Anxiety is part of a person's unique defense system, which is designed to inform him of possible internal or external danger. But sometimes this system fails and then a person begins to worry without visible reasons or the degree of his fear is not commensurate with the degree of danger.
This condition is usually called a panic attack.
During a panic attack, a person experiences severe anxiety and cannot control it in any way.
Classification of panic attacks
Based on the nature of their occurrence, the disorders under consideration are classified into situational, spontaneous and conditionally situational.
- Spontaneous ones appear suddenly and often without any particular reason or circumstances.
- Situational ones arise as a result of strong experiences or traumatic events. They can also be caused by a pronounced feeling of anticipation.
- Conditional-situational ones arise due to the influence of biological or chemical factors on the body. These include narcotic substances, alcohol, hormonal disbalance and others.
Based on the nature of the manifestation, it is worth considering typical and atypical panic attacks.
- For a typical panic attack The clinical picture is characterized by the manifestation of cardiovascular symptoms in the form of pain in the heart area, pressure surges. Very often, people in this condition are hospitalized due to the risk of developing a hypertensive crisis.
- With an atypical attack, muscle cramps, speech disorders (aphasia), problems with hearing and vision, as well as malfunctions of the musculoskeletal system appear. Vomiting and loss of consciousness are allowed, the apogee of which is excessive urination.
Diagnostics
To create a complete and clear clinical picture pathological phenomenon it is necessary:
- analyze the symptoms that accompany the paroxysm;
- identify, if any, the symptoms preceding the paroxysm and the symptoms that arose as a result of the attack;
- determine the time boundaries of the attack;
- analyze factors and situations that could provoke an attack;
- analyze the pathological phenomenon in the sleep-wake cycle.
When diagnosing panic disorder, experts use clear criteria.
A panic attack is said to occur if the patient has the following symptoms:
- hypertrophied fear, reaching the point of horror and accompanied by a feeling of the inevitability of death;
- feeling of internal psycho-emotional tension;
- the presence of four or more panic-associated symptoms.
List of panic-associated symptoms:
- tachycardia, rapid pulse;
- increased sweating;
- tremor throughout the body, chills;
- feeling as if you are suffocating, shortness of breath;
- a feeling of tightness and discomfort in the left chest;
- nausea, vomiting and abdominal discomfort;
- foggy consciousness, dizziness, lightheadedness;
- disorientation in space, depersonalization;
- fear of committing an uncontrollable act, fear of losing one’s mind;
- fear of death;
- numbness in the extremities;
- sensation of waves of cold and heat passing through the body.
The key criterion for a panic attack is hypertrophied anxiety. The degree of its severity can vary from a feeling of internal discomfort to a clearly manifested affect of panic.
In the first variant, a panic attack is not burdened with an emotional component and is manifested mainly by vegetative symptoms. Such attacks occur most often in neurological practice.
The study revealed that as the disease worsens, the severity of fear during attacks decreases.
The number of panic-associated symptoms may vary among patients. Sometimes there are cases where full-fledged attacks are accompanied by only 2-3 panic-associated symptoms. These attacks are called "minor panic attacks."
But if the clinical picture shows 5-6 symptoms that are not characteristic of panic disorder, then such a diagnosis must be excluded. To simplify the diagnosis of a panic attack, there is a test that allows you to quickly determine this condition. The test is based on an index of panic attack typicality.
The key difference between panic disorder and others pathological conditions is the absence of a prodromal period. The attacks appear suddenly and develop to their peak within 10 minutes. After an attack, weakness and inner emptiness are felt throughout the body. Some patients report a feeling of “relief.”
However, confusion and sleep in the post-attack period are not characteristic of panic disorder.
When diagnosing this type of disorder, it is necessary to take into account the duration of the panic attack. On average it lasts from 15 minutes to half an hour. But there have also been cases of longer lasting panic attacks. During the tests, a direct relationship was established between the number of atypical symptoms accompanying the attack and its duration.
To obtain a complete clinical picture of panic attacks, it is necessary to analyze the causes of their occurrence. In most patients, panic attacks begin spontaneously, however, with the help of a detailed conversation, it is possible to determine not only spontaneous insurmountable worries, but also situational ones, which are a reaction to some “dangerous” circumstances.
