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A. Re-manifestable panic attacks of sudden, overgrown anxiety and somatic discomfort, arising, as a rule, spontaneously and not related to specific situations (objects) or a real threat to life.

B. Panic attack reaches a maximum for 10 minutes and can continue usually no more than an hour.

B. Panic disorder is not due to another mental disorder, somatic and neurological diseases.

G. Between attacks The condition should be relatively free from disturbing symptoms (although an alarming waiting for an attack is usual).

D. must be present during the panic attack of at least 4 of the following most common symptoms:
1) rapid heartbeat;
2) a sense of air shortness;
3) a feeling of suffocation;
4) dizziness;
5) sweating;
6) tremor, "inner trembling";
7) Burning, pre-perspective condition;
8) discomfort or chest pain;
9) nausea or other gastrointestinal symptoms;
10) paresthesia;
11) chills or tide of blood to face;
12) a sense of removal, separation from themselves (depersonalization) and a sense of remoteness, unreality (dealerialization);
13) fear of death;
14) Fear of loss of self-control, the fear of going crazy.

Clinical picture of PA can vary significantly,
In this regard, they allocate varieties of PA:
a) on the representation of symptoms:
. large (deployed) pa - 4 symptoms and more
. Small (symptomatic poor) - less than 4 symptoms.

Large attacks arise less often than small (1 time / month - week), and small can occur to several times a day.
b) by the severity of certain components:
. Vegetative (typical) - with the predominance of somategoetatic disorders and non-differency of phobias;
. hyperventive - with leading hyperventive disorders, reinforced breathing, reflexian apnea, paresthesias, pain in muscles related to respiratory alkalosis;
. Phobic - secondary phobias prevail in the structure of PA over vegetative symptoms, but are still not sufficient for the criteria of an alarm-phobic disorder. Occur when the joining of fear in situations, potentially dangerous, according to the patient, for the emergence of attacks;
. Affective- with depressive and obsessive symptoms or dysforial experiences;
. Deconsonizational and delaimal.

Numerous surveys, in combination with the ineffectiveness of treatment, strengthen their conviction in the seriousness of their condition, generate a negative attitude towards individual doctors and disbelief in medicine as a whole. If we consider that psychotherapy is not performed with patients or generally, psychotherapy is not explained, the essence of the symptoms that persist or often recurrent, the development of a patient of the hypochondriacity becomes quite explained, the search for numerous doctors, social deadaption.

The most frequent and clinically significant manifestation of vegetative dysfunction on the side of the bronchopulmonary system is the so-called hyperventive syndrome (DHW), characterized by a violation of the respiratory pattern in the form of inadequate metabolism of ventilation, accompanied by various clinical symptoms. The main pathogenetic mechanism of manifestations of hyperventilation syndrome is the alveolar and arterial hypocria, which itself does not necessarily cause symptoms, and manifests itself with individual sensitivity and impaired adaptation to chronic hypocrine.

The key to the diagnosis of DHW is the complaints of the patient who often put a doctor in a dead end that is not aware of such violations.

Basic clinical manifestation DHW is respiratory discomfort in the form of a sense of dissatisfaction with a breath, which patients describe as shortness of breath, a shortage of air and even suffocations. These sensations are usually enhanced in stuffy rooms, from close clothes. Bad tolerability of stuffed premises are peculiar to such patients.

They are characterized by frequent sighs and yawns, noted by the patients themselves or their surrounding. A constant desire to make deep breaths leads to the development of hypocris, which is accompanied by dizziness, suddenly coming weakness, fainted states, sometimes convulsions. Such symptoms can be involuntarily reproduced during the auscultation of patients, especially if the doctor underestimates and does not take into account the possibility of the presence of a DHW in a patient.

At the same time, with a clinical examination of the patient, physicians use a simple provocative sample with hyperventilation, offering a patient to make some quick and deep breaths, after which patients note the appearance of the above symptoms. Typically, patients suspected lung disease ( bronchial asthma, chronical bronchitis) or cardiovascular pathology, which entails the conduct of unjustified and non-informative surveys. Appointed at the same time drug treatment (nitrates, bronchopholics, etc.), as a rule, turns out to be ineffective.

