Panic disorder (episodic paroxysmal anxiety)

Anxiety disorder is a collective term that implies disorders of a neurotic nature with their typical clinical picture. Anxiety depressive disorder occurs in both young and old people.

Panic disorder is a mental disorder during which people experience attacks of severe anxiety and fear, accompanied by vegetative manifestations. Seizures appear spontaneously, without a previous cause. Recurrence frequency ranges from several times a year to several times a day. At the same time, the person is in constant fear due to the expectation of a new attack.

Why does anxiety disorder occur?

As in the case of most mental disorders, no one can say exactly why anxiety clings to us: too little is known about the brain to talk about the reasons with confidence. Several factors are likely to blame, from ever-present genetics to traumatic experiences.

For some, anxiety appears due to the stimulation of certain parts of the brain, for others, hormones - serotonin and norepinephrine - are acting up, and for others, the disorder occurs as a result of other diseases, and not necessarily mental ones.

Treatment

This disease is one of the most benign in psychiatry and has a good prognosis with adequate therapy.

The most effective treatment methods:

• Drug therapy: tranquilizers, antidepressants, neurometabolic therapy, mood stabilizers and neuroleptics.
• Psychotherapy: cognitive therapy, psychodynamic methods.
• Biofeedback therapy.
• Physiotherapy.
• Exercise therapy, massage, reflexology.

How to quickly help

Find out more about how you can relieve a panic attack at home and using improvised means here.

Treatment of panic disorder at the ROSA Clinic:

• Quick relief from a panic attack. Prevention of recurrence of attacks.
• Examination of the nervous system and mental sphere. Identifying the causes of the disease.
• Safe medicinal, psychotherapeutic and non-medicinal therapy methods.
• Own hospital.
• Around the clock.
• Anonymously. We don't register.

Causes

The etiology (origin) of the disease is not fully understood; experts suggest that it is provoked by the following factors:

• chronic heart or hormonal diseases, persistent circulatory disorders;
• taking psychoactive substances or their abrupt withdrawal, chronic alcoholism or drug addiction;
• head injuries and their consequences;
• prolonged stressful situations;
• melancholic temperament or anxious accentuation of character;
• mental trauma in early childhood or in adults in extreme situations (war, being on the verge of life and death, the departure of loved ones or deprivation of their support);
• high susceptibility to dangers, their exaggeration;
• neurotic conditions (neurasthenia, depression, hysteria) or mental illnesses (schizophrenia, paranoia, mania).

Causes

The main reasons for the development of panic disorder are predisposition.

In the mental sphere, predisposition is characterized by such traits as increased suspiciousness and anxiety, a tendency to doubt, lack of self-confidence, and increased attention to health problems.

Biological factors of predisposition to panic attacks: heredity (the presence of persons with mental disorders among blood relatives), disruption of the physiological mechanisms responsible for regulating the exchange of neurotransmitters in the brain.

Social factors: information overload, sleep-wake disturbances, abuse of psychoactive substances, sedatives and sleeping pills.

In addition to the causes, factors that directly trigger a panic attack play an important role: stress, psychological trauma, overwork, hangover or withdrawal symptoms, sleepless night the night before, hormonal changes in the body.

Symptoms of a panic attack

Cognitive

• Fear of death
• Fear of going crazy or losing control
• Feeling of unreality, unusualness, detachment from the environment

Somatic

• Chest pain or discomfort
• Dizziness, unsteadiness, weakness
• Feeling of suffocation
• Feeling hot or chills
• Nausea or other discomfort in the stomach
• Numbness or tingling sensation
• Palpitations or rapid pulse
• Feeling short of breath or having trouble breathing
• Excessive sweating
• Tremors and shaking

Panic attacks can occur in other anxiety disorders, especially in situations associated with underlying symptoms of the disease (for example, a person with a fear of snakes may develop panic at the sight of a snake). In true panic disorder, some panic attacks develop spontaneously.

