Learning environment

Nature of major, number of years of study

Immediate and cumulative impact over time

Psychological disturbance

Depression Anxiety Stress

Traumatic Behavior

Psychological - physiological - social factors: promote the occurrence and worsen

Sex

Place of residence

Department

Vehicle