Panic attacks: causes of the disease, symptoms, diagnosis and treatment

What are panic attacks and their types
Symptoms
Physical
Causes
Panic attack in a dream
What to do during a panic attack: first aid
Treatment
Drug treatment
Psychotherapy
Phytotherapy
Breathing exercises
Physical exercise
Consequences
Conclusion

Attention! Drug use causes irreparable harm to health and poses a danger to life!

The term panic attacks appeared relatively recently; earlier doctors called it differently, namely vegetative-vascular disorders that were associated with stress. In medical practice, the disorder is also called cardioneurosis, sympathoadrenaline or autonomic crisis. Attacks can be isolated or regular, the latter disrupting a person’s life and causing complications. A panic attack does not pose a direct threat to a person’s life, but requires urgent treatment.

Panic attacks

Previously, the state of panic attacks was classified as a symptom of vegetative dystonia syndrome. Panic attacks have been considered an independent disease since 1980. They are now included in the International Classification of Diseases. Today, experts are reconsidering the approach to panic attacks: increasingly, doctors attribute the symptoms of the disease to neuroses, and all emerging disorders are considered neurotic disorders of autonomic dysfunction.

Paroxysms of a panic nature affect almost 5% of the population. Residents of megacities are the most vulnerable to the manifestation of this disease. As a rule, the first attacks begin between the ages of 25 and 45 years. A milder form of panic attacks is observed in old age, when the symptoms are mild, and during an attack of panic attacks the emotional part noticeably predominates. Panic attacks can be a consequence of a paroxysm experienced in youth.

Panic attacks can be a single attack or a series. In case of relapse, the disease should be classified as panic disorder. If previously the disease was dealt with exclusively by neurologists, now psychiatrists and psychologists also deal with the patient for these disorders. The symptoms are also of interest to doctors in the fields of pulmonology, endocrinology, gastroenterology and cardiology.

Contributing Factors

In addition to the main causes of a panic attack, there are also provoking factors. They increase the likelihood of developing the disorder even in completely healthy people.

These factors include:

Low physical activity. Leads to the emergence of various negative thoughts and high impulsiveness. Physical inactivity is especially dangerous for teenagers.
Excessive caffeine consumption. Contributes to low levels of emotional exhaustion.
Smoking and alcoholism. They have a negative effect on blood vessels and reduce resistance to stress and depression.
Sleep disorder, when a person is often in a state of lack of sleep.
Emotional poverty. Holding thoughts and emotions inside for long periods of time often leads to anxiety attacks.

Causes of panic attacks

Panic attacks are traditionally provoked by physiological, biological and psychogenic factors. Often there is a combination of factors, one of which causes the initial attack, and others – its relapses.

Physiogenic triggers appear as a result of physical overload, high insolation, acclimatization, meteorological fluctuations, drug use, etc. Some medications can also, to one degree or another, affect the occurrence of panic attacks: cholecystokinin (used in diagnosing the gastrointestinal tract), bemegride (added for induction of anesthesia), some types of steroids.

Patients prone to panic attacks mostly have similar character traits and personality traits. For men, this is an unusually reverent concern for their own health. Women have a desire to be in the center of attention, attracting interest to themselves, drama and excessive demonstrativeness. People who prioritize caring for others over being selfish about themselves have never experienced panic attacks.

What happens if PA is not treated?

Each subsequent attack is accompanied by more acute sensations. A person may develop a new phobia - a strong fear of repetition of paroxysms; he continues to live in constant tension, expecting the situation to worsen. Regardless of the intensity of the physiological symptoms, this disorder is not fatal. Treatment of panic attacks is necessary to prevent the development of phobias, increased anxiety and nervousness.

The patient begins to radically change his life and adapt to his condition. He avoids places with large crowds of people, supermarkets, and stops using any public transport. Gradually, such a person isolates himself from society, prefers not to engage in professional activities, and spends all his time indoors. He stops communicating on confidential topics with his loved ones, and there is a risk of developing serious mental complications. Patients with panic attacks often suffer from neurasthenia, neuroses, sleep disturbances, depression, and asthenia. The nervous system is exhausted, the person tries to relieve the symptoms with self-selected medications.

Regularly recurring attacks lead to loss of appetite and disruption of the functions of important organs, in particular the gastrointestinal tract. Conscious refusal of food leads to physical exhaustion. In this case, treatment of dystrophy is often required; this process is lengthy and is not always completed successfully. It all depends on the condition of the body, the presence of internal reserves to fight the disease.