Paroxysmal anxiety disorder

Paroxysmal anxiety disorder, or panic attack, or anxiety-vegetative disorder. A panic attack is an acute attack of increased anxiety and causeless fear. Features of paroxysmal anxiety disorder: appear in an unpredictable situation, are accompanied by mental and physiological symptoms, come on quickly and go away quickly.

Anxiety-panic disorder is manifested by symptoms:

• increased blood pressure, tachycardia, shortness of breath;
• hyperhidrosis;
• trembling of fingers and hands;
• nausea, vomiting, dizziness;
• depersonalization and derealization - feelings as if the world suddenly changed, changed colors;
• fear of death;
• insomnia;
• increased body temperature;
• cramps of the arms and legs;
• lump in throat.

The severity of a panic attack varies from simple, when internal tension and fear arise, to a feeling of imminent death. On average, an exacerbation lasts from 15 to 30 minutes. Acute anxiety disorder can occur from once a day to once a month: one patient experiences 3 attacks daily, another - once a month.

Treatment of panic disorder

• Drug therapy (antidepressants, benzodiazepines).
• Rational psychotherapy.

Treatment is prescribed only after confirmation of the diagnosis by a medical specialist.

Essential drugs

There are contraindications. Specialist consultation is required.

• Amitriptyline (sedative, antidepressant). Dosage regimen: orally, at a dose of 12.5–25 mg/day, then the dose is gradually increased to a tolerable level (on average by 12.5–25 mg over 3–5 days). The average effective daily dose is 150–200 mg/day, rarely reaching 300 mg.
• Fluoxetine (antidepressant). Dosage regimen: orally, in the first half of the day, at an initial dose of 5 mg per 1 dose. If necessary, the dose can be increased to 40-60 mg/day, divided into 2-3 doses.
• Sertraline (antidepressant). Dosage regimen: orally, in the initial dose - 25-50 mg 1 time per day in the morning or evening.
• Citalopram (antidepressant). Dosage regimen: orally, for 1 week the recommended dose is 10 mg/day, then the dose is increased to 20 mg/day. The daily dose, depending on the individual response of the patient, can subsequently be increased to 40 mg/day. The drug is taken at any time, once a day.

Generalized anxiety disorder

The existing signs of the problem will help determine the presence of this pathology in a person who often experiences anxiety for a long time. For a person suffering from generalized anxiety disorder, changes trigger feelings of anxiety—going on vacation, going on a visit—even upcoming pleasant events cause a feeling of concern. At the same time, patients cannot control the excessiveness of their fears.

The feeling of anxiety and accompanying unhappiness is persistent and empty. The disorder lacks a clear phobic element. This manifests itself in the fact that the patient, worried about fear for his own health and the well-being of loved ones, begins to experience an uncertain feeling caused by a harbinger of impending misfortune.

Complex of manifestations

Symptoms of anxiety disorders are divided into two groups:

1. Somatic symptoms . Characterized by pain, deterioration of health: headaches, sleep disturbances, darkening of the eyes, sweating, frequent and painful urination. We can say that a person feels changes on the physical level, and this further aggravates the anxious state.
2. Mental symptoms : emotional stress, a person’s inability to relax, fixation on the situation, constantly turning it over, forgetfulness, inability to concentrate on something, inability to remember new information, irritability and aggression.

The transition of all of the above symptoms into a chronic form leads to such unpleasant consequences as neurosis, chronic depression and stress. Living in a gray, scary world, where there is no joy, no laughter, no creativity, no love, no sex, no friendship, no delicious dinner or breakfast... all these are the consequences of untreated mental disorders.

