1. Background and Purpose
Anxiety disorder is a psychiatric disorder most commonly encountered in primary medical institutions along with depression. In particular, Korean society has to adapt to various values and rapid changes, and is easily exposed to acute or chronic stress, and has an environmental factor that leads to a high prevalence of anxiety disorders.
According to a report by the World Health Organization (WHO), the proportion of the world’s population with anxiety disorders in 2015 was 3.6%, and the total number of people with anxiety disorders was estimated to be 264 million. the total for 2015 has increased by 14.9% since 2005. Prevalence Survey In the results of systematic study analysis, the prevalence of pooled period was 6.7% (6.0-7.6%) in 122 surveys, and the lifetime prevalence rate in 70 surveys was 12.9% (11.3-14.7%).
In Korea, the lifetime prevalence rate of anxiety disorder was 9.3% (male 6.7%, female 11.7%) and annual prevalence rate 5.7% (male 3.8%, female 7.5%) in the survey of mental disorders in Korea conducted every five years. Researchers estimate that 2.24 million people have experienced disability. In 2011, the lifetime prevalence rate was 8.7% (male 3.7%, female 9.8%) and the annual prevalence rate increased to 6.8%, Researchers estimate that 2.24 million people have experienced disability. this is high compared to the lifelong prevalence rate of 5.3% (7.5% in 2011) and 1.9% (3.6% in 2011) in 2016 for mood disorders, a typical psychiatric disorder along with anxiety disorders and the overall prevalence of mood disorders, including depression, is decreasing. However, the lifetime use rate of mental health services for patients with anxiety disorders was 25.1% in 2011 and 27.3% in 2016, which is still low for mood disorders including depression by 37.7% in 2011 and 52.5% in 2016.
Looking at the prevalence of each sub-classified disease, the lifetime prevalence was 0.6% for obsessive-compulsive disorder, 1.5% for post-traumatic stress disorder, 0.5% for panic disorder, 0.7% for agoraphobia, 1.6% for social anxiety disorder, 2.4% for generalized anxiety disorder, and 5.6% for specific phobia. the annual prevalence rate was 0.4% for obsessive-compulsive disorder, 0.5% for post-traumatic stress disorder, 0.2% for panic disorder, 0.2% for agoraphobia, 0.4% for social anxiety disorder, and 0.4% for generalized anxiety disorder.
the purpose of developing treatment guidelines for anxiety disorders is as follows.
Studies to date have shown that anxiety disorder causes an increase in the co-morbidity of other mental and physical disorders, increases the cost of health care services, and causes psychosocial damage. For this reason, the need to diagnose anxiety disorders early and treat them without delay has been constantly emerging.
Especially, the diversity of physical symptoms that appear in anxiety disorders may have diagnostic errors, and the psychological symptoms are not limited to specific episodes in origin. the symptoms are formed by interacting with various factors such as individual personality characteristics and the surrounding social environment. In many cases, diagnosis and management are problematic in the clinical field.
therefore, there has been a constant demand to develop guidelines to enable optimized treatment in primary Korean medical care institutions. However, pattern identications, a characteristic of Korean medical diagnosis, can be a strength in diagnosis-treatment of anxiety disorders characterized by a variety of symptoms. therefore, this study aims to
secure the most appropriate Korean medical diagnosis and treatment criteria for anxiety disorders by developing a standard Korean Medicine Clinical Practice Guideline for Anxiety Disorders.
The interventions covered in this practice guideline’s development process include not only herbal medicines and acupuncture treatments commonly used in the clinical practice of Korean medicine, but also psychotherapy such as Qigong, meditation, relaxation therapy, and Biofeedback in consideration of the expandability of Korean medicine treatment tools. In this way, it was intended to provide evidence for strengthening and expanding Korean medicine security.
the development of Korean Medicine Clinical Practice Guideline for Anxiety Disorders followed the GRADE methodology, which is a standardized international development guideline. However, in consideration of Korean medicine’s unique strengths and characteristics, the level of evidence and the recommendation grade was derived with the consensus of the expert group. In particular, this guideline focused on its objectivity and convenience in use in order to increase its utility in primary Korean medical care institutions. the systematic literature review conducted for this was conducted based on a randomized controlled clinical study with the most precise level of evidence and focused on the convenience of treatment interventions as much as possible in consideration of the clinical utilization at the primary care institution.
2. Overview of disease
the anxiety disorder category includes conditions characterized by extreme fear, anxiety, and related behavioral disorders. DSM-5 standard anxiety disorder-related disorders include: anxiety disorders, selective encephalopathy, specific phobias, social anxiety disorder (social phobia), panic disorder, generalized anxiety disorder. DSM-5 criteria for anxiety disorder-related disorders include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder(social phobia), panic disorder, and generalized anxiety disorder. Here, anxiety is a wide range of very unpleasant and vaguely anxious feelings and related physical symptoms (headache, palpitations, elevated blood pressure, tachycardia, sweating, chest tightness, reflexes, enlarged pupils, tremors, gastrointestinal discomfort, frequent urination) and behavioral symptoms (irritability, strolling). In other words, it is the most basic reaction pattern that occurs when a living body tries to adapt to an unfamiliar environment.
It is expected that the anxiety disorder studied in this guideline is highly prevalent, it is the main disease of the mental illness survey of the Ministry of Health and Welfare, and it is expected to be applied to the medical treatment tool that ‘General Anxiety disorder’, ‘panic disorder’, ‘social phobia’ and includes post-traumatic stress disorder which belongs to DSM-Ⅳ-TR category of anxiety disorder.
Anxiety disorder belongs to the category of fright palpitations (驚悸) and fearful throbbing (怔忡) narrowly in the classification of symptoms of Korean medicine, but it does not entirely include the diversity of symptoms of anxiety disorder. Various symptoms such as epigastric pain with palpitation (悸心痛), insomnia (不眠), headache (頭痛), sweating (汗症), aphasia (不語症), thirst (口渴), tremor (振顫), dizziness (眩暈), plum-pit qi (梅核氣), diarrhea (泄瀉), blurred vision (眼昏), and consumptive disease (虛勞) can appear in anxiety disorder. As such, anxiety disorder is a representative disease that requires standardized treatment standards, primarily due to the diversity of symptoms in Korean medicine.
