Vegetative crises, or panic attacks

Panic attack (PA), or vegetative crisis (VC), is the most dramatic and dramatic manifestation of the syndrome of vegetative dystonia (SVD) or panic disorders (PR).

The causes of vegetative crisis (panic attacks)

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.

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 frequent are vegetative manifestations: in the respiratory system - difficulty breathing, shortness of breath, a feeling of suffocation, a feeling of lack of air, etc .; in cardiovascular - discomfort and pain in the left side of the chest, palpitations, pulsations, sensations of interruptions, heart sinking. Less often there are disorders from the gastrointestinal tract - nausea, vomiting, belching, unpleasant sensations in the epigastric region. As a rule, at the time of the crisis, dizziness, sweating, oznobopodobny hyperkinesis, heat and cold waves, paresthesia and coldness of the hands and feet. In the vast majority of cases, attacks result 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 refer to almost identical states, on the one hand emphasize their general radical - paroxysmal, and on the other - reflect the dominance of those or other: views on the essence of paroxysms and its pathogenesis.

The term "vegetative crisis", traditional for domestic medicine, focuses on the vegetative manifestations of paroxysm. The vegetative crisis is a paroxysmal manifestation of CHD, i.e. Psycho-vegetative paroxysm (PVP).

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

Sigmund Freud at the end of the last century described "anxiety attack» (anxiety attack), in which the alarm occurred suddenly, was not provoked by any ideas and accompanied by respiratory failure, heart and other bodily functions. Such states were described by Freud within the framework of the "anxiety neurosis" or "anxiety neurosis". The word "panic" takes its origin from the name of the ancient Greek god Pan. According to the myths, the unexpected appearance of Pan caused such horror that the man rushed headlong to escape, not understanding the road, not realizing that the flight itself could threaten death. The concepts of the suddenness and unexpectedness of an attack appear to be of fundamental importance for understanding the pathogenesis of vegetative crises or panic attacks.

The term "panic attack" has received worldwide recognition today thanks to the classification of the American Association of Psychiatrists. Members of this Association in 1980 proposed a new manual for the diagnosis of mental diseases - 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. The recurrence of seizures in which intense fear or discomfort in combination with 4 or more of the symptoms listed below develops suddenly and reach their peak within 10 minutes:
   • pulsations, strong palpitation, rapid pulse;
   • sweating;
   • chills, tremor;
   • 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;
   • sensation of dizziness, instability, lightness in the head, or pre-occlusive condition;
   • a sense of derealization, depersonalization;
   • fear of going insane or doing an uncontrollable act;
   • fear of death;
   • feeling of numbness or tingling (paresthesia);
   • waves of heat and cold.
2. The emergence of panic attacks is not due to the direct physiological action of any substances (for example, drug dependence or drug intake) or somatic diseases (eg, 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", "post-traumatic stress disorders".

Thus, if we summarize the criteria necessary to diagnose panic attacks, then they include:

1. paroxysmal;
2. polysystemic autonomic symptoms;
3. emotional-affective disorders, the severity of which can range from a "feeling of discomfort" to "panic."

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

Panic attacks as major (nuclear) phenomena (syndromes) are included in two headings: "Panic disorders without agoraphobia" and "Panic disorders with agoraphobia."

"Agoraphobia," respectively, is defined as "anxiety about or avoiding places or situations, the outcome of which can be difficult (or difficult) or in which it can not be helped in case of PA or panic-like symptoms."

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

Epidemiological studies before the development of standardized diagnostic criteria revealed 2.0-4.7% of anxiety disorders in the population. According to statistics, panic attacks (according to the criteria of DSM-III) are observed in 3% of the population and up to 6% in persons who primarily seek primary medical care.