Content

• 1 Classification of paroxysmal conditions [2] 1.1 I. Paroxysmal conditions of hereditary diseases
• 1.2 II. Paroxysmal conditions in organic diseases of the nervous system
• 1.3 III. Paroxysmal states within the framework of psychovegetative syndrome
• 1.4 IV. Paroxysmal conditions in diseases of internal organs
• 1.5 V. Paroxysmal conditions in diseases of the endocrine system
• 1.6 VI. Paroxysmal states in metabolic disorders
• 1.7 VII. Paroxysmal conditions in infectious diseases
• 1.8 VIII. Paroxysmal states during intoxication

Classification of paroxysmal conditions [2]

I. Paroxysmal states of hereditary diseases

• a) hereditary systemic degenerations of the nervous system: hepatocerebral dystrophy (Wilson-Konovalov disease); deforming muscular dystonia (torsion dystonia); Tourette's disease;
• b) hereditary metabolic diseases: phenylketonuria; histidinemia;
• c) hereditary disorders of lipid metabolism: amaurotic idiocy; Gaucher disease; leukodystrophy; mucolipidoses;
• d) hereditary disorders of carbohydrate metabolism: galactosemia; glycogenosis;
• e) phakomatoses: Recklinghausen neurofibromatosis; Bourneville tuberous sclerosis; encephalotrigeminal angiomatosis Sturge-Weber;
• f) hereditary neuromuscular diseases: paroxysmal myoplegia; paroxysmal myoplegic syndromes; myasthenia gravis; myoclonus; myoclonus - Unferricht-Lundborg epilepsy;
• g) genuine epilepsy.

II. Paroxysmal conditions in organic diseases of the nervous system

• a) injuries of the central and peripheral nervous system: post-traumatic diencephalic crises; post-traumatic myoclonus; post-traumatic epilepsy; causalgia;
• b) neoplasms of the brain and spinal cord: paroxysmal conditions associated with liquorodynamic disorders; vestibulovegetative paroxysms; epileptic seizures;
• c) vascular diseases of the nervous system: acute discirculatory encephalopathy; ischemic strokes; hemorrhagic strokes; hyper- and hypotonic cerebral crises; venous cerebral crises; vascular abnormalities; aorto-cerebral crises; vertebrobasilar crises; transient ischemic paroxysms; epileptiform cerebral crises;
• d) other organic diseases: paroxysmal myoplegia syndrome of cerebral origin; periodic hibernation syndrome; Odin's punishment syndrome; pontine myelinosis; juvenile shaking palsy;
• e) neuralgic paroxysms: trigeminal neuralgia; neuralgia of the glossopharyngeal nerve; neuralgia of the superior laryngeal nerve.

III. Paroxysmal states within the framework of psychovegetative syndrome

• a) vegetative-vascular paroxysms: cerebral; cardiac; abdominal; vertebral;
• b) vegetalgia: Charlen syndrome; Slader's syndrome; ear node syndrome; anterior sympathetic Glaser syndrome; posterior sympathetic Barre-Lieu syndrome;
• c) neuroses: general neuroses; systemic neuroses; paroxysmal states in mental disorders: endogenous depression; masked depression; hysterical reactions; affective shock reactions.

IV. Paroxysmal conditions in diseases of internal organs

• a) heart disease: congenital defects; heart rhythm disturbances; myocardial infarction; paroxysmal tachycardia; primary heart tumors;
• b) kidney disease: renal hypertension; uremia; eclamptic (pseudo-uremic coma); hereditary renal diseases (Schaffer's syndrome, familial juvenile nephrophthisis, Albright's osteodystrophy);
• c) liver diseases: acute hepatitis; hepatic coma; biliary (hepatic) colic; cirrhosis of the liver; calculous cholecystitis;
• d) lung diseases: lobar pneumonia; chronic pulmonary failure; bronchial asthma; inflammatory lung diseases with the presence of a purulent process; malignant diseases in the lungs;
• e) diseases of the blood and hematopoietic organs: pernicious anemia (Addison-Birmer disease); hemorrhagic diathesis (Schönlein-Henoch disease, Werlhoff disease, hemophilia); leukemia (tumor or vascular types); lymphogranulomatosis (Hodgkin's disease); erythremia (Vaquez disease).

