Anxiety and Anxiety attack
Anxiety attack – All of us have repeatedly experienced anxiety – excitement before an important meeting for us, the final exam. But what is this feeling in reality? Anxiety is the way our body prepares us to accept the challenge. Our heart pumps more blood, saturating the body with oxygen, and he is ready to act. We become vigilant and more efficiently solve physical and emotional problems. It is natural to feel anxiety when our safety, health or happiness is under threat. However, sometimes an anxious state can become overwhelming and destructive and appear from nowhere. Excessive, prolonged bouts of anxiety may reflect a person’s developing anxiety disorder with accompanying anxiety attacks.
Attempts to study anxiety conditions have been undertaken by many specialists. The first time to systemize neurosis-like conditions was undertaken by the French psychiatrist Charcot. Inside his pupil Sigmund Freud described the panic attack as an “anxiety attack.” The term “panic attack” was introduced in 1980 by the American Psychiatric Association (DSM-III) as the main manifestation of panic disorders.
Theories of the occurrence of anxiety attacks and associated anxiety disorders are still being studied. Scientists have attempted to neuroanatomically study which structures of the brain are responsible for the development of panic. It was established that the damage to the temporal lobes of the brain and certain parts of the limbic system provokes a decrease in fear and aggression. Stimulation of these departments, on the contrary, leads to the development of anxiety and fear. Stimulate a panic attack by intravenous injection of sodium lactate. So, in 5 percent of healthy people, after an injection of lactate, an attack of anxiety sets in. In sick people this figure is 70 percent. A similar effect is caused by carbon dioxide.
FROM NORM – TO DISORDER
Anxiety is a typical adequate reaction to stress, it is quite useful in some situations. This feeling warns us of danger, helps to prepare and concentrate.
Anxiety refers to the expectation of a threatening event in the future and is most often manifested in muscle tension and avoiding human behavior. Fear is an emotional reaction to an immediate danger.
Anxious disorder is different from normal feelings of nervousness and anxiety. It is characterized by reinforced repeatedly, often unreasonable, fear and symptoms:
- excessive anxiety,
- inability to relax,
- tachycardia, arrhythmia
- pain or pressure in the chest,
- “lumpy” in the throat,
- dry mouth,
- inconsistent breathing,
- a sense of fear, inhibition, inability to control behavior,
- trembling, sweating, chills,
- a pre-fainting condition, dizziness,
- thoughts of death.
Everyone during stressful situations is able to survive the described situations. But individuals with anxiety disorders can experience them in a calm environment, without cause, together with more severe manifestations.
Anxiety attack (or episodic paroxysmal anxiety)
Anxiety attack is a subtype of anxiety disorder, which refers to disorders of the neurotic level associated with stress. Anxiety attack is replaced in a few minutes and lasts no more than 10 – 20 minutes, also suddenly and passes.
Anxiety attack can be both an independent disease, and in the frame of any disorder. Attacks of panic can occur not only in patients with mental illnesses, but also in other nonpsychic diseases.
In modern society, disturbing attacks occur quite often. According to the latest data, about 10 to 20 percent of the population suffer one or more attacks throughout their lives. This means that one out of every five people undergoes a panic attack once in a lifetime.
Constant anxious attacks were suffered from 0.5 to 1 percent of people. However, the figures vary greatly depending on the locality and the country. Thus, American authors give higher figures (for example, that more than 2.7 percent of Americans are subject to periodic anxiety attacks). In two thirds of cases, anxiety attacks are combined with other neurotic or psychotic disorders.
In 70 percent of cases, panic anxiety is complicated by depressive symptoms and suicide risk. In 20 percent of cases, the association of alcoholic or drug dependence was found. Frequency of occurrence of panic attacks among women is 5 times higher than among men. The average age for both men and women is 25 to 35 years. (After 60 years)
Stages of development of an anxiety attack
Despite the rapid and sometimes almost instantaneous course of anxious attacks, a cascade of reactions takes place in the body during this time.
A step-by-step mechanism for developing an anxious attack:
• release of adrenaline and other catecholamines following stress;
• narrowing of blood vessels;
• increased heart rate ;
• Increased respiratory rate;
• Reducing the concentration of carbon dioxide in the blood;
• Accumulation of lactic acid in tissues at the periphery.
The mechanism of an anxiety attack boils down to the sudden release of anxiety into the blood of a stress hormone called adrenaline. One of the most pronounced effects of adrenaline is its vasoconstrictive effect. A sharp narrowing of the vessels leads to an increase in pressure, which is a very common symptom in panic attacks. Also adrenaline leads to an increase in heart rate (tachycardia) and respiration (a person begins to breathe deeply and often). Tachycardia is the cause of dyspnea and the feeling that a person lacks air. This state of gasping and lack of air further intensifies fear and anxiety.
At the height of elevated blood pressure and other symptoms, the patient may experience derealization. Thus the person does not understand, where he is and that with it. This is why it is recommended to remain in place for an attack.
