Panic attacks

Description:

The Panic Attack (PA) represents inexplicable, painful for the patient, the attack of heavy alarm accompanied with fear in combination with various vegetative (somatic) symptoms.

Domestic doctors used long time and use the terms "vegetative crisis", "sympathoadrenal crisis", "cardioneurosis", "VSD (Vegeto-vascular Dystonia) with a Krizovy Current", "NTsD — Neurocirculatory Dystonia" reflecting ideas of disturbances of the autonomic nervous system depending on the leading symptom now. The terms "panic attack" and "panic frustration" have world recognition and are entered into the International classification of diseases of the 10th review.

For detection of expressiveness of the panic attacks the scale of weight of panic frustration is used. This scale is used also in the form of a self-assessment questionnaire as the test for the panic attacks.

Symptoms of the Panic attacks:

The panic attack is characterized by an attack of fear, panic or alarm and/or feeling of internal tension in combination with four or more of the list of symptoms associated with panic:

  1. Heartbeat, the speeded-up pulse
  2. Perspiration
  3. Fever, tremor, feeling of an internal shiver
  4. Feeling of shortage of air, asthma
  5. Suffocation or the complicated breath
  6. Pain or discomfort in the left half of a thorax
  7. Nausea or abdominal discomfort
  8. Feeling of dizziness, instability, ease in the head or a preunconscious state
  9. Feeling of a derealization, depersonalization
  10. Fear to go crazy or make an uncontrollable act
  11. Fear of death
  12. Feeling of numbness or a pricking (paresthesia) in extremities
  13. Sleeplessness
  14. Confusion of thoughts (decrease in randomness of thinking)

There are also other symptoms which did not enter the list: abdominal pains, frustration of a chair, the speeded-up urination, feeling of a lump in a throat, gait disturbance, a vision disorder or hearing, a spasm in hands or legs, disorder of motive functions.
Intensity of the main criterion of the panic attack (alarm attacks) can vary over a wide range: from the expressed panic state to feeling of internal tension. In the latter case, when into the forefront the vegetative (somatic) component acts, tell about "not insurance" the PAS or about "panic without panic". The attacks impoverished by emotional manifestations meet in therapeutic and neurologic practice more often. Also, in process of development of a disease, fear level in the attacks decreases.

Duration of attacks can vary of several minutes till several o'clock, averaging 15 — 30 min. Frequency of attacks — from several in day to 1 — 2 times a month. Most of patients speak about spontaneity (nesprovotsirovannost) of the attacks. However active inquiry allows to reveal along with the spontaneous attacks also the situational attacks arising in potentially "threatened" situations. Can be such situations: use of transport, stay in crowd or the closed space, need to leave own dwelling etc.

The person who for the first time faced this state is strongly frightened, begins to think of any serious illness of heart, endocrine or nervous systems, digestion, can call "ambulance". He begins to visit doctors, trying to establish the reasons of "attacks". The treatment the patient of the panic attack as manifestations of any somatopathy, leads to frequentations of the doctor, repeated consultations at specialists of various profile (cardiologists, neuropathologists, endocrinologists, gastroenterologists, therapists), to unjustified diagnostic testings, and makes at the patient an impression about complexity and uniqueness of his disease. Incorrect ideas of the patient of an essence of a disease lead to emergence of the hypochiondrial symptoms promoting weighting of disease.

Vrachi-internisty, as a rule, do not find organic pathology, recommend to visit the psychotherapist. At personal interest of the doctor cases of hyper diagnosis and purpose of treatment according to the false diagnosis meet. At the same time sedative, vascular and metabolic drugs with doubtful evidential base and not predicted action are often appointed. In the most positive case the recommendations of the general character connected with change of a way of life meet: to have a rest, play more sports, not to be overtasked, avoid stresses, to switch. Often banal and sample appointments meet: to accept vegetable sedative drugs (a valerian, a motherwort).

In most cases the panic attacks are not limited to one attack. The first episodes leave an indelible mark in memory of the patient. It leads to emergence of a syndrome of alarm of "expectation" of an attack which, in turn, fixes repeatability of the attacks. Repetition of the attacks in similar situations (transport, stay in crowd etc.), promotes formation of restrictive behavior, that is avoiding potentially dangerous, for development of PAS, places and situations. The alarm concerning possible development of the attack in a certain place (situation) and avoiding of this place (situation) is defined by the term "agoraphobia". Increase of agorafobichesky symptomatology leads to social disadaptation of the patient. Because of fear patients can be not able to leave the house or to remain alone, doom themselves to house arrest, become a burden for relatives. Existence of an agoraphobia at panic frustration indicates more serious illness, attracts the worst forecast and demands special medical tactics. Also situational depression which makes heavier the course of a disease too, especially can join if the patient cannot long understand what happens to it, does not find the help, support, does not receive simplification.