V. Paroxysmal conditions in diseases of the endocrine system

• pheochromocytoma; Itsenko-Cushing's disease; Conn's syndrome; thyrotoxic periodic paralysis; hypoparathyroidism; Addisonian crisis; paroxysmal myoplegia syndrome of cerebral origin; climacteric syndrome.

VI. Paroxysmal states in metabolic disorders

• hypoxia; hypercapnia; mixed; other metabolic disorders.

VII. Paroxysmal conditions in infectious diseases

• a) encephalitis: acute hemorrhagic encephalitis; epidemic encephalitis (Economo's disease); Japanese encephalitis, mosquito; Schilder's periaxial encephalitis; subacute, sclerosing encephalitis; Creutzfeldt-Jakob disease; neurolupus; neurosyphilis; neurorheumatism (minor chorea);
• b) post-vaccination: anti-rabies; anti-smallpox;
• c) parasitic: cysticercosis; schistosomiasis; echinococcosis.

VIII. Paroxysmal states during intoxication

• alcoholic; acute alcoholic encephalopathy Gaye-Wernicke; poisoning by technical poisons; drug poisoning, including drugs.

Why is anxiety disorder dangerous?

One way or another, a developed anxiety disorder is a very unpleasant and even dangerous thing. Moreover, its danger is hidden.

Increased anxiety significantly reduces a person’s quality of life. The fact is that the natural reaction to a real threat will be to try to avoid this threat. Absolutely logical behavior for a primitive person becomes an obstacle to the quality life of a civilized person.

Anxious people tend to engage in “safe” avoidance behavior. Do not travel on public transport, do not go out unaccompanied, always have a phone and a set of necessary medications at hand, etc.

In severe cases, anxiety can cause a person to become disabled because they are unable to simply leave the house. However, severe cases do not arise immediately, are rare, and manifest themselves quite clearly. You can notice them in time and begin to take action. Most anxiety disorders do not have such pronounced symptoms, but their impact on a person’s life can be quite significant.

A socially anxious person will avoid public activity, and this limits his ability to develop.

Health anxiety, associated with a variety of physical symptoms that occur during anxiety conditions, leads to a waste of time and money on unnecessary medical examinations and manipulations. And it’s also good if there are no side effects or complications.

Situational anxiety

This type is caused by new circumstances or changes. This is also provoked by various events that bring certain inconvenience to a person. Its manifestation is very common. Often the patient experiences panic attacks or extreme anxiety in certain situations. An environment that makes one person anxious may not affect another at all. For example, some people feel uncomfortable in crowds or in narrow places. Therefore, being in a tightly packed line, say in a bank or in a store, causes them to feel extreme anxiety, possibly a panic attack. Others, however, experience anxiety when major life changes occur. Such as going to college, getting married, having children, etc.

Diagnosis

To establish the correct diagnosis, you need to pay attention so that the concern is not associated with:

• A panic attack, although panic attacks can occur in a person with GAD.
• Embarrassment in public, as in social anxiety disorder .
• Intrusive thoughts as in obsessive-compulsive disorder .
• Withdrawal from home or close relatives, as in separation anxiety disorder.
• Weight gain, as with anorexia nervosa.
• Multiple physical complaints, as in somatization disorder.
• Serious illnesses, such as hypochondria.
• Worry and anxiety during post-traumatic stress disorder (PTSD).

Anxiety, restlessness, or physical symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning. Also, symptoms must meet the following conditions:

• The disorder is not associated with the direct physiological effects of any substance, such as a drug or medication.
• The manifestations of the above symptoms do not depend on general health conditions, such as hyperthyroidism.
• Occurs exclusively during a mood disorder or psychotic disorder.

