Panic attacks and panic disorder

A panic attack is a suddenly beginning short-term attack of pronounced discomfort or fear, accompanied by somatic or cognitive symptoms. Panic disorder consists of repeating panic attacks, usually accompanied by fear of their repetition or the behavior of avoiding situations that can provoke the development of attack. Diagnosis is based on clinical data. Isolated panic attacks may not require treatment. In the treatment of panic disorder, drug therapy, psychotherapy (for example, exposition therapy, cognitive-biofiral therapy) are used or both.

Panic attacks are quite common, throughout the year it gets ill about 10 % of the population. Most people recover without treatment, only some develop panic disorder. Panic disorder is less common, it gets ill 2-3 % of the population in a 12-month period. Panic disorder usually begins in late adolescence, early adulthood; Women get sick 2-3 times more often than men.

Symptoms of panic attacks and panic disorders

The panic attack begins suddenly and includes at least 4 symptoms of 13. The symptoms usually reach a peak in 10 minutes, then gradually, for several minutes, disappear, while there are practically no signs that the doctor can observe. Despite the discomfort, sometimes very strong, panic attacks do not pose a danger to life.

Symptoms of a panic attack

Cognitive

• Fear of death
• Fear of going crazy or lose control
• A feeling of unreality, unusualness, detachment from the surrounding

Somatic

• Pain or discomfort in the chest
• Dizziness, instability, weakness
• Sensation of suffocation
• Sensation of heat or chills
• Nausea or other unpleasant sensations in the stomach
• Numbness or tingling sensation
• Heartbeat or rapid pulse
• A feeling of lack of air or shortness of breath
• Increased sweating
• Tremor and trembling

Panic attacks can be observed with other alarming disorders, especially in situations associated with the main signs of the disease (for example, in a person with fear of snakes, panic can develop at the sight of a snake). With a true panic disorder, some panic attacks develop spontaneously.

Most patients with a panic disorder have anxiety, fear of the onset of another attack (anxiety), they avoid places and situations in which panic was previously observed. Patients with a panic disorder often believe that they suffer from a severe heart disease, lungs or brain; They often visit a family doctor or seek help from the ambulance department. Unfortunately, in these situations, the main attention is focused on somatic symptoms, and the correct diagnosis is often not established. Many patients with panic disorder also have symptoms of great depression.

The diagnosis of panic disorder is made after the exclusion of somatic diseases that may have similar symptoms in accordance with the criteria for the leadership of the diagnostic and statistics of mental disorders, the 4th edition (DSM-IV).

Treatment of panic attacks and panic disorders

Some patients recover without any treatment, especially if they continue to resist the situations in which panic attacks are observed. In other patients, especially left without treatment, the disease acquires a chronic intermittent course.

Patients need to explain that treatment usually helps to control the symptoms. If the avoiding behavior has not formed, then perhaps there will be a sufficiently explanatory conversation about anxiety, support in returning and staying in places where panic attacks were observed. However, in situations of long-leasing disorder, with frequent panic attacks and avoiding behavior, drug therapy is needed in combination with more intense psychotherapeutic interventions.

Many drugs can prevent or significantly reduce the leading anxiety (“anxiety forward”), avoidance, quantity and intensity of panic attacks. Different classes of antidepressants - SIOOS, inhibitors of the reverse capture of serotonin and norepinephrine (SIOSSN), serotonin modulators, tricyclic antidepressants (TCA), monoaminoxidase inhibitors are approximately equally effective. At the same time, the SIOS and SIZSN have certain advantages over other antidepressants due to a more favorable profile of side effects. Benzodiazepines act faster than antidepressants, but with their use it is likely to develop physical dependence and such side effects as drowsiness, ataxia, memory disorders. Antidepressants are often prescribed in combination with benzodiazepines at the beginning of treatment, with the subsequent gradual abolition of benzodiazepines after the manifestation of the effect of the antidepressant. Panic attacks are often resumed after the cessation of medication.

Various methods of psychotherapy are effective. Exposition therapy, in which the patient confronts with his fears, helps reduce the fear and complications caused by avoiding behavior. For example, a patient who is afraid to faint is offered with rotation on a chair or hyperventilation to achieve a fainting, so the patient demonstrates that the feeling of fainting does not yet lead to fainting. Cognitive-bichhevioral therapy includes the patient’s teaching recognition and control over distorted thoughts and false beliefs and helps to change the patient’s behavior to a more adaptive one. For example, patients who describe their heart rate or a sense of suffocation in certain places or situations and are afraid that they will develop a heart attack, it is explained that their anxiety is unreasonable and it is necessary to respond with slowly controlled breathing or other methods that cause relaxation.