Pathogenesis of panic attacks

The causes of panic attacks are explained by several theories. The work of researchers in this matter is significantly complicated by the uncertainty of patients regarding the causes of the attack, as well as the inability to connect the traumatic situation and paroxysm. Because of this, there is no complete certainty regarding the causes of the disease. An additional complicating factor is the rapid progression of panic attacks and their sudden onset.

The most modern approach to the causes of panic attacks is the influx of anxious thoughts on the patient, which is not justified by absolutely anything. Under the influence of these thoughts, adrenaline and other catecholamines begin to be actively produced. As a result, blood pressure increases significantly and blood vessels narrow. Arterial hypertension during panic attacks affects even those people who have an absolutely normal premorbid background. Sodium lactate accumulates in the tissues, the concentration of CO2 gas in the blood decreases, breathing quickens, and tachycardia may appear. As a result of these disorders, a feeling of lightheadedness, derealization, and dizziness occurs.

During panic attacks, the brain activates cerebral chemoreceptors, which are highly sensitive to changes in the composition of gases in the blood. In parallel, noradrenergic neurons become hyperactivated. As a result, feelings of anxiety and fear increase, and the panic attack only intensifies.

Causes

Most often, panic attacks are considered as mental disorders, but they can occur in people with a sensitive psyche when suffering from an illness, especially a severe one, before an upcoming surgical intervention, during an economic crisis, etc.

Therefore, the following reasons for the development of panic attacks in women and men are identified:

Heart diseases, in particular angina pectoris, coronary artery disease, mitral valve prolapse, myocardial infarction, and bronchial asthma can cause a feeling of depression and danger to life. This is aggravated by the occurrence of symptoms characteristic of these diseases, especially shortness of breath, increased heart rate, and discomfort of varying degrees of intensity in the chest area. As a result, anxiety may develop, but in such situations it is the physical signs of a panic attack that come to the fore, while the psychological ones (feelings of fear, anxiety) are usually moderately expressed.
Gastrointestinal pathologies, including gastric ulcers and especially irritable bowel syndrome.
Endocrine disorders, especially thyrotoxicosis and pheochromocytoma, can imitate conditions characteristic of panic attacks due to the development of a vegetative crisis, but in reality they are not.
Physiological changes caused by changes in hormonal levels or the passage of certain life stages: the beginning of menstruation in girls, initiation of sexual relations, pregnancy, childbirth, menopause, etc.
Taking certain medications, in particular drugs based on cholecystokinin, as well as drugs that activate the production of this hormone in the body, glucocorticosteroids and bemegride. Basically, such drugs are used to treat neurological diseases, severe inflammatory processes, withdrawal syndromes and mental disorders.
Mental problems and disorders, including severe shocks (death of a loved one, divorce, dismissal), depression, schizophrenia, post-traumatic stress disorder, obsessive-compulsive disorder. People who have various phobias often suffer from panic attacks, including those who are afraid of society, heights, closed spaces, the dark, and diseases. In such situations, panic attacks are more manifested by emotional disturbances, especially causeless, severe fear and anxiety. In this case, physical manifestations are expressed moderately or even weakly.

It is important to distinguish a phobia from a panic attack, although in both cases we are talking about a neurotic disorder and stress. But in the first case, fear arises in direct connection with a causal factor (darkness, closed space, height, etc.), and a panic attack can occur in isolation without any clear reason. But sooner or later, phobias almost always lead to panic attacks.

However, the causes of panic attacks may also lie in the influence of social factors. Thus, a large number of researchers have come to the conclusion that a large role in the development of anxiety disorders is played by a large information load, a very fast pace of life and constant stress. This point of view is supported by the fact that residents of cities, especially megacities in highly developed countries, suffer from panic attacks tens of times more often than residents of rural areas.

It is the influence of society that largely explains the cases of panic attacks in children and adolescents. They are often observed in especially emotionally labile children before competitions, competitions, exams, etc. But this does not exclude the possibility that somatic factors, especially bronchial asthma, which has recently been increasingly diagnosed in children, are involved in the development of anxiety attacks. In such situations, the risk of exacerbation of bronchial obstruction increases against the background of severe anxiety.

Often children, and subsequently adults, who have suffered sexual abuse at an early age are susceptible to panic attacks.

Not the least important factor in the occurrence of panic attacks is the general level of stress resistance of a person. It is known that certain factors can reduce it, which creates the preconditions for the occurrence of an anxiety disorder. These include:

the presence of bad habits, in particular abuse of caffeine-containing drinks, smoking, alcohol and/or drug use;
maintaining a sedentary lifestyle;
suppression of emotions, accumulation of grievances, presence of internal conflicts;
sleep disorders.

