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Generic Ziac (Biosoprolol - hydrochlorothiazide 2.5mg + 6.25/5mg + 6.25mg)
SYMPTOMS HOW TO SPOT: FEAR OF DISEASE- THE CARDIAC NEUROSIS
The cardiac neurosis is a common form of hypochondriasis. This may take two forms. The first is an excessively high level of anxiety suffered by someone who has had a heart attack and has recovered. The anxiety is apt to manifest itself by a frequently recurrent acute fear of dying. Symptoms such as chest pain and tightness, breathiessness and palpitations are experienced, although these are not due to recurrence of the disease, and the affected person finds great difficulty in returning to a normal life. The second is an unjustified conviction that one is suffering from .heart disease. This is notoriously persistent and difficult to treat. Often, there is a family background of heart trouble and a belief that heart disease is hereditary - which it is not. The conviction is usually fortified by various symptoms, especially harmless palpitation, and chest pain, usually arising from heartburn.
Strong medical reassurance, even after comprehensive examination and investigation, seldom succeeds in dispelling the belief and the unfortunate mental sufferer goes from doctor to doctor almost as if hoping for confirmation of the fears. There is little to be done to help people with this unfortunate problem. Logical arguments, and demonstration that they are capable of physical exertion impossible for people with heart disease, do not impress. In most cases, the cardiac neurotic lives a long and medically uneventful life. In some cases, as in Moliere's, he does not.
Herein lies the doctor's dilemma. In the great majority of cases the complaints are entirely imaginary and to carry out repeated examinations and tests is not only a waste of medical time and resources, but will also strengthen the patient's fears and make the hypochondriasis worse. The wise doctor will spend a good deal of time in careful history-taking before deciding that the patient is a hypochondriac, and will then offer a full scheme of examination and tests, with the explicit understanding that, if these are negative, that will be the end of investigation of the current complaint.
Unfortunately, the true nature of hypochondriasis remains obscure, so no logical approach to treatment is possible. It has been thought to be a form of pathological depression, but it doesn't respond to anti-depressive treatment. The patient has full insight and cannot, by definition, be considered psychotic. The nearest reasonable classification is to view it as an inherent personality defect characterized by a low threshold to fear, to sensation and to the awareness of the normal functions of the body. The hypochondriac is, essentially, a person who is constantly looking inwards instead of out.
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