Increased and frequent breathing leads to a decrease in the concentration of carbon dioxide in the lungs, and then in the blood. This, in turn, leads to a violation of the acid balance (pH) of the blood. It is the fluctuations in the acidity of the blood that cause such symptoms as dizziness and numbness in the limbs. At the same time, lactic acid (lactate) accumulates in the tissues, which, according to experimental studies, is a stimulant of anxiety.
Thus, in the mechanism of development of an anxiety attack, a vicious circle is observed. The more intense the anxiety, the more expressive the symptomatology (the feeling of suffocation, increased heart rate ), which further stimulates anxiety.
The causes of anxiety attacks
Anxiety attack can develop in the framework of any disease or any surgical intervention, which is stress for a person. Among somatic diseases, heart diseases, respiratory system pathologies, endocrine diseases predominate. However, most often the base for the development of an attack is mental pathology.
Somatic (bodily) diseases
Panic in somatic diseases is also called somatization anxiety. This means that the soil for the development of anxiety is human disease and its relation to this disease. At first, in the presence of this or that pathology, the patients experience emotional instability, depression and frustration. Then, against a background of the general or common status some signs – a discomfort in a breast, a dyspnea, pains in heart which are accompanied by anxiety.
The peculiarity of panic attacks in somatic diseases is their emotional impoverishment. In the clinical picture, vegetative symptoms (frequent palpitation, sweating) come first. Severity of anxiety can be moderate or severe, but, nevertheless, it is inferior to the intensity of physical symptoms.
Somatic diseases that can be accompanied by panic attacks:
• heart disease (angina pectoris, myocardial infarction);
• Some physiological conditions (pregnancy, childbirth, the onset of the menstrual cycle, the onset of sexual activity);
• endocrine diseases;
• taking certain medications.
These and other conditions are accompanied by hormonal changes in the body, and are also a strong traumatic factor for emotionally labile people. In this case, attacks can be accompanied with other mental symptoms, for example, with a depressive episode.
To date, the most actively studied postpartum depression. In this case, the depressive episode can proceed with anxiety. Anxiety can be either permanent or in the form of attacks. In both cases, a low mood (the main classic symptom of depression) is accompanied by intense anxiety, that is, panic.
Some preparations may also trigger panic attacks. Basically, these are drugs used in neurology, intensive care and psychiatry.
• drugs that stimulate the secretion of cholecystokinin;
• Steroid preparations;
• bemegridum ;
The strongest stimulant of anxiety is the cholecystokinin hormone and medications that stimulate its secretion. This hormone is synthesized in the digestive and nervous system of a person and is a regulator of fear and anxiety. It is noted that in people with panic attacks, cholecystokinin is in increased concentration.
Steroid drugs have a direct stimulating effect on the central nervous system. First of all, these are anti-asthmatic drugs. Also these are anabolic steroids, they can cause both panic attacks and other mental disorders.
Bemegridum in combination with other drugs is often used in anesthesia for injection into anesthesia. But also used for poisoning or overdose with barbiturates. Bemegrid stimulates the central nervous system and is capable of causing hallucinations. Bemegrid in combination with ketamine (“ketamine therapy”) is used in the treatment of alcoholism, sometimes causing persistent mental changes.
Anxiety attacks in this case are characterized by severe emotional symptoms. The main symptom of this is uncontrolled, pointless fear. The feeling of an imminent catastrophe as if “paralyzes” a person. Panic attack can be accompanied not only by motor excitement, but also vice versa – stupor.
Mental pathologies, the symptoms of which can be anxiety attacks:
• fears (phobias);
• endogenous mental illness (schizophrenia);
• post-traumatic stress disorder and adaptation disorder;
• obsessive-compulsive disorder (OCD).
Physical symptoms of panic attack:
- hot flashes or cold;
- frequent urination;
- shortness of breath and chest pain;
- dry mouth
Mental symptoms :
Most often these symptoms prevail over the others. The feeling of impending disaster and imminent danger forces people to hide, not to leave the house, to restrict social contacts.
• sensation of impending adversity and surrounding danger;
• Fear of dying or simply pointless fear;
• timidity and stiffness or, conversely, motor anxiety;
• sensation of a lump in the throat;
• “slip of view” (a person can not keep his eyes on one object);
• a sense of unreality of what is happening (the world is perceived as distant, some sounds and objects are distorted);
A common characteristic of all these symptoms is their suddenness. The appearance of panic is not preceded by any aura (be it a headache or a bad feeling). Most often, patients describe the symptoms as “a bolt from the blue”. All these symptoms appear and increase in intensity very quickly. In the head there is an influx of thoughts, they are often confused, and a person is not able to explain who or what he is afraid of.
Panic without panic
Special interest of doctors is attracted to panic attacks, in which emotional stress is practically absent, and physical symptoms are not very pronounced. Such panic attacks without fear are called “masked anxiety” or “alexithymic panic.” Masked, it’s called because fear and anxiety are masked by other symptoms. In this case, the symptoms that the patient presents are not true, but functional. For example, he may have a decrease or no vision at all, while there are no problems with the apparatus of vision.
Symptoms of panic without panic:
• lack of voice (aphonia);
• Lack of speech (mutism);
• Lack of vision (amaurosis);
• Violation of gait