Such circumstances may include being in a confined space, traveling on a trolleybus, speaking in front of a large audience, etc.
Panic attacks occur during wakefulness, mainly during the day or evening, but there are patients with attacks that appear not only during the day, but also at night. Very rarely, patients with predominantly nocturnal panic attacks are observed.
What does a doctor need to know?
In the International Directory of Diseases panic disorder diagnosed if the following criteria are present:
- Repeated panic attacks.
- Panic attacks last for at least a month and are accompanied by the following symptoms:
- fear of repeating a panic attack;
- fear of worsening the attack, loss of reason and self-control;
- significant behavioral change caused by attacks.
Self-diagnosis
You can detect panic disorder yourself.
A special questionnaire for identifying panic attacks, developed by American psychologist Wayne Caton, can help with this. The test has been tested and has high validity and reliability
By reading the test questions and answering them “yes” or “no,” you can get the most reliable result, typical for self-diagnosis.
Anxiety attacks that are painfully experienced by a person accompanied by fear are called a panic attack (PA). It prevents the individual from adapting to a full life. A panic attack test is used as the first step to identifying the problem. However, the mandatory participation of a specialist is necessary.
Features of the test
You can take a PA symptom test online. If you answered yes to the first question, then contact psychologist.
Panic disorder test questions help determine your condition:
- Have you had any feelings of fear, anxiety, or horror over the past 3-4 months?
- If yes, please clarify, is this your first time encountering such sensations?
- Do you feel anxious about having another attack?
- Were the manifestations unexpected or related to a specific uncomfortable situation?
- Has the fear of death appeared?
Results on a panic attack test are not a diagnosis. Only the thoughtful approach of a certified specialist will establish the presence of the disease.
Determining the degree of panic attack
The line between anxiety states seems unnoticeable, but the treatment differs significantly. Specialist Nikita Valerievich Baturin will help get rid of of this disease if you have identified symptoms of a panic attack.
Think about whether over the past 4 months you have felt:
- Rapid, difficult breathing, lack of air?
- Excessive sweating, when sweat “rolls like hail”?
- Strong heartbeat (jumping out of the chest)?
- Lump in throat, choking?
- An unpleasant feeling of tightness in the chest, or chest pain?
- Weakness, dizziness?
- Numbness, tingling in the limbs, throughout the body?
If you answered yes, then take an extended test and consult a psychologist.
Clinically expressed PA is accompanied by fear, which appears unexpectedly. An attack is characterized by symptoms that frighten a person:
- sudden;
- a feeling of unreality of what is happening;
- chest pain, suffocation;
- horror sudden death or loss of control;
- the emergence of fear of going crazy.
Note! The panic attack rapidly increases and reaches its maximum after 5-7 minutes. The development of the attack is observed for 15-20 minutes.
Such symptoms occur in mental, somatic diseases. The feeling of interruptions in the heartbeat, pain in the left side of the sternum is perceived by a person as a manifestation of the disease. An attack provokes an increase in blood pressure. The patient lacks air, and fear of suffocation increases. Dizziness and lightheadedness appear.
When a test for a panic attack and anxiety indicates that there are signs of a disorder, then you need to consult a psychologist or psychotherapist. You will receive specialized assistance. Are you aware of the presence psychological problem. See what solutions exist.
A doctor's view of a panic attack and a panic attack test.
Panic attack often not considered from the perspective of the disease. Under certain conditions, almost anyone can experience a panic attack. In the presence of a strong emotional stress There may be manifestations at the body level that indicate panic attacks. However, sometimes panic begins to progress and is diagnosed in
1.9-3.6% of the population. With some advantage among women.
During a panic attack, a person feels intense fear, which is combined with physical manifestations. I mentioned the symptoms of panic attacks earlier, so I won’t dwell on them.
When diagnosed by a doctor, an attack can be classified as a vegetative crisis orvegetative-vascular dystonia. However, panic attack is now a globally recognized term, included in classification of diseases.
In order to classify your attack according to a panic attack, I offer you a small test.
The Panic Attack Test was compiled by Wayne J. Katon. Full name: Patient Health Questionnaire (PHQ) Panic Screening Questions.
1. Question about the presence of anxiety attacks. (answer “Yes”, “No”)
a) have you experienced attacks of sudden anxiety, fear or horror during the last 4 months?
