Panic attacks

A panic attack is an unpredictable attack of intense fear or anxiety combined with a variety of autonomic multi-organ symptoms. Some people are helped by medications such as During an attack there may be a combination of several of the following symptoms: hyperhidrosis, palpitations, shortness of breath, chills, hot flashes, fear of madness or death, nausea, dizziness, etc. Confirmation of the diagnosis is based on meeting the diagnostic criteria of panic paroxysms and the exclusion of somatic pathology in which similar seizures may occur. Treatment is a combination of psychotherapeutic and medication methods of attack control and therapy during the intercrisis period, as well as teaching and training the patient how to independently overcome paroxysms.

General Information
The name “panic attack” was introduced by American specialists in 1980. Gradually it became widespread and is now included in the International Classification of Diseases (ICD-10). Earlier, the term “emotional-vegetative crisis” was used, and similar paroxysms were considered within the framework of vegetovascular dystonia. In modern medicine, the concept of “panic attack” is being revised. Understanding of a primary psychological factor and secondary character of vegetative symptoms has led to necessity of treating such paroxysms as neuroses, and accompanying vegetative disorders as vegetative dysfunctions, which are an integral part of neurotic disorder.

Panic paroxysms are a widespread problem. Statistical sources indicate that up to 5% of the population has experienced such conditions. The vast majority of them are residents of metropolitan areas. The most typical age of the first attack is 25-45 years old. At older age, panic attack proceeds with noticeably less symptomatology and a predominance of the emotional component. In some patients, it is a relapse of paroxysms observed in youth.

Panic attack can occur as a single paroxysm or as a series of attacks. In the latter case, we are talking about a panic disorder. If earlier in domestic medicine, panic attacks were the subject of curation exclusively by neurologists, then today it is an interdisciplinary pathology, the subject of study by psychology, psychiatry and neurology. In addition, the psychosomatic coloring of the attacks brings panic attacks into the category of problems relevant to practitioners in many other fields of medicine – cardiology, gastroenterology, endocrinology, pulmonology.

There are 3 groups of factors that can provoke a panic attack: psychogenic, biological and physiogenic. In clinical practice it is noticed that often operates a combination of several provoking triggers. And some of them are determinative in the occurrence of a primary attack, while others initiate repetitions of panic attacks.

Among psychogenic triggers, the most significant are conflict situations – clarification of relationships, divorce, scandal at work, leaving the family, etc. In second place are acute psychologically traumatic events – accidents, death of a loved one, illness, etc. There are also abstract psychogenic factors influencing the psyche by the mechanism of contraposition or identification. These include books, documentaries and feature films, television programs and various Internet resources.

As biological triggers, various hormonal rearrangements act (basically, in women in connection with pregnancy, miscarriage, childbirth, menopause), the beginning of sexual relations, reception of hormones, features of the menstrual cycle (algomenorrhea, dysmenorrhea). It should be noted that panic attacks are not considered paroxysms caused by endocrine diseases – hormonally active adrenal tumors (pheochromocytoma) and thyroid diseases running with hyperthyroidism.

Physiogenic triggers include acute alcohol intoxication, drug intake, meteorological fluctuations, acclimatization, excessive insolation, physical overexertion. Certain pharmacological drugs can provoke a panic attack. For example: steroids (prednisolone, dexamethasone, anabolic steroids); bemgrid, used to induce anesthesia; cholecystokinin, used in the instrumental diagnosis of gastrointestinal organs.

As a rule, the occurrence of panic attacks is seen in individuals with certain personality traits. For women, it is demonstrativeness, drama, desire for attention, expectation of interest and participation from others. For men it is initial anxiety, increased concern about their health and, as a consequence, excessive listening to the state of their physical body.

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