Reasons of the Panic attacks:

The etiology of panic frustration in many respects remains not clear. In any case, at this state interaction of many psychological and biological mechanisms matters. From the point of view of a psychodynamics, the condition of fear and alarm is a response to zhizneugrozhayushchy manifestation in a flow of consciousness of thoughts, impulses or desires, painful and inadmissible for the patient, i.e. the psychological conflict connected with the past or present takes place. Therefore alarm reaction in this case is an attempt to mobilize and anticipate danger for own "I".
The panic attacks have a serious genetic basis: family burdeness on this state (a disease 15–17% of relatives of the first degree suffer) is found, also big concordance at enzygotic twins (80–90%) is described [9, 10].
Attacks arise at the people having certain personal features more often. So, among women persons to whom demonstrativeness, the exaggerated need to draw attention to itself and thirst of recognition is inherent prevail. In the behavior they are quite often drawn, exaggerating feelings, aim to interest in themselves and quickly cool down to those who do not show to them that extent of participation for which they wait (so-called gistrionny persons). At men absolutely other type of a patokharakterologiya – what is called as "health morbid depression" quite often comes to light. It is about particular, intense interest in the physical health. For them it is important to be engaged constantly in improvement and to feel in an excellent form.
It is often possible to track communication of panic frustration with the experienced negative emotions in the childhood. Approximately a half of the children suffering from a school phobia (i.e. fear of school), at a growing has symptoms of the panic attacks.

Treatment of the Panic attacks:

In treatment of panic frustration allocate two directions: the first – stopping of an attack of the panic attack; the second – the prevention of development of the subsequent episodes of the panic attacks and the syndromes accompanying them (such as agoraphobia, depression, alarm of expectation etc.).
Now emit the following drugs used for treatment of panic frustration: tricyclic and tetracyclic antidepressants, the selection serotonergic drugs, MAO inhibitors and benzodiazepines.
Treat tricyclic and tetracyclic antidepressants: Imipraminum (Melipraminum), кломипрамин (anafranit), дезимипрамин (petilit, пертофран), amitriptyline (Triptizolum), нортриптилин, миансерин (леривон), Maprotilinum (ludiomil), тианептин (koaksit).
From benzodiazepines in treatment of the panic attacks are used: to alprozala (Хелекс), clonazepam (Antelepsinum, rivotril).
The following drugs belong to antidepressants of selective effect (selective serotonin reuptake inhibitors): sertraline (Asentra, золофт, lyustrat), fluoxetine (Fluval, Prozac), пароксетин (paksit, дероксат, аропакс), флувоксамин (феварин), tsipramit (to tsitolapra, tsipra), тианептин (koaksit).
Tricyclic antidepressants exert impact on such components of panic frustration as an agoraphobia, a depression, alarm of expectation. However these drugs have very serious shortcoming – long stage of latency. Improvement occurs two-three weeks later from an initiation of treatment, and the final therapeutic effect can be shown 8–10 weeks later. In the first weeks of treatment the aggravation of symptoms of a disease is sometimes observed.
Selective serotonin reuptake inhibitors are considered as the safest, lack of the side effects which are found at reception of tricyclic antidepressants is characteristic of them. They can be applied in long-term schemes of treatment at the long preventing therapy. They influence panic, an agoraphobia, a depression and alarm. And impact on alarm is not followed by sedative side effect. The main lack of this group of drugs is the possibility of emergence within the first two-three weeks of treatment of such symptoms as irritability, sleeplessness, nervousness, strengthening of alarm.
High-potential benzodiazepines control both the panic attacks, and alarm of expectation. However in stopping of agorafobichesky frustration these drugs are less effective, than tricyclic antidepressants and selective serotonin reuptake inhibitors. Influence on depressive frustration at high-potential benzodiazepines is also less expressed. At this class of drugs a number of advantages is had: their use allows to achieve bystry therapeutic effect (within several days), lack of an aggravation of symptoms at the initial stage of therapy. To avoid dependence formation, the course of treatment should not exceed four weeks.
The choice of basic drug is defined by a clinical picture of a disease and features of effect of drug. Average therapeutic doses are used. For stopping of the developed panic attack one of the most effective drugs are benzodiazepines, and it is more preferable drugs of bystry action: to alprazola (Хелекс), diazepam, lorazepam.
Duration of treatment makes at least six-nine months (provided that attacks are completely stopped). The indication to drug withdrawal is the full reduction of the panic attack (the period of 30-40 days, free from panic) and disappearance of alarm of expectation.
In addition to pharmacotherapy psychotherapy courses, respiratory gymnastics, auto-training are conducted.
Use of so-called vegetotropny drugs (анаприлин, Pyrroxanum, Belloidum, белласпон) in combination with vascular and metabolic therapy (cinnarizine, Cavintonum, trental, nootropil, piracetam, Cerebrolysinum) inefficiently can also promote synchronization of a disease.