20-30% of people taking cannabinoids experience panic attacks. This is one of the most common side effects of smoking marijuana.

Symptoms of a panic attack

Panic attacks are often a consequence of a mental disorder (schizophrenia, hysterical neurosis, depression, etc.) or somatic diseases (peptic ulcer, neurocirculatory dystonia, coronary artery disease, etc.). Psychological factors determine polysymptoms, as well as the presence of subjective and objective symptoms.

Often panic attacks have no connection with real danger. In this case, the disease takes a sudden start, the symptoms rapidly intensify, and then decline, leaving the patient alone with the state of recovery after the attack. Typically, panic attacks last about 15 minutes. In rare cases, short attacks (about 10 minutes) and long attacks (about 1 hour) have been observed. The most powerful attack is considered to be 5-10 minutes into its manifestation. Patients, recalling this period, complain of the particular severity of the attack, as well as a certain emptiness and depression.

The most common complaints are a feeling of suffocation, pain in the heart, cardiac arrest or excessive activity, breathing problems, lack of air, etc. Symptoms such as paresthesia, dizziness, chills, and sweating are often encountered. At the end of the attack there is polyuria. Patients often talk about cognitive impairment: depersonalization, unclear sound, blurry objects, lightheadedness, and so on. More rare symptoms are vomiting, belching, nausea and other gastrointestinal symptoms.

The first panic attack, with rare exceptions, is expressed by a specific fear of death. When repeated, it takes on a clear form: a person is overcome by the fear of death from some disease or accident. A feeling of anxiety appears, which is difficult to explain in any way, internal tension. Often patients reach a state of passion. Some patients are most susceptible to emotional disorders: feelings of pity, insignificance, hopelessness.

During panic attacks, certain functional disturbances may occur: twisting of the arms, chills, mutism, blurred vision, numbness of the limbs, changes in gait, etc.

Consequences

Panic attacks significantly worsen a person’s quality of life and, if left untreated, can cause the following complications:

self-isolation, fear of society, interruption of contacts with other people;
decreased self-esteem;
loss of confidence in the future;
wariness, anxiety, which can provoke aggression towards the environment;
sexual dysfunction;
the formation of mental disorders with frequent repetition of attacks;
conflicts in the family;
problems at work, study;
abuse of alcohol and drugs to combat panic;
exacerbation of chronic diseases;
disorders of the digestive tract, dystrophy due to refusal to eat due to anxiety;
fear of death.

Course of panic attacks

A panic attack can be abortive (less than 4 symptoms) or extensive (more than 4 symptoms). Abortive attacks can occur several times a day. In turn, a full-blown panic attack can manifest itself both quite often (several times a week) and rarely (once every few months). As a rule, patients are susceptible to both types of panic attacks. It is only in exceptional cases that a person is overcome only by extensive attacks.

Patients adapt to the consequences of a panic attack in different ways. For some, panic paroxysms are pronounced (inability to distinguish the inter-crisis period from a panic attack), others feel healthy. In the intervals between attacks, chills, hypothermia, emotional and psychopathological manifestations, headache, diarrhea, constipation, cardialgic symptoms, etc. may be observed.

After several panic attacks, patients experience an inferior lifestyle and a certain limitation associated with avoiding places and situations in which the crisis occurred.

Diagnosis of a panic attack

A study of patients with panic paroxysm clearly demonstrates the presence of most symptoms of autonomic dysfunction. Autonomic disorders can also be detected in the period between attacks. At the same time, neurological studies do not provide any information; no serious neurological abnormalities are detected among patients.

After suffering a panic attack, patients should undergo pathopsychological examination, neuropsychological examination, personality structure study and other psychological examinations.

After panic attacks, various procedures may be prescribed, the list of which directly depends on the clinical manifestations of the disease. Most often, patients are subject to the following studies: ECG, X-ray of the lungs, ultrasound of the heart, 24-hour monitoring of blood pressure and ECG, MRI of the brain, ultrasound of the abdominal cavity, analysis of gastric juice, FGDS, and so on. Additional consultations with specialists in related fields of medicine may be required: pulmonology, cardiology, endocrinology, psychiatry, etc.

Diagnostics

If signs characteristic of panic attacks appear, you should contact a neurologist, psychologist or psychiatrist. Diagnosis begins with establishing the number of episodes of panic fear. A person is said to be susceptible to panic attacks if there are several such cases that arise spontaneously without the presence of a real threat to life and health, as well as outside the use of drugs or medications.

