Panic attacks are sudden periods of intense fear that may include palpitations, sweats, trembling, shortness of breath, numbness, or the feeling that something bad will happen. Maximum symptoms occur within minutes. Usually they last for about 30 minutes but the duration can vary from second to hour. There may be a fear of losing control or chest pain. The panic attack itself is not physically dangerous.
Panic attacks can occur due to a number of disorders including panic disorder, social anxiety disorder, post traumatic stress disorder, drug use disorder, depression, and medical problems. They can be triggered or occur unexpectedly. Smoking and psychological pressure increase the risk of panic attacks. Prior to diagnosis, conditions that produce similar symptoms should be ruled out, such as hyperthyroidism, hyperparathyroidism, heart disease, lung disease, and drug use.
The treatment of panic attacks should be directed at the underlying cause. In those who often carry out attacks, counseling or treatment may be used. Breathing exercises and muscle relaxation techniques can also help. Those affected have a higher risk of suicide.
In Europe about 3% of the population suffers panic attacks in a given year while in the United States they affect about 11%. They are more common in women than men. They often start at puberty or early adulthood. Children and older people are less affected.
Video Panic attack
Signs and symptoms
People with panic attacks often report fear of death or heart attack, flashing vision, fainting or nausea, numbness throughout the body, heavy breathing and hyperventilation, or loss of body control. Some people also suffer from tunnel vision, largely because the blood flow leaves the head to a more critical body part in defense. These feelings can trigger a strong urge to escape or escape from the place where the attacks begin (a consequence of a "fight-or-flight response", in which the hormone that causes this response is released in significant amounts). This response floods the body with hormones, especially epinephrine (adrenaline), which helps in defending against harm.
Panic attacks are the response of the sympathetic nervous system (SNS). The most common symptoms include shaking, dyspnea, palpitations of the heart, chest pain (or chest tightness), hot flashes, cold winks, burning sensations (especially in the face or neck area), sweating, nausea, dizziness (or slight vertigo ), mild headaches, hyperventilation, paresthesias (tingling sensations), choking or tightness sensations, difficulty moving, and derealization. These physical symptoms are interpreted with alarms in people who are vulnerable to panic attacks. This results in an increase in anxiety and forms a positive feedback loop.
Shortness of breath and chest pain are the dominant symptoms. People who suffer from panic attacks may incorrectly associate it with a heart attack and thus seek treatment in the emergency room. Because chest pain and shortness of breath are signs of cardiovascular disease, including unstable angina and myocardial infarction (heart attack), the diagnosis of exclusion (excluding other conditions) should be performed before diagnosing panic attacks. It is important to do this for people whose mental health and heart health status is unknown. This can be done using an electrocardiogram and a mental health assessment.
Panic attacks are distinguished from other forms of anxiety by their intensity and sudden suddenness. They often experience concurrent with anxiety disorders and other psychological conditions, although panic attacks generally do not show mental disorders.
Maps Panic attack
Cause
There are long-term, biological, environmental, and social causes of panic attacks. In 1993, Fava et al. proposed a staging method to understand the origin of the disorder. The first stage in developing disorders involves predisposing factors, such as genetics, personality, and lack of well-being. Panic disorder is common in early adulthood, although it can occur at any age. It happens more often in women and more often in people with above-average intelligence. Multiple studies of twins in which one identical twin has anxiety disorder have reported 31-88% incidence of other twins also have an anxiety disorder diagnosis.
Biological causes may include obsessive compulsive disorder, Postural Orthostatic Tachycardia Syndrome, posttraumatic traumatic disorders, hypoglycemia, hyperthyroidism, Wilson's disease, mitral valve prolapse, pheochromocytoma, and inner ear disorders (labyrinthitis). Dysregulation of the norepinephrine system at the seruleus locus, the brain stem area, has been linked to panic attacks.
Panic attacks can also occur due to short-term stress. Significant personal losses, including emotional attachment with a romantic partner, life transition, and significant life changes can lead to panic attacks. A person with an anxious temper, an excessive need for certainty, hypochondriacal fears, an overly cautious world view, and cumulative stress have correlated with panic attacks. In adolescents, social transition can also be a cause.
People will often experience panic attacks as a direct result of the exposure of an object/situation that they have the phobia. Panic attacks can also become attached to situations where certain situations are associated with panic because of previous attacks in certain situations. People may also have a cognitive or behavioral tendency to have panic attacks in certain situations.