(if the answer is “yes”, continue answering the questions).
b) have you ever had similar attacks before?
c) do some of these attacks occur unexpectedly, without connection with a specific situation where you would feel anxiety or discomfort?
d) are you afraid of an attack or its consequences?
2. During your last attack (attack), you experienced:
(answer “Yes”, “No”)
a) shallow, rapid breathing
b) palpitations, pulsation, interruptions in heart function or a feeling of cardiac arrest
c) pain or discomfort in the left side of the chest
d) sweating
e) feeling of lack of air, shortness of breath
f) waves of heat or cold
g) nausea, stomach discomfort, diarrhea or cravings
h) dizziness, unsteadiness, brain fog or lightheadedness
i) tingling or numbness sensations in the body or limbs
j) trembling in the body, limbs, twitching or tightening of the body (limbs)
k) fear of death or irreversible consequences of an attack?
If you answer “Yes” to questions in paragraph 1 a-d and “Yes” to any 4 questions in paragraph 2 a-k, you can be considered to be experiencing panic attacks.
To determine whether you have panic attacks, answer “yes” or “no” to the following questions: Have you experienced attacks (attacks) of sudden anxiety, fear or horror during the last 4 months?
(Katon W.J. Patient Health Questionnaire (PHQ) Panic Screening Questions)
Current panic attack detection test
To determine whether you have panic attacks, answer “yes” or “no” to the following questions:
a) have you experienced attacks of sudden anxiety, fear or horror during the last 4 months?
b) have you ever had similar attacks before?
c) do some of these attacks occur unexpectedly, without connection with a specific situation where you would feel anxiety or discomfort?
d) are you afraid of an attack or its consequences?
If you answered"No"for at least one question, this meansthat you don't have panic attacks.
If you answered"Yes"to all four questions,then take the test to identify panic attacks further.
1. DURING YOUR LAST ATTACK, YOU EXPERIENCED:
P shallow, rapid breathing
No
2. Palpitations, pulsation, interruptions in heart function or a feeling of cardiac arrest
No
3. Pain or discomfort in the left side of the chest
No
4. Sweating
No
5. Feeling of lack of air, shortness of breath
No
6. Waves of heat or cold
No
7. Nausea, stomach discomfort, diarrhea or cravings
No
8. Dizziness, unsteadiness, brain fog, or lightheadedness
No
9. Tingling or numbness sensations in the body or limbs
No
10. Trembling in the body, limbs, twitching or tightening of the body (limbs)
No
11. Fear of death or irreversible consequences of an attack
No
If you answered “yes” to any four questions, you are having panic attacks and you need to see a psychotherapist or psychiatrist.
Since the “triggering” factor of a panic attack is most often anxiety, timely identification and treatment of an anxiety disorder is very important. Published. If you have any questions about this topic, ask them to the experts and readers of our project
P.S. And remember, just by changing your consciousness, we are changing the world together! © econet
Panic attacks, panic disorder... A huge number of books and articles are devoted to this problem. At any search engine On the Internet you can find thousands of pages and forums devoted to this issue.
And yet, patients with panic attacks walk and walk “in circles” in search of a doctor who can help them: numerous examinations and long courses Treatments by general practitioners alternate with similar courses by cardiologists, gastroenterologists, pulmonologists, and endocrinologists.
The longer the examination and unsuccessful treatment continue, the more the fear of having some mysterious serious disease that cannot be diagnosed and treated grows; which in turn causes increased anxiety and more frequent panic attacks.
This situation persists until the patient meets a competent doctor who will refer the patient to a psychotherapist or psychiatrist (or the patient himself decides to contact one of these specialists). Only then does adequate treatment begin, panic attacks go away, and the condition completely returns to normal.
Very often a patient with panic attacks long years unsuccessfully treated, having a diagnosis: “vegetative-vascular dystonia”, “neuro-circulatory dystonia”, “vegetative crises (paroxysms)”, or “sympatho-adrenal crises”. In most cases, behind these diagnoses there is a panic disorder that needs to be treated and which can be completely cured.
What are panic attacks?