Often, respiratory disorders are accompanied by cardiac symptoms (cardialgia, rhythm disorders), a sense of anxiety and fear, other manifestations of vegetative dysfunction, which aggravates the conviction of the patient in the presence of severe disease, sharply enhance the alarm-phobic symptoms

V.Tashlykov, D.V. Kovpak

The right medical name of panic attacks is "episodic paroxysmal anxiety." Panic attacks The code for the ICD 10 has F41.0. Disorder refer to the subsection of other alarming disorders of the neurotic subsection associated with stress and somatoforms. And he, in turn, refers to a section with mental disorders and behavior disorders. The full path to the section, where the panic attack is assigned to the ICD 10, - V: F00-F99: F40-F48: F41: F41.0. It should be noted that the disorder can be observed autonomously, but may be a secondary phenomenon in depressive disorder. Separately, one should select panic attacks in agoraphobia that have their own F40.0 code. In this case, PA is a form of expression of basic neurosis.

The duration of the bosic attack depends on several factors

Answer the question of how much the panic attack lasts exactly possible is not possible. The fact is that they are associated with primary and secondary signs. The latter refers to the effect of depersonalization and delaimalization, other subsequent experiences - the fear of die, go crazy, just fall into fainting, which can pursue the patient for a long time after completing the attack. Directly critical moment can be quite short - 10-20 minutes. However, its completion does not mean that the attack will not arise again, after a very short period of time.

In some patients, some of the somatic symptoms can be maintained for a long time after the attack. For example, after the panic attack headache or the pain in the heart area is saved. It also worsens the state and contributes to the development of many parallel neurosis. In this context, it is not so important how much the panic attack lasts in itself, and we need to keep on the general worsening of the patient's life.

Attacks that are denoted by the code F41.0 do not have a clear dependence on the circumstances. Attack can be overtaken anywhere and at any time. If someone had a panic attack after a meal, then a person can bind the disorder itself precisely with the welcome. But this is an illusion ... Tomorrow, the attack can occur completely in another place and under other circumstances.

A long time for PA was trying to explain the vegetaryous dystonia. However, being a common descriptive designation of a number of somatic diseases, IT cannot be an explanation, since we would try to explain some psychosomatic diseases by others. Operate the nature of the appearance of PA, just the case when they are associated with depression or agoraphobia. Both, in their endogenous forms, is a psyche disorder that is generated by some internal conflict. Most often, he can be expressed by the words about distrust. A person loses his confidence in his own body, to himself as a subject capable of living.

Even if the duration of the panic attack is small, some symptoms remain after the attack

So, in one patient, 28 years old panic attacks arose immediately after the death of the father, whom he loved very much. But the point is not that such an impact has provided stress. The guy suddenly met with death, with the fact that the person just smiled and made plans for the future, and after an hour it was not. Of course, he thought that he could die too at any moment. A powerful mental protest led the psyche to provoke this very death, which he was so afraid. But not in the form of suicide, but in the form of somatic - pain in the field of heart, rapid heartbeat, difficulty breathing. Reached the ridiculous. The young man was so afraid that she would now fall, which fell in advance. From this it covered shame. He locked in four walls without any agoraphobia.

Yoga on the contrary

The complexity of such situations is that the patient understands that he needs to change his attitude towards death and life issues, but another part does not want to do this. It is actually a dyewoman - it's not fantasy.

Pro suffering from this disorder can be said that they are some yoga on the contrary. Those are able to control their heart and breathing, biological processes in the body to achieve certain purposes. Thus, they implement their potential, strive for samadhi or enlightenment, pay attention to their health. In this case, the psyche force is mainly used. Here the power is exactly the same, but released on the arbitrary of fate.

Like a car with a sleeping driver. These people do not even think that something happens to their body. The heart actually beats very often, the hands are trembling, there is plenty of sweating. All the time how much the attack attack lasts patients are convinced that it makes no sense to make sure. When the doctor becomes counting the pulse, then will also detect 120 beats per minute. However, there are no signs of the disease of the cardiovascular system. All this makes the psyche of man. If you ask the patient to cause the same thing in his will, then he will not succeed.

Yoga classes help a person change his attitude to life and death issues

In addition to the main, additional symptoms may also be observed. For example, do not hurry with distrust of the girl, who believes that it is due to the panic attacks. In that way, to lose weight the patient can actually, only the cause of the seizures and weight loss is the same - mental disorder. This is not attacks something cause. They are only one of the forms of expressing internal conflict. Panic attack and weight loss are connected just like any body change in any neurosis or psychosis.