Some preserving causes include avoiding panic-inducing situations or environments, anxious/negative self-talk ("what if" thinking), false beliefs ("these symptoms are dangerous and/or dangerous"), withholding feelings.
Hyperventilation syndrome can occur when a person breathes from the chest, which can cause overbreathing (exhaling excessive carbon dioxide in relation to the amount of oxygen in a person's bloodstream). Hyperventilation syndrome can cause respiratory alkalosis and hypokapnia. This syndrome often involves prominent mouth breathing as well. This causes a group of symptoms, including fast heartbeats, dizziness, and dizziness, which can trigger panic attacks.
Panic attacks can also be caused by substances. Termination or reduction is marked in doses of substances such as drugs (withdrawal drugs), eg antidepressants (antidepressant termination syndrome), can cause panic attacks. According to the Harvard Mental Health Letter, "the most frequently reported smoking side effects are anxiety and panic attacks." Studies report that about 20% to 30% of recreational users experience such problems after smoking marijuana.
Panic disorder
Repeated people, persistent attacks or feel very anxious about having other attacks are said to have panic disorder. Panic disorder is very different from other types of anxiety disorders in panic attacks that are often abrupt and unwarranted. However, panic attacks experienced by people with panic disorder can also be attributed to or aggravated by a particular place or situation, making daily life difficult.
Agoraphobia
Agoraphobia is an anxiety disorder that mainly consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer can not escape. Panic attacks are usually associated with agoraphobia and fear can not escape from a bad situation. As a result, severe agoraphobia sufferers can be confined to their homes, having difficulty traveling from this "safe place". The word "agoraphobia" is the English adoption of the Greek words agora (?????) and phobos (?????). The term "agora" refers to the place where the ancient Greeks used to gather and talk about municipal issues, so it basically applies to any or all public places; But the essence of agoraphobia is the fear of panic attacks especially if it happens in public because the victim may feel like he can not escape. In the case of agoraphobia caused by social phobia or social anxiety, the sufferer may be very embarrassed by having a general panic attack in the first place. This translation is the reason for the common misconception that agoraphobia is a fear of open space, and not clinically accurate. Agoraphobia, as described in this way, is actually a professional examination of symptoms when making a diagnosis of panic disorder. Other syndromes such as obsessive compulsive disorder or post-stress traumatic disorder and social anxiety disorder may also cause agoraphobia; basically any irrational fear that makes a person out of the outside can cause the syndrome.
Symptoms of panic attacks can be experimentally induced in the laboratory in various ways. Among them, for research purposes, by administering bolus injections from cholecystokinin-tetrapeptide neuropeptide (CCK-4). Various animal models of panic attacks have been studied experimentally.
Neurotransmitter imbalance
Many neurotransmitters are affected when the body is under increasing stress and anxiety that accompanies panic attacks. Some include serotonin, GABA (gamma-aminobutyric acid), dopamine, norepinephrine, and glutamate. More research on how these neurotransmitters interact with each other during a panic attack is needed to make a strong conclusion.
Increased serotonin in certain pathways of the brain appears to be correlated with less anxiety. Another evidence that shows serotonin plays a role in anxiety is that people who use SSRIs tend to feel anxiety reduction when their brains have more serotonin available for use.
The major inhibitory neurotransmitter in the central nervous system (CNS) is GABA. Most pathways that use GABA tend to reduce anxiety immediately.
The role of Dopamine in anxiety is not well understood. Some antipsychotic drugs that affect dopamine production have been shown to treat anxiety. However, this may be associated with a dopamine tendency to enhance feelings of self-efficacy and self-confidence, which reduce anxiety indirectly.
Many of the physical symptoms of anxiety, such as rapid heartbeat and hand tremor, are governed by norepinephrine. Drugs that counteract the effects of norepinephrine may be effective in reducing the physical symptoms of panic attacks.
Because glutamate is the main excitation neurotransmitter involved in the central nervous system (CNS), it can be found in almost all neural pathways in the body. Glutamate may be involved in conditioning, which is the process by which certain fears are formed, and extinction, which is the abolition of such fear.
Pathophysiology
The symptoms of panic attacks can cause people to feel that their body is failing. The symptoms can be understood as follows. First, there is often a sudden fear attack with little stimulus. This leads to the release of adrenaline (epinephrine) which brings a fight-or-flight response as the body prepares for heavy physical activity. This results in an increase in heart rate (tachycardia), rapid breathing (hyperventilation) which can be considered as shortness of breath (dyspnea), and sweating. Because severe activity is rare, hyperventilation causes a decrease in carbon dioxide levels in the lungs and then in the blood. This causes a shift in blood pH (respiratory alkalosis or hypokapnia), causing metabolic compensation of acidosis that activates a chemosensing mechanism that translates this pH shift into autonomic and respiratory responses. The person himself can ignore hyperventilation, having become preoccupied with the associated somatic symptoms.