These are sudden, unpredictable and short-term attacks of severe anxiety, accompanied by various unpleasant sensations, among which:
- rapid heartbeat, irregular heartbeat, pain in the heart area
- feeling of shortness of breath or even suffocation
- increased blood pressure
- headache
- dizziness, weakness, lightheadedness
- chills or sweating, sometimes so-called “cold sweat”
- nausea, abdominal pain, stool upset
- discomfort in various parts body (numbness, tingling, etc.)
The most important symptom that always accompanies an attack is fear (losing consciousness, going crazy or dying).
It must be said that most of the listed symptoms occur in many people at a time of stress, since in this situation the brain seems to give a command to the entire body: “Attention, danger!”, which means you must either attack the source of danger or run away from it. To ensure this activity, hormones are released into the blood, and then muscle tone increases, breathing and heart rate increase, sweating increases - the body is ready for action. If this condition causes fear, then the severity and duration of the unpleasant sensations increases and a panic attack develops.
A person’s behavior during a panic attack varies: someone fusses, moans, calls for help, rushes to the street, “to Fresh air”, others lie, afraid to move, others take all kinds of medications and call an ambulance.
Prevalence of panic disorder.
Every person who experiences panic disorder believes that they are the only ones suffering from this disease. In fact, the prevalence of panic disorder is 4-5% of the population, and erased forms of the disease are detected in almost 10% of the population, that is, every tenth person on Earth is more or less familiar with panic attacks.
Causes, development, prognosis.
Let's start with the prognosis, because this is very important: despite the fact that panic attacks are accompanied by very unpleasant sensations, they do not pose a threat to life.
There are various theories explaining the reasons for the development of panic disorder, emphasizing that the likelihood of developing the disease is very high when these factors are combined.
A significant role is played by hereditary predisposition, the presence of which does not necessarily mean the development of the disease, but only indicates the advisability of carrying out preventive measures.
Another factor is reversible (that is, completely disappearing after a course of treatment) changes in the central nervous system associated with metabolic disorders of a number of substances (in particular, serotonin and norepinephrine). Every fifth patient with panic disorder is diagnosed with mental trauma suffered in childhood (alcoholism of parents, constant conflicts in the family, manifestations of aggression), leading to the formation of a feeling of insecurity, anxiety and childhood fears.
One of the significant reasons is the patient’s personal characteristics (anxiety, suspiciousness, uncertainty, excessive attention to one’s feelings, increased emotionality, need for attention, help and support), which affect the tolerance to stress.
The first panic attack most often develops during a period of stress (work overload, conflicts in the family, divorce, illness of loved ones), or anticipation of stress (before an exam, public speaking, business trip), but can develop for no apparent reason. Physical overload, consumption of alcohol, large amounts of coffee or other stimulants can also be a provoking factor.
If panic disorder is left untreated, it can get worse. On initial stages patients rarely turn to psychotherapists and psychiatrists. Finding no reason for unexpected attacks of anxiety, patients with panic disorder often think that they have a serious illness: a panic attack is perceived as a “heart attack,” “stroke,” or “the beginning of madness.”
Already after the first panic attack, a fear of being in a situation in which the attack occurred may develop, and panic attacks occur more often and in the most different situations. The person begins to avoid these situations; he finds himself, as it were, “captive” of his condition - he cannot go anywhere without the accompaniment of loved ones, and is constantly waiting for the development of a panic attack. Very often there is a fear of being in an awkward position, losing consciousness, or getting into a situation where it is impossible to immediately get help from doctors.
Other fears are also added: fear of crowds, open space, traffic jams, large stores, metro, walks, enclosed spaces, travel, etc. So-called restrictive behavior is formed - the patient stops using transport, leaving the house, sharply limiting his living space and activity . At this stage, panic disorder is often accompanied by depression, requiring immediate medical treatment.
In order to reduce fear or cope with panic, many resort to alcohol or sedatives. It is very important to know that this is the wrong tactic, which can lead to alcohol or drug addiction and significantly complicate the treatment of panic disorder.
Here is one of the many clinical cases.
Nikolai, 27 years old. He successfully graduated from college and worked at a company. The last few months have been very heavy loads at work, the issue of career growth was being decided, I had to work until late in the evening, including weekends. He took his birthday as an occasion to “have a good rest”: he had a hearty feast until late at night, drank a lot, and hardly slept. The next day - off to work.