Treatment of panic attacks

PA treatment can be only integrated. The basis of its medication scheme is quite difficult to develop. The allocation of PA in the autonomous unit is fully justified, but does not mean that panic attacks with the code F41.0 on the ICD 10 Take place with people without internal conflicts perfectly. We can only talk about that earlier acute symptoms Not observed.

Currently it is assumed that almost the main form of psychotherapy in this case is the one that is based on a cognitive approach. Nothing in principle, in principle, against this direction, it should still be noted that this is not the only efficient way of work. A good positive effect can give bodily-oriented psychotherapy.

True, the very direction of the physician is a little shy, because it was initially associated with such concepts as bioenergy, which in science did not receive any official reinforcement. However, many methods and exercises are mainly working with breathing, give good positive results and for prevention and during attacks. No less effective should be the approach of existential psychology.

The assurance of the patients is that nothing happens to them that no one else from the panic attack can be and fairly, but does not have a special effect. First, it is still not entirely true. The physical sensations are quite concrete. Secondly, mental disorders are a medical problem, which is very even happening and not all patients, unfortunately, remain alive. Therefore, you need to start not with the assurance of people in the fact that they are all invented, but with the explanation of the nature of disorders. Even if you came up, how to be now?

1. It is understood that the psyche disorder is something that creates discomfort, but has its own positive functions. In any case, it is corrected.
2. Work with attacks. For example, learn to manage your condition with breathing exercises.
3. To understand what role this panic is playing in life. Fear can stop from something, saying that in life something is wrong.
4. Learn to pass through fear, be able to ignore it.

You need to learn to overcome your fear

As for medicines, their main role is to bring a person to the state when psychotherapy will be the most effective. Sometimes you can do without them. The duration of neurosis of this type can stretch for more than a year. But you do not need to lean very much. If, for example, someone has an agoraphobia with panic attacks, he cannot leave his apartment, then the quality of life will certainly be terrible. Medicines together with psychotherapy are able to bring a patient from the "black strip" in just a month. Everything else, he, depending on the situation, can continue to take drugs and only occasionally visit the psychotherapist.

Some special nutrition for panic attacks or additional procedures usually depend on individual preferences.

Panic attacks Participated in the international classification of diseases of the tenth revision ( mKB-10.). This directory is necessary as a single registry of diseases for doctors of all specializations.

Panic attack is placed in a section with mental disorders and behavior disorders (V, F00-F99). Subsection: Neurotic, associated with stress and

somatoform disorders (F40-F48): Other alarm disorders (F41): Panic disorder [episodic paroxysmal anxiety] (F41.0).

Thus, the full way to panic attacks on the ICD-10 looks like this: V: F00-F99: F40-F48: F41: F41.0.

The definition of panic attack or disorder in the ICD-10 sounds as follows (I give it literally): a characteristic feature of the disorder is the recurrent attacks of a sharply expressed anxiety (panic) that are not limited to any particular situation or complex of circumstances and, therefore, unpredictable. As with other disturbing disorders, the main symptoms includes a sudden appearance of heartbeats, pain for the sternum, a feeling of suffocation, nausea and a sense of unreality (depersonalization or delinealization). In addition, as a secondary phenomenon is often praised to die, lose control of oneself or go crazy. Panic disorder should not be used as the main diagnosis, if the patient had a depressive disorder at the beginning of a panic attack. In this case, the attack of panic is most likely, is secondary in relation to depression. Exception: Panic disorder with agoraphobia (F40.0).

As you can see, the panic attack on the ICD-10 may not only be isolated, but to include agoraphobia or depression.

Agorafobia (F40.0)

A fairly well-defined group of phobias, which includes fear of going out of the house, enter shops, fear of crowds and public places, fear alone to travel by train, by bus, plane. Panic disorder is an ordinary feature of episodes and in the past, and in the present. In addition, depressive and obsessive symptoms and social phobias are often present as an additional characteristic. Often the avoidance of phobic situations is often expressed, and the persons suffering from agoraphobia do not have great concern, as they are able to avoid these "hazards."

