Autonomic crises, or panic attacks

A panic attack (PA), or vegetative crisis (VC), is the most striking and dramatic manifestation of vegetative dystonia syndrome (VDS) or panic disorders (PD).

Causes of vegetative crisis (panic attacks)

Special epidemiological studies, the sample size of which reached 3000 people, convincingly showed that panic attacks are most common in the age group from 25 to 64 years, with some predominance in the group of 25-44 years, and least common in the age group over 65 years. Panic attacks that occur in elderly patients (over 65 years) are usually poorer in symptoms, there may be only 2-4 symptoms in a paroxysm, but the emotional components are usually quite pronounced. Characterizing elderly patients with panic attacks, one can note their physical, intellectual and emotional integrity, which is probably a necessary prerequisite for the occurrence of panic attacks in old age. Sometimes it is possible to find out that panic attacks in old age are a relapse or exacerbation of panic attacks observed in the patient from a young age.

Vegetative crises, or panic attacks - Causes

Symptoms of panic attacks

The main feature of vegetative manifestations is the presence of both subjective and objective disorders and their polysystemic nature. The most common vegetative manifestations are: in the respiratory system - difficulty breathing, shortness of breath, a feeling of suffocation, a feeling of lack of air, etc.; in the cardiovascular system - discomfort and pain in the left half of the chest, palpitations, pulsation, a feeling of interruptions, a sinking heart. Less common are disorders of the gastrointestinal tract - nausea, vomiting, belching, discomfort in the epigastric region. As a rule, dizziness, sweating, chill-like hyperkinesis, waves of heat and cold, paresthesia and cold hands and feet are observed at the time of the crisis. In the overwhelming majority of cases, attacks end in polyuria, and sometimes with frequent loose stools.

Vegetative crises, or panic attacks - Symptoms

Terminology and classification

Both terms - "vegetative crisis" and "panic attack", equally used to designate practically identical conditions, on the one hand emphasize their common radical - paroxysmal nature, and on the other - reflect the dominance of one or another: views on the essence of the paroxysm itself and its pathogenesis.

The term "vegetative crisis", traditional for domestic medicine, emphasizes the vegetative manifestations of paroxysm. Vegetative crisis is a paroxysmal manifestation of congenital heart disease, i.e. psychovegetative paroxysm (PVP).

The concept of autonomic dysfunction as the basis of crises has been recognized by neurologists and internists.

At the end of the last century, Sigmund Freud described “anxiety attacks” in which anxiety arose suddenly, was not provoked by any ideas, and was accompanied by disturbances in breathing, cardiac activity, and other bodily functions. Freud described such conditions within the framework of “anxiety neurosis” or “worry neurosis.” The word “panic” originates from the name of the ancient Greek god Pan. According to myths, Pan, who suddenly appeared, caused such horror that a person would rush headlong to run, not looking where he was going, not realizing that the flight itself could lead to death. The concepts of suddenness and unexpectedness of the attack may be of fundamental importance for understanding the pathogenesis of vegetative crises or panic attacks.

The term "panic attack" has gained worldwide recognition today thanks to the classification of the American Psychiatric Association. In 1980, members of this Association proposed a new manual for the diagnosis of mental illnesses - DSM-III, which was based on specific, mainly phenomenological, criteria. In the latest version of this manual (DSM-IV), the diagnostic criteria for panic attacks are as follows:

1. Recurrent attacks in which intense fear or discomfort, combined with 4 or more of the following symptoms, develop suddenly and reach their peak within 10 minutes:
   • pulsations, strong heartbeat, rapid pulse;
   • sweating;
   • chills, tremors;
   • feeling of lack of air, shortness of breath;
   • difficulty breathing, suffocation;
   • pain or discomfort in the left side of the chest;
   • nausea or abdominal discomfort;
   • feeling dizzy, unsteady, lightheaded, or light-headed;
   • feeling of derealization, depersonalization;
   • fear of going crazy or committing an uncontrollable act;
   • fear of death;
   • a feeling of numbness or tingling (paresthesia);
   • waves of heat and cold.
2. The occurrence of panic attacks is not caused by the direct physiological effects of any substances (for example, drug addiction or taking medications) or somatic diseases (for example, thyrotoxicosis).
3. In most cases, panic attacks do not occur as a result of other anxiety disorders, such as “social” and “simple” phobias, “obsessive-phobic disorders,” or “post-traumatic stress disorders.”

Thus, if we summarize the criteria necessary for diagnosing panic attacks, they include:

1. paroxysmal;
2. polysystemic vegetative symptoms;
3. emotional and affective disorders, the severity of which can range from “a feeling of discomfort” to “panic”.

The diagnosis of panic disorders takes into account the recurrence of panic attacks and excludes a direct causal relationship with drug factors, somatic diseases and other clinical entities included in the class of "anxiety disorders" (DSM-IV).

Panic attacks as the main (core) phenomena (syndromes) are included in two headings: “Panic disorders without agoraphobia” and “Panic disorders with agoraphobia”.

"Agoraphobia" is accordingly defined as "anxiety about or avoidance of places or situations from which escape may be difficult (or difficult) or from which help cannot be provided if panic attacks or panic-like symptoms occur."

In turn, both PR and AF are included in the class of "anxiety disorders". In the International Classification of Mental Disorders, 10th revision (ICD-10) of 1994, panic disorders are included in the section "Neurotic, stress-related and somatoform disorders".

Epidemiological studies before the development of standardized diagnostic criteria identified 2.0-4.7% of anxiety disorders in the population. According to statistics, panic attacks (according to DSM-III criteria) are observed in 3% of the population and up to 6% of people seeking primary medical care for the first time.