In addition, this hypocapnia and adrenaline release during a panic attack causes vasoconstriction resulting in a slightly reduced blood flow to the head which causes dizziness and a mild headache. Panic attacks can cause blood sugar to be pulled from the brain and into the main muscles. Neuroimaging shows increased activity in the amygdala, thalamus, hypothalamus, and brainstem areas including perianqueductal gray, parabrachial, and Locus coeruleus. In particular, the amygdala has been suggested to have an important role. The combination of high passion in the amygdala and brainstem along with decreased blood flow and blood sugar in the brain can cause activity to decrease dramatically in the prefrontal cortex region of the brain. There is evidence that having anxiety disorder increases the risk of cardiovascular disease (CVD). Those affected also experienced a decrease in heart rate variability.
Cardiovascular Disease
People who have been diagnosed with panic disorder have about twice the risk of coronary heart disease. Certain stress responses to depression have also been shown to increase risk and those diagnosed with depression and panic disorder are nearly three times as likely to be at risk.
Diagnosis
DSM-5 diagnostic criteria for panic attacks include periods of intense fear or discomfort, in which four (or more) of the following symptoms develop suddenly and peak within minutes:
In DSM-5, certain cultural symptoms (eg, tinnitus, neck pain, headache, and screaming or uncontrollable crying) can be seen. Such symptoms should not count as one of the four necessary symptoms.
Some or all of these symptoms can be found in the presence of pheochromocytoma.
Screening tools such as Severity Scale Disorders of panic can be used to detect possible interference and suggest the need for a formal diagnostic assessment.
Treatment
Panic disorder can be effectively treated with a variety of interventions, including psychological and drug therapy with the strongest and most consistent evidence showing that cognitive behavioral therapy has the longest and longest duration of effect, followed by certain selective serotonin reuptake inhibitors. Subsequent research by Barbara Milrod and her colleagues suggests that psychoanalytic psychotherapy may be effective in reducing panic attacks, however, the results themselves must be handled with caution. While results obtained in joint treatment that include cognitive behavioral therapy and selective serotonin reuptake inhibitors are confirmed by many studies and meta-analyzes, obtained by Barbara Milrod does not. The scientific reliability of psychoanalytic psychotherapy to treat panic disorder has not been addressed. In particular, the mechanism by which psychoanalysis reduces panic is not understood; whereas cognitive-behavioral therapy has a clear conceptual basis that can be applied to panic. The term anxiolytic has become almost identical to benzodiazepines because these compounds have, for nearly 40 years, the drug of choice for anxiety-related stress.
A 2009 review found positive results from therapy and treatment and improved outcomes when they were combined.
Lifestyle changes
Caffeine can cause or aggravate panic anxiety. Anxiety may increase temporarily as it withdraws from caffeine and other drugs.
Increased and regular aerobic exercise such as running has been shown to have a positive effect in fighting panic anxiety. There is evidence to suggest that this effect is correlated with the release of exercise-induced endorphins and subsequent reduction of the stress hormone cortisol.
There is still the possibility of panic symptoms to be triggered or aggravated by the increased respiratory rate that occurs during aerobic exercise. This increase in respiratory rate can lead to hyperventilation and hyperventilation syndrome, which resembles the symptoms of a heart attack, triggering a panic attack. The benefits of incorporating a sports regimen have shown the best results when pacing accordingly.
Muscle relaxation techniques are useful for some individuals. This can be learned using recordings, videos, or books. While muscle relaxation proves to be less effective than cognitive behavioral therapy in controlled trials, many people still find at least temporary relief from muscle relaxation.
Breathing exercises
In most cases hyperventilation is involved, exacerbating the effects of panic attacks. Exercise breathing exercise helps balance the levels of oxygen and CO 2 in the blood.
David D. Burns recommends breathing exercises for those who suffer from anxiety. One such breathing exercise is a 5-2-5 count. Using the abdomen (or diaphragm) - and not the chest - inhale (feel the stomach out, as opposed to the inflated chest) for 5 seconds. When the maximal point of inhalation is reached, hold your breath for 2 seconds. Then slowly exhale, more than 5 seconds. Repeat this cycle twice and then breathe 'normally' for 5 cycles (1 cycle = 1 inhale 1 exhale). The point is to focus on breathing and relax the heartbeat. Regular diaphragmatic breathing can be achieved by extending outbreath by counting or humming.