Anxiety spectrum disorders

Anxiety is a completely normal manifestation of emotion and in the general population can be described according to a normal Gaussian distribution. We are talking about anxiety spectrum disorders when anxiety interferes with a person’s normal functioning and causes him to suffer on its own. The “switching” of “normal anxiety” into “anxiety spectrum disorder” occurs when a hereditary predisposition (neurobiological factor) is combined with the influence of environmental factors (psychosocial stressors). We emphasize that “neurobiological dysfunction” largely depends on the genetic characteristics of the patient, since all anxiety disorders demonstrate either a moderate or pronounced dependence on heredity with a high risk of morbidity throughout life. The influence of heredity on specific phobias is especially noticeable; for example, a fear of spiders or snakes is inherited quite clearly. Psychosocial stressors in childhood and adolescence play a particularly important role in the genesis of anxiety spectrum disorders that manifest themselves in adulthood (separation from parents, frequent family conflicts, childhood illnesses, cases of sexual or physical abuse, family history of mental disorders).

Anxiety spectrum disorders are quite common in the practice of psychiatrists (Kessler et.al., 2012). Panic disorders with or without agoraphobia, despite the fact that they are less common than other anxiety spectrum disorders, often require treatment of patients in a hospital setting. In addition, these anxiety spectrum disorders are often combined with various somatic and neurological diseases. In 75% of cases, panic disorders (panic attacks) are combined with agoraphobia. Generalized anxiety disorder, in turn, is highly comorbid with major depression (severe depressive episode), and researchers often identify common biological bases for these mental disorders. Patients with social phobia (social anxiety disorder) in most cases have anxious and suspicious personality traits, against the background of which social phobia seems to be secondary in nature and is also combined with somatic and neurological diseases. Despite the fact that social phobia is a fairly common disorder, it is relatively rarely diagnosed and treated by clinicians. In the practice of a psychiatrist, individual phobias are often encountered; they are generally quite common, and are most often associated with anxious and suspicious character traits; often, the genetic factor plays a fairly significant role here. Here, patients also rarely seek help, since they can periodically control their phobias. Research on specific phobias is noticeably smaller in number than other anxiety spectrum disorders. Certain anxiety disorders were most often considered by child psychiatrists and were described under the name “neurotic disorders of childhood.” However, recently, individual anxiety disorders are increasingly being studied by psychiatrists who treat adult outpatients.

Anxiety spectrum disorders traditionally include obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Obsessive-compulsive spectrum disorders include trichotillomania, excoriation disorders (skin lesions), dysmorphic somatic disorders (BDD), and hoarding. Painful anxiety disorders are included in a new diagnostic category of the American DSM-5 classification under the heading “Somatic Symptom and Related Disorders”. One of the main symptoms of this mental disorder is excessive preoccupation with one’s physical illnesses (hypochondriasis). Mixed anxiety and depressive disorders are registered only in the International Classification of Mental Disorders (ICD-10). These disorders are often identified by emergency physicians, internists, and neurologists. Research into the biological background of these disorders is extremely limited.

Anxiety spectrum disorders most often debut or come to the attention of a doctor between the ages of 22 and 28 years. In women, these disorders are registered almost 1.5-2 times more often than in men. Bimodal peaks of obsessive-compulsive disorder are observed at the ages of 12-14 and 20-22 years.

Neuroimaging of anxiety spectrum disorders has proven useful in early studies in this area by Fontaine et al (1990), which identified changes in the temporal lobe, including areas of abnormal activity and signs of asymmetric atrophy. Sobanski et al. (2010) found a decrease in the volume of the temporal and frontal lobes in anxiety spectrum disorders. Small bilaterally expressed amygdala dimensions have also been reported in panic disorders (Massana et.al., 2003). Some authors have noted a decrease in gray matter density in the parahippocampal gyrus in patients with panic attacks. One study found a decrease in the volume of the right posteromedial prefrontal cortex. in patients with panic disorder and absence of the posterior orbital gyrus. Functional changes were noted by Lai (2011), who found significant correlations between decreased gray matter volume in the right basal ganglia and the severity of panic disorder with agoraphobia. Decreases in gray matter volume have been identified in the putamen in patients with panic disorder.

How to treat

Anxious personality deviation is determined in the patient during a conversation with a doctor, as well as with the help of psychological tests. The doctor must analyze the signs of the disease before prescribing a treatment regimen.