I got up early in the morning, it was a very hot day, while I was walking to the metro I felt headache, rapid heartbeat (which is understandable after a sleepless night and drinking alcohol). There was a crowd in the subway car, it was impossible to sit down, after a while the heart began to beat even faster, a feeling of weakness and dizziness appeared. I remembered that an elderly relative had recently had a heart attack, I was afraid that “his heart would become bad, the doctors wouldn’t have time to help,” and he barely made it to work.
The next day, on the way to the metro, a panic attack developed: severe anxiety, sweating, dizziness, rapid heartbeat, weakness, fear of death. I started driving to work by car, at first everything was fine, but a few days later I got stuck in a traffic jam, the panic attack recurred, I felt a desire to run out of the car, and fear that no one could help.
He went to a cardiologist, was completely examined, and the doctor said that he was absolutely healthy. Nikolai decided: “the heart is healthy, but there may be problems with the vessels of the head,” and underwent a detailed examination at a neurological clinic, where they also did not reveal any changes in the vessels of the brain. During this period, panic attacks occurred more and more often, and developed not only in transport, but also on the street.
Nikolai stopped working, spent almost all his time at home, and only went out when accompanied by his family. He was sure that he was seriously ill, and it was incurable - after all, the doctors found nothing for him, which means it was unknown how to treat him. Only a year later, on the advice of friends, Nikolai turned to a psychotherapist. He came to the consultation accompanied by his wife, and while driving by car he had panic attacks several times.
Nikolai was assigned drug treatment and a course of psychotherapy was conducted. After 2 weeks, the panic attacks passed, but the fear of their recurrence remained. A month later, Nikolai was able to get behind the wheel of his car and go to work. Traffic jams were already perceived calmly as a common occurrence in our lives. I started working and gradually settled into my usual rhythm. After 2 months I tried to get on the subway, then several more psychotherapy sessions were held, and I began to ride the subway completely calmly.
After 3 months, the condition completely returned to normal; moreover, self-esteem, self-confidence and self-confidence increased. Nikolai decided to get the second higher education, do an internship abroad (I hadn’t even thought about it before). More than 5 years have passed, Nikolai is doing well, he has become the commercial director of a successful company and remembers his former fears with a smile. Panic attacks and fears no longer arose, and the psychotherapeutic methods he mastered are very helpful in work and in life.
Is it possible to cope with panic disorder on your own?
Often patients, their relatives, and sometimes doctors, believe that panic disorder is not worth treating, but that you just need to “pull yourself together.” This is absolutely the wrong approach. Treatment is necessary, and the sooner treatment begins, the faster the condition can be normalized. Panic disorder is highly treatable. Before contacting a doctor, you can use some on your own psychological techniques, aimed at reducing anxiety, and herbal medicines ( medicinal herbs), which have a calming effect. But in order to get rid of panic attacks, restore a normal lifestyle, and learn to calmly overcome various stressful situations in the future, you need to consult a psychotherapist or psychiatrist as quickly as possible.
Panic attack treatment.
In the vast majority of cases, the most effective is the combined use of medication and psychotherapy. Among the methods of psychotherapy used in the treatment of panic disorder, the effectiveness of psychological relaxation methods, behavioral and cognitive-behavioral psychotherapy, neuro-linguistic programming, and suggestion methods has already been proven.
Let me emphasize once again that almost everything Scientific research devoted to the problem of treating panic disorder, have proven the maximum effectiveness of the combined use of drug treatment and psychotherapy. The choice of drug treatment and psychotherapy method depends on many variables (patient characteristics; causes, nature of the course and duration of panic disorder; presence concomitant diseases). Therefore, a course of treatment to cure panic disorder is developed individually for each patient, taking into account all its characteristics.
How to help yourself during a panic attack?
- First of all, you need to switch your attention and not focus on negative sensations. To do this, you can use the following techniques:
- start counting cars or people passing by, read poetry to yourself, hum some song;
- Place a thin elastic band around your wrist. When you feel the first symptoms of panic approaching, pull the elastic band and release it so that it clicks on the skin;
- fold your palms into a “boat” (“handful”, as if you want to scoop up water with your palms), place them on your face so that they cover your mouth and nose. Breathe calmly, slightly lengthening your exhalation (you can count to yourself: inhale in two counts (one, two), exhale in four counts (one, two, three, four).