To develop the most effective treatment tactics, it is also important to establish the type of panic attacks. There are:

expected (situationally related and situationally predisposed) – when anxiety attacks are associated with the presence of a specific fear, for example, heights;
unexpected – when there is no obvious reason for the occurrence of fear and a clearly traceable trigger, so it is impossible to predict in advance the possibility of its occurrence.

In the first case, panic attacks are largely a consequence of the presence of one or another phobia, obsessive-compulsive disorder, post-traumatic disorder, or depression. Therefore, in these cases they are secondary, and therefore treatment will be aimed primarily at eliminating the cause of their occurrence.

Sometimes an additional consultation with a cardiologist, gastroenterologist, endocrinologist or pulmonologist may be required to detect disorders in the cardiovascular, endocrine, respiratory or digestive systems. In such situations, a fairly wide range of studies may be required to exclude underlying diseases, including:

ECG;
daily monitoring of ECG and blood pressure;
Ultrasound of the heart, abdominal organs;
X-rays of light;
determination of the level of basic hormones;
EEG;
X-ray or MRI of the cervical spine;
Doppler ultrasound of cerebral vessels.

Therefore, panic disorders, as the main diagnosis, are spoken of only in cases of sudden onset of severe anxiety with the development of physical symptoms to a greater or lesser extent. It is important that there is no anxiety during the period between attacks.

It is also necessary to establish the severity of the patient’s condition at the time of the attack using tests aimed at detecting fears and a special scale. The Spielberg scale is often used for this purpose. To do this, he is asked to fill out a special questionnaire or orally answer the doctor’s questions. In addition, it is important for the doctor to observe the patient over a certain period of time, and also to obtain information about when and what diseases he suffered, how often he is exposed to stress and how much he is exposed to it, what changes have occurred in his life, etc.

Diagnostic criteria

A feeling of discomfort and fear, the manifestation of more than 4 symptoms during repeated paroxysms are the basis for a diagnosis of “Panic attack”. At the first manifestation of the disease, a diagnosis is not made. Also, the diagnosis is questioned if 5-6 of the following symptoms are present: visual impairment, blurred hearing, gait disturbances, cramps in the limbs, numbness of the limbs and temporary paralysis, all-paresis, etc. A single panic attack resulting from a physical or psychological disorder is not interpreted as a disease. overvoltage, as well as getting into a situation where the patient is in real danger. Only with repeated attacks with pronounced autonomic disorders and psychopathological disorders can we talk about the full development of the disease.

Panic attack treatment

The main approach to treating a panic attack is the interaction of a psychologist and a neurologist, who jointly try to convince the patient on a subconscious level that a panic attack is not a disease, does not pose a risk to his life and health, and can also be controlled by the patient himself. Changing your perspective on various life situations is one of the most important aspects of recovery.

Antidepressants (tricyclic and tetracyclic) occupy a special place in drug treatment. However, their effectiveness does not appear for the first few weeks, and the symptoms of panic attacks during this period may become more pronounced. After about two months, the stage of maximum effectiveness of the drugs begins. Among the drugs, the most common are cipramil, fluvoxamine, fluoxetine, paroxetine, sertraline.

If desired, the patient can be prescribed various benzodiazepines. They do not increase the symptoms of a panic attack and are more effective from the moment of use, however, these drugs are not recommended for use for more than 4 weeks due to the risk of dependence on them. In addition, they are ineffective for depressive disorders. As a rule, these drugs are recommended for use to relieve paroxysms.

The choice of drug treatment method is entirely individual. As a rule, the course of drug use is 6 months or more. A complete cessation of the use of medications is relevant only in cases where the panic attack has not recurred within 40 days.

Breathing control is the simplest and most effective non-drug therapy. The patient needs to take as deep a breath as possible and hold his breath for as long as possible. After this, you need to exhale slowly. At the same time, you need to try to relax your body and close your eyes. This exercise is recommended to be repeated about 15-20 times. You are allowed to take a short pause of a few standard inhalations and exhalations.

Basic information and theories of origin

A panic attack can last from a few minutes to an hour. But most often it lasts no more than half an hour and goes away as abruptly as it appeared. And although it does not pose a serious threat to physical health, such attacks of severe fear are very exhausting and damage a person’s mental state. In addition, having once suffered such an attack, people are unconsciously afraid of its repetition and are constantly in a state of stress, which further aggravates the situation. In the future, panic attacks can lead to:

avoiding crowded places and limiting movement;
fear of being alone;
fear of being far from home or in a place where it is impossible to quickly receive qualified medical care;
severe depressive states;
disturbances in concentration;
loss of performance.