Depressive episode (F32.0)

In the lungs, medium or severe typical cases of depressive episodes in the patient, a reduced mood is noted, reducing the energeticness and the fall in activity. Reduced the ability to rejoice, enjoy, wondering, focus. The usual is pronounced fatigue even after the minimum effort. Usually sleep and reduced appetite. Self-assessment and self-confidence are almost always reduced, even with light forms of the disease. Often there are thoughts about their own guilt and uselessness. The reduced mood, a little changing day of day, does not depend on the circumstances and may be accompanied by so-called somatic symptoms, such as loss of interest in the surrounding and loss of sensations that make fun, awakening in the morning a few hours earlier than usual time, strengthening depression in the morning, expressed Psychomotor inhibition, anxiety, loss of appetite, weight loss and a decrease in libido. Depending on the number and severity of the symptoms, the depressive episode can be classified as light, moderately pronounced and heavy.

Hello, panically afraid and other readers of the book. I am practicing psychotherapy for almost 20 years, over the past 7 years there have been a lot of patients with a diagnosis of "Panic attacks". I want to tell you about panic attacks, and if you understand what I explained, and do some clear, accessible recommendations, then get rid of panic attacks. The result of psychotherapy: "I understood! I know what to do!". Warranties - 100%, if fully implemented recommendations.

* * *

Led Book Foreign Fragment Panic attacks. And how to get rid of them (Elena Skibo) Granted by our book partner - LITRES.

PA, definition, symptoms, ICD-10. Reactive depression. Atypical panic attacks

"Panic (from the Greek Panikon is scoreless horror) is a psychological state caused by the threatening impact of external conditions and expressed in a sense of acute fear, covering a person, an uncontrolled and uncontrolled desire to avoid a dangerous situation."

"Anxiety is a negatively painted emotion, expressing the feeling of uncertainty, waiting for negative events, hard-determined premonitions. Strong spiritual excitement, anxiety, confusion. The signal of the upcoming danger. Unlike the causes of fear, the reasons for the alarm are usually not realized, but it prevents human participation in potentially harmful behavior or encourages him to increase the probability of prosperous event of events. "

International Classification of Diseases-10

CIFR on the ICD-10 F41.0.

"The main feature is repeated seizures of severe alarm (panic) that are not limited to a certain situation or circumstances and therefore unpredictable. As with other alarming disorders, the dominant symptoms vary from different patients, but the common heartbeat, chest pain, a feeling of suffocation, dizziness and a sense of unrealism (depersonalization or delinealization) are common. The secondary fear of death, self-control or madness loss is also almost inevitable. Usually attacks continue only minutes, although at times and longer; Their frequency and course of disorder are quite variable. In panic attack, patients often experience sharply growing fear and vegetative symptoms that lead to the fact that the patients hurriedly leave the place where there are. If this occurs in a specific situation, for example, in a bus or in a crowd, the patient may subsequently avoid this situation. Similarly, frequent and unpredictable panic attacks cause fear to remain one or appear in crowded places. Panic attack often leads to the constant fear of the emergence of another attack.

Diagnostic instructions:

In this classification, the panic attack arising in the established phobic situation is considered an expression of the gravity of phobia, which in diagnostics should be taken into account in the first place. Panic disorder should be diagnosed as a primary diagnosis only in the absence of any of the phobias in F40.-.

For a reliable diagnosis, it is necessary that several heavy attacks of vegetative anxiety occurred over the period of about 1 month:

a) under circumstances that are not related to an objective threat;

b) attacks should not be limited to known or predictable situations;

c) between attacks the state must be relatively free from alarming symptoms (although anti-anti-alarm is usual).

Differential diagnosis:

Panic disorder must be distinguished from panic attacks arising as part of the established phobic disorders, as already noted. Panic attacks can be secondary to depressive disorders, especially in men, and if the criteria for depressive disorder are also detected, the panic disorder should not be established as a primary diagnosis.

On the duration of the reactive state In a modern classification - "disorders associated with stress and impaired adaptation", allocate short-term (no more than 1 month) and prolonged (from 1-2 months to 2 years) depressive reactions.

Attack of acute alarm (panic) is accompanied by unpleasant physical sensations and psychological discomfort:

Heartbeat, rapid pulse, interruptions in the heart.

Pain or discomfort in the left half of the chest.

Feeling of lack of air, breathing, shortness of breath.

Sweating, tingling or numbness in hand and legs.

Chills, tremor, feeling of the inner trembling.

Nausea, discomfort in the stomach.

Feeling of dizziness or pre-corrupt state.

Fear to go crazy or commit an uncontrollable act.

Fear of death.

The feeling of the unreality of what is happening.