Treatment will help make it easier for the patient to interact with others. The main method is psychotherapy. The best results are shown by a combination of behavioral and cognitive psychotherapeutic techniques. During classes, the psychotherapist explains to the patient his usual thinking patterns and helps to correct them. Treatment of TPD is difficult to imagine without group forms of classes. They allow you to consolidate the received theoretical advice in practice through live communication with other people.

Treatment also includes the use of medications. It is preferable to use antidepressants, primarily of the SSRI class. Anti-anxiety medications (tranquilizers) may also be used. To combat the symptoms of autonomic disorders (tachycardia, etc.), beta-blockers are used.

There are contraindications, you need to consult a specialist!

Treatment options

1. Drug treatment. Specialized therapy quickly equalizes the emotional background, relieves constant anxious thoughts, stabilizes the sleep-wake cycle, and the body gets the opportunity to recover.
2. Work with a psychologist, psychotherapist. Rational psychotherapy helps the patient analyze and understand the primary causes of anxious thoughts, learn to distinguish between productive and unproductive anxiety, and also learn to change their attitude towards emerging troubles and problems. If you cannot change the situation, you need to change your attitude towards it!
3. Relaxation skills training. To relieve the symptoms of GAD and prevent its occurrence, stress-relieving exercises are very helpful. Muscle relaxation, stabilization of blood pressure, correct calm breathing: this state, which is achieved by certain physical exercises, is beneficial for relieving the symptoms of GAD.
4. Group psychotherapy. Some people with generalized anxiety disorder find it much easier to cope when they are around others with similar problems. Loneliness during illness makes a person more vulnerable.
5. Lifestyle changes. This stage includes both the normalization of sleep and wakefulness, the selection of an optimal diet and light physical activity, and the exclusion of traumatic situations, which serve as a “trigger” for generalized anxiety disorder.

Related posts:

1. Is it possible to quickly cure phobias? A phobia is a neurosis that manifests itself in the form of a strong, difficult...
2. Causes of acute stress Acute stress is the most common - it occurs in connection with an immediate threat or...
3. Constant fear and anxiety in women Almost all people have experienced feelings of anxiety and fear at least once...
4. Constant lies. Mental illness or character trait? Pathological lying or pseudology is a pathological tendency to tell a false...

Therapy

Treatment for anxiety disorder involves several stages. They need to be completed sequentially, without trying to choose the easiest option for yourself and forget about all the others. How to treat this condition? Let's take a closer look.

Recognizing the problem

All therapy begins with conscious intention. First, the problem must be acknowledged. Only then will it stop seeming so huge and unsolvable. When a person sees his difficulties, he can already guess how to approach them, find reasonable ways out of the current situation. It takes a lot of courage and being really honest with yourself to make bold decisions.

Individual boundaries

Building your own perspectives will help protect you from negative manifestations. The better we understand our individual boundaries, the easier it becomes to move towards success. The desired result will not be long in coming, since the potential of an individual can be fully revealed only when a clear understanding of oneself is acquired. In most cases, this helps fill you with joy.

Working with self-esteem

It is very important to have adequate self-esteem and be able to appreciate yourself. Only then do many anxieties and doubts begin to dissipate. You need to constantly tell yourself that you deserve the best. Then positive changes can easily enter your life.

Personal achievements

Individual aspirations must necessarily end in a satisfactory result. When a person comes to a positive result, he can then set bigger and better goals for himself. A large flow of creative energy appears, which you want to use for the benefit of yourself and those around you.

Thus, anxiety-phobic disorder is a condition that needs the right approach. Here you need to take full responsibility for what is happening. You need to know how to cure it without destroying your personality or shaking your self-confidence. The most important thing to remember is that you need to cultivate faith in yourself, constantly reinforce your confidence, and accumulate individual victories. If you cannot cope with the problem, contact the Irakli Pozharisky Psychology Center. Working with a specialist will help remove internal blocks and free yourself from a negative state.