To cope with panic attacks more easily, you need to learn to relax. To do this, you can master any relaxation method, for example, progressive muscle relaxation. When you learn how to quickly relieve muscle tension, you can easily reduce your anxiety levels. The fact is that anxiety and relaxation are exactly opposite states, they cannot exist at the same time, so relaxing muscles in situations that cause tension allows you to reduce the level of anxiety, get rid of negative feelings, make it easier to perceive stressful situations and prevent panic attacks.
Another way is to learn to breathe correctly. Many people, at the time of a panic attack, have a feeling of lack of air, it seems that there is “not enough oxygen” and they want to take a deep breath. In fact, a person takes deep breaths and oversaturation with oxygen occurs, which causes increased anxiety and a feeling of lack of air. Mastering the method of so-called diaphragmatic breathing and breathing-relaxation training will allow you to cope with this problem.
This is the most simple methods helping yourself with panic disorder. I repeat that the maximum effect in the treatment of panic disorder can be achieved with the help of a properly selected course of therapy, including drug treatment and psychotherapy, that is, with the help of a specialist - a psychotherapist or psychiatrist.
And you should always remember - “the road can be mastered by those who walk” - panic disorder can be cured if it is treated.
Test to detect panic attacks
(Katon W.J. Patient Health Questionnaire (PHQ) Panic Screening Questions)
A. Anxiety attacks.
1. Have you had attacks of sudden anxiety, fear or horror during the last 4 months?
2. Have you ever had similar attacks before?
3. Do some of these attacks occur unexpectedly, without connection to a specific situation where you would feel anxiety or discomfort?
4. Do you have a fear of an attack or its consequences?
B. During your last attack, you experienced:
1) shallow, rapid breathing
2) palpitations, pulsation, interruptions in the functioning of the heart or a feeling of its stopping
3) pain or discomfort in the left side of the chest
4) sweating
6) feeling of lack of air, shortness of breath
6) waves of heat or cold
7) nausea, stomach discomfort, diarrhea or urge to do so
8.) dizziness, unsteadiness, brain fog or lightheadedness
9) tingling or numbness sensations in the body or limbs
10) trembling in the body, limbs, twitching or tightening of the body (limbs)
11) fear of death or irreversible consequences of an attack
If you answered “yes” to at least one question in section A and any four questions in section B, you are having panic attacks and you need to see a psychotherapist or psychiatrist.
Since the “triggering” factor of a panic attack is most often anxiety, timely identification and treatment of an anxiety disorder is very important.
Anxiety test
Instructions. Read each statement carefully and choose an answer based on how you have been feeling over the past month.
- I feel tense and uneasy:
a) all the time; b) often; c) from time to time, sometimes; d) I don’t feel it at all
I feel afraid, it feels like something terrible is about to happen
a) yes, this is so, and the fear is very strong; b) yes, this is true, but the fear is not very strong;
c) sometimes I do, but it doesn’t bother me; d) I don’t feel it at all
Restless thoughts are spinning in my head
a) constantly; b) most time; c) from time to time; d) only sometimes
I can easily sit down and relax
a) this is not true at all; b) only rarely is this true; c) perhaps this is so; d) yes, that's true
I experience internal tension or trembling
a) very often; b) often; c) sometimes; d) I don’t feel it at all
I find it difficult to sit still, as if I constantly need to move
a) yes, that's true; b) perhaps this is so; c) only to some extent this is true;
d) that's not true at all
I feel a sense of panic
a) very often; b) quite often; c) sometimes; d) doesn't happen
Now calculate the result:
Answer option “a” corresponds to 3 points, “b” – 2, “c” – 1, “d” – 0 points. Add up your points.
If the sum of points is from 0 to 3, the level of anxiety is within normal limits;
from 4 to 7 – a slight increase in the level of anxiety, we advise you to consult a psychologist;
from 8 to 10 – moderate anxiety, it is best to consult a psychotherapist to correct the condition;
from 11 to 15 – severe anxiety, we recommend that you consult a psychotherapist and undergo a course of treatment;
16 points or more – a sharp increase in the level of anxiety; qualified treatment by a psychiatrist or psychotherapist is required.
Ayvazyan Tatyana Albertovna, neuroclinic.ru