As the panic disorder is weighted, the following changes occur: single seizures are moving into more frequent. New symptoms appear - a constant fear of health, the formation of avoiding behavior (a person ceases to go outside, ride in transport, reduces performance), planning each of his step, based on the fact that the attack can begin at any time.

In such situations, doctors neurologists, cardiologists, therapists put diagnoses:

"Vegeth-vascular dystonia" (VD);

"cardiopsychoneurosis";

"Panic disorder";

"Vegetative crisis";

"Cardionerement";

"Anxious syndrome" or "anxious-depressive syndrome".

Diagnosis "Vegetoe Vascular Distonia" Describes somatic malfunctions in the vegetative nervous system. That is, the root of the problem is physiological disorders, and psychological problems arise later, as a result of this.

Diagnosis "Panic disorder" In the international classifier of diseases of the 10th publication is located in the column "Mental disorders and disorders of behavior". Which means: in the treatment of panic attacks, it is necessary to pay primarily a psyche, not physiology.

Intergreacy period for panic attacks It may proceed from several hours to several years. It is characterized by the following symptoms:

Permanent expectation of a new panic attack.

Hiking for doctors and carrying out a multitude of surveys.

Frequent repetitive thoughts about what happened, constant talk about their problems.

Search on the Internet information on panic attacks, visiting forums, "Zhoi's discharge".

Avoiding situations that can cause a panic attack attack, a change in the overall pattern of behavior, a change in lifestyle, restrictions on many activities.

Increased attention to their bodily signals.

Availability medicinal preparationswhich can help buy a measurement apparatus arterial pressureconstant control of blood pressure.

The fear of the accumulation of people (transport, crowd).

Fear of open space or fear of closed spaces.

Fear of the fact that the attack can arise at any moment.

Gradual formation of depression.

Reactive depression - violation of the emotional sphere, which arises as a consequence of some serious stressful situation.

Among the most frequent reasons reactive depression: the death of a loved one, breaking with his beloved person, divorce, bankruptcy, financial collapse, loss of work, trial, large conflict at work, serious material losses, dismissal, sharp lifestyle change, relocation, somatic disease, surgical intervention etc.

Symptoms of reactive depression:

Consistently reduced mood;

Sleep disorders;

Loss of appetite and, as a result, weight loss;

Pessimistic attitude to life;

Inhibition in movements and mental reactions;

Unfortunate weakness;

Increased irritability;

Headaches, malfunctions in breathing and other vegetative violations;

Plasticity;

Depressed state;

Feeling of hopelessness;

Constant concentration of consciousness on the accomplished event;

Deep despair, fear, thoughts about death.

Poslisiness to panic attacks.

Genetic predisposition

Pathological education B. childhood;

Features of functioning nervous system, temperament;

Personal characteristics (imperativeness, impressionability, impulsiveness, vulnerability, leaning to fixation on experiences);

Demonstrative and exteroidal accentuation of character;

Features of the hormonal background, disease of the endocrine system.

Atypical Panic Attack attack . A person may not experience the emotions of fear, anxiety; Such panic attacks are called "panic without panic", or "non-pershent panic attacks."

Manifested by the following symptoms:

Feeling of irritation (longing, depression, hopelessness);

Local pains (headaches, pain in the heart, abdomen, backs);

Feeling "Coma in the throat";

Feeling of weakness in hands or legs;

Violation of vision or hearing;

Gait violation;

Loss of consciousness;

Convulsions;

Nausea or vomiting.

After the first attack or the next attack of fear, a person goes to the hospital, turning first to the therapist, cardiologist, a gastroenterologist or a neurologist. It rarely gets to a psychiatrist prescribing neuroleptics, antidepressants, tranquilizers, from which the effect if it happens, then insignificant and short. Preparations are mostly devastating symptom, reduce the anxiety, but they do not eliminate the main cause of fear. And at best, doctors recommend to visit the psychotherapist, and at worst they treat non-existent diseases or bred hands and give "banal" recommendations: more relaxing, play sports, not nervous, drink vitamins, Valerian or Novopaalsit.

Treatment of panic attacks - the task of a psychotherapist, to which a person usually falls immediately, after the development of depression and deterioration of the quality of life. The earlier person in this case turn to a psychotherapist, the faster and easier will be treated.

and) feeling of dizziness, instability, displacement;

k) the feeling that items are unreal (deoryalization) or that your own I moved away or "is not here" (depersonalization);