Today, panic attacks are not uncommon among either women or men. Although women are 5 times more likely to suffer from them than men. According to statistics, about 10-20% of people around the world experience a panic attack at least once in their lives. In other words, almost every fifth person experienced an attack of severe fear at least once. Therefore, many experts already consider panic attacks not even as a disorder, but as a feature of human behavior.

At the same time, about 0.5-1% of people regularly experience panic attacks. But this is an average. It varies greatly depending on a person's region of residence, country, social conditions and other factors. In such situations, they already speak of the presence of pathology, and in 2/3 of all cases, neurological or mental disorders are detected. And 20% of people from this number have alcohol or drug addiction.

Most often, panic attacks are observed in women and men aged 25-45 years. Although they can also occur in older people and adolescents. It has been noted that they are more typical for people with an above average level of intelligence.

Panic attacks can occur on their own or develop against the background of other diseases, not only mental, but also pathologies of the cardiovascular, endocrine system and others. Sigmund Freud once attempted to describe panic attacks by calling them anxiety attacks. Subsequently, they were considered as a manifestation of vegetative-vascular dystonia and were called an emotional-vegetative crisis.

A large amount of work has been done on the study of anxiety states, and only in 1980 the term “panic attack” was introduced, including in ICD-10, to describe the main manifestation of such disorders. But research in this area and anxiety disorders developing against the background of panic attacks is still ongoing. The result of this was the creation of a number of theories of the occurrence of panic attacks, although today many experts are inclined to believe that a panic attack is a consequence of a combination of various factors described in individual theories.

It has been precisely established that the primary source of their development is the physiological processes occurring in the body as a result of stress, namely changes in the functioning of the temporal lobes of the brain and some parts of the limbic system (a set of brain structures located on the sides of the thalamus). As a result of anxious thoughts, adrenaline is released, which aggravates anxiety. This in turn can trigger a panic attack, which increases anxiety. This creates a vicious circle that can be difficult to break.

Catecholamine theory

This hypothesis is based on the possibility of a panic attack occurring against the background of an increase in the level of catecholamines, which include adrenaline. They are produced by the adrenal cortex in response to stress factors. These compounds have stimulant properties, meaning they cause blood vessels to constrict, which leads to increased blood pressure levels, and also stimulate the nervous system and lead to an increase in heart rate.

Genetic theory

This theory is based on the fact that 15-20% of people suffering from panic attacks have relatives with the same anxiety disorders.

Psychoanalytic theory

This hypothesis was developed by S. Freud and has since been refined by other researchers. According to it, panic attacks occur against the background of a lack of emotional, including sexual, release, and the presence of a person’s conflict with himself and his needs. This leads to physical tension. Over time, a conflict or other stressful situation provokes the development of anxiety.

Behavioral theory

This theory is based on the connection between a panic attack and external causes, which can be situations that threaten a person in one way or another. The resulting increase in heart rate is recorded by the body as a trigger. And subsequently, when the pulse rate increases, which may be a symptom of one or another heart pathology, a panic attack develops even in the absence of a threat.

This theory also describes cases of the development of anxiety states in people prone to pessimism. For example, one day, while in transport, a person is struck by the thought that an accident might happen. If it causes fear, a panic attack may develop even against the background of complete well-being and no danger to life. In such cases, a panic attack is not a consequence of a direct threat, but of a far-fetched potential situation.

Cognitive theory

This theory is based on a person’s ability to misinterpret their feelings. Thus, shortness of breath after exercise or increased heart rate may be mistakenly perceived as life-threatening. The result is fear and a panic attack.

Forecast

The patient’s personality traits directly affect the course of a panic attack, its severity and duration. Panic attacks become most severe for patients who perceived the first such incident as a real disaster. Sometimes the reaction of health care workers can also contribute to a faster progression of the disease. For example, when hospitalizing a patient in an ambulance, a thought is formed in his subconscious about serious health problems and the presence of serious illnesses.

Starting treatment as quickly as possible contributes to a positive prognosis for recovery. Each attack aggravates the situation, creates limitations in behavior, and is also clear evidence for the patient that the disease exists and is very dangerous. Recovery is possible when two factors coincide: adequate treatment by medical professionals and the efforts of the patient himself. In chronic panic attacks, these factors will contribute to a colossal increase in interpanic time.

Primary appointment with a neurologist: 1850 RUR.