Vegetative crises, or panic attacks: causes

Special epidemiological studies, the sample size of which reached 3,000 people, convincingly showed that panic attacks are most common between the ages of 25 and 64 with some predominance in the 25-44 year group, most rarely at the age of over 65. Panic attacks occurring in elderly patients (over 65 years of age) are usually poorer in symptoms, in paroxysms there may be only 2-4 symptoms, but emotional components are usually quite pronounced. Characterizing elderly patients with panic attacks, one can note their physical, intellectual and emotional safety, which is probably a necessary prerequisite for the emergence of panic attacks in the elderly. Sometimes it is possible to find out that panic attacks of the elderly age are a relapse or aggravation of panic attacks observed in a patient from a young age.

Sex and panic disorder

The data of most epidemiological studies show the prevalence of the representation of women over men in patients with PR. Our studies, as well as literature data, show a 3-4-fold prevalence of women over men among patients with panic attacks. In an attempt to explain the predominance of women in PR, the importance of hormonal factors is discussed, which is reflected in the data of relevant studies on the relationship between the debut and the course of PR with hormonal changes. On the other hand, it can not be ruled out that the large representation of women in PR is associated with psychosocial factors, namely with a different socioeconomic level, reflecting the contemporary social role of women.

At the same time, a smaller representation of men can be associated with the transformation of anxiety disorders into alcoholism. There are reports that almost half of men with panic attacks had a history of alcohol abuse. It is suggested that alcoholism is a secondary manifestation of anxiety disorders, that is, patients with panic attacks use alcohol as a "self-treatment" with symptoms of anxiety.

Duration of paroxysms

One of the diagnostic criteria for panic attacks is the duration of the attack, and although spontaneous panic attacks can last for an hour, nevertheless, most of the duration of the majority is determined by minutes. The majority of patients estimate the duration of paroxysm in time necessary for its arrest (call "ambulance", the effect of taking the drug). The analysis of the patients studied by us showed that almost 80% of patients with panic attacks estimated the duration of most seizures in minutes and about 20% in hours. The duration of paroxysms with hysterical symptoms (FNS) was more often estimated in hours, and in a third of patients they could last for 24 hours, often serially flowing. In the latter, there was a significant spread in the duration of seizures - from minutes to days.

The daily distribution of panic attacks (panic attacks of sleep and wakefulness)

Analysis of the literature and own data show that most patients have ever experienced a panic attack during the night sleep, but only in 30-45% of patients these episodes are repeated. Nocturnal paroxysms can occur before the patients fall asleep, awaken them immediately after falling asleep, appear in the first and second half of the night, arise from sleep or through some interval after awakening in the middle of the night. According to our (employee M. Bashmakov, who examined 124 patients with panic attacks, more than half of the patients (54.2%) had panic attacks of sleep and wakefulness at the same time, and only 20.8% had exclusively panic attacks sleep, it is necessary to distinguish between a panic attack of sleep and frightening dreams, which awakens the patient, feeling fear and accompanying vegetative symptoms.These phenomena, despite their external similarity, are related to different stages of sleep. Sleep aks occur during slow sleep, usually in the late period of the 2nd stage or early in the third stage of sleep, while awful dreams usually appear in the phase of fast sleep. According to Mellman et al. (1989), patients with panic attacks of sleep more often than patients with panic attacks of wakefulness report that a relaxed state can be a provoking factor for panic attacks.For patients with panic attacks of sleep, the following sequence of events can be regarded as characteristic:

1. the appearance of panic attacks of sleep;
2. the occurrence of the fear of sleep caused by them;
3. delaying bedtime and periodic deprivation;
4. the appearance of periods of relaxation in connection with sleep deprivation and the emergence of panic attacks associated with both sleep deprivation and relaxation;
5. further increase in fear of sleep and restrictive behavior.

[1], [2], [3], [4], [5]

Social disadaptation

For all the relativity of the concept of social maladjustment, which does not take into account mainly family disadaptation, nevertheless there are objective criteria for assessing the degree of social maladjustment. The latter include: departure from work, a group of disabilities with the possibility of financial support, the need for urgent medical care and hospital stay. In addition, it is necessary to take into account the impossibility of independent movement outside the home, the inability to remain alone at home, i.e., the degree of agoraphobic syndrome and restrictive behavior, which cause social maladjustment.

Special studies conducted on large contingents showed that up to 30% of patients with acute respiratory disease used "first aid", while in the population this figure was 1%. About emotional disorders, 35.3% of patients with PR were permanently treated, and about 20% for "somatic" problems. The financial support in the form of pensions or disability benefits was used by 26.8% of patients with PR.

The own study of patients with different types of paroxysms showed that with the appearance of an atypical radical, the degree and quality of social maladaptation varies, which is probably related to the personality premorbid against which the PA develops. Patients with atypical panic attacks (AMPA) and demonstrative seizures (DP) significantly increase the degree of social maladjustment, i.е. As the atypical radical increases in paroxysm, social maladaptation increases, and in the case of atypical panic attacks, "leave from work" and "disability group" are equally represented; in the case of DP, rental arrangements in the form of a "disability group" prevail. In the other three groups, social disadaptation was observed much more often, and it is obvious that if patients with DP received a secondary benefit in the form of material and, possibly, moral compensation ("patient role"), then patients in groups of atypical panic attacks and Cr. - ETC. Preferred not to work temporarily, not only not receiving social compensation, but often also at the expense of their material situation.

Although there is a concept of a spontaneous (unprovoked) crisis in clinical practice and literature, or, as it is also called, "a crisis against a background of clear sky," nevertheless, as a rule, it concerns more often the patient's ignorance of the cause that triggered the crisis.

Factors provoking a vegetative crisis (panic attack)

Factors	Significance of factors
	I	II	III
Psychogenic	The situation of the culmination of the conflict (divorce, explanation with the spouse, withdrawal from the family, etc.)	Acute stressful effects (death of loved ones, illness or accident, iatrogenia, etc.)	Abstract factors acting on the mechanism of identification or opposition (movies, books, etc.)
Biological	Hormonal reorganization (pregnancy, childbirth, end of lactation, menopause)	The onset of sexual activity, abortion, the use of hormonal drugs	Menstrual cycle
Physiogenic	Alcoholic excesses	Meteotropic factors, insolation, physical loads, etc.

In clinical practice, as a rule, there is a constellation of various factors. It should be emphasized the different significance of each of these factors in provoking crises. So, some of them can be decisive in provoking the first crisis (the culmination of a conflict, the death of a loved one, abortion, excessive intake of alcohol, etc.), while others are less specific and provoke repeated VC (metofactors, menstruation, emotional and physical stress, and t etc.).

[6], [7]