Although breathing into paper bags is a common recommendation for short-term treatment of symptoms of acute panic attacks, it has been criticized as being inferior to measured breathing, potentially aggravating panic attacks and possibly reducing the blood oxygen required. While paper bagging techniques increase the required carbon dioxide and thus reduce the symptoms, it may be too low the level of oxygen in the bloodstream.
Capnometry, which provides CO 2 levels exhaled, can help guide breathing.
Therapeutic
According to the American Psychological Association, "most experts agree that a combination of cognitive and behavioral therapy is the best treatment for panic disorder." Treatment may also be appropriate in some cases. The first part of therapy is largely informational; many people are greatly helped by just understanding what a panic disorder is and how many are suffering. Many people who suffer from panic disorder worry that their panic attacks mean they are "crazy" or that the panic can cause a heart attack. Cognitive restructuring helps people change their minds in a more realistic and positive way of looking at attacks. Behavior avoidance is one of the key aspects that prevent people with panic attacks often from healthy functioning. Exposure therapy, which includes repeated and prolonged confrontation with the dreaded situation and body sensations, helps weaken the anxiety response to these external and internal stimuli and reinforces a realistic way of looking at panic symptoms.
In a deeper level psychoanalytic approach, in the theory of a particular object relationship, panic attacks are often associated with separation (psychology), paranoid-schizoid and depressed positions, and paranoid anxiety. They are often found in comorbidities with personality impairment thresholds and child sexual abuse. Paranoid anxiety can reach the state of anxiety anxiety.
The efficacy of group therapy therapy for conventional individual therapy for people with panic disorder with or without agoraphobia appears similar.
Drugs
The choice of medication for panic attacks usually includes benzodiazepines and antidepressants. Benzodiazepines are prescribed less frequently because of their potential side effects, such as dependence, fatigue, slurred speech, and memory loss. Antidepressant treatments for panic attacks include selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and MAO inhibitors (MAOIs). SSRIs in particular tend to be the first drug used to treat panic attacks. Selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants appear similar for short-term efficacy. SSRIs carry relatively low risk due to the fact that they are not associated with much tolerance or dependence, and are difficult to overdose. TCA is similar to SSRIs in many advantages, but it comes with more common side effects such as weight gain and cognitive impairment. They are also easier to overdose. MAOI is generally recommended for patients who have not responded to other forms of treatment.
While the use of drugs in treating panic attacks can be very successful, it is generally recommended that people also be in some form of therapy, such as behavior-cognitive therapy. Treatment of the drug is usually used throughout the duration of panic attack symptoms, and stopped after the patient is symptom free for at least six months. It is usually safest to withdraw from this drug gradually while undergoing therapy. While treatment seems promising for children and adolescents, they have a higher risk of suicide while using these drugs and their well-being should be closely monitored.
Prognosis
About one-third are resistant to treatment. These people continue to experience panic attacks and various other panic disorder symptoms after receiving treatment.
Many people who were treated for panic attacks began to experience limited symptom attacks. This panic attack is less comprehensive, with less than four body symptoms experienced.
It is not unusual to experience only one or two symptoms at a time, such as the vibrations in their feet, the shortness of breath, or the heat waves that sting their bodies, which are not like hot flashes due to lack of estrogen. Some of the symptoms, such as the vibrations in the legs, are quite different from the normal sensations that clearly indicate panic disorder. Other symptoms on the list may occur in people who may or may not have panic disorder. Panic disorder does not require four or more symptoms for all present at the same time. Panic pain and countless heartbeats are enough to show a panic attack.
Epidemiology
In Europe about 3% of the population suffers panic attacks in a given year while in the United States they affect about 11%. They are more common in women than men. They often start at puberty or early adulthood. Children and older people are less affected. A meta-analysis was conducted on data collected on twin studies and family studies on the relationship between genes and panic disorder. The researchers also examined the possibility of association with phobias, obsessive-compulsive disorder (OCD), and generalized anxiety disorder. The researchers used a database called MEDLINE to collect their data. The results conclude that the disorder mentioned above has a genetic component and is inherited or passed on through genes. For non-phobias, the possibility of inheriting is 30% -40% and for phobias, it is 50% -60%.
See also
- Nerve details
References
External links
- Panic attacks on Curlie (based on DMOZ)
Source of the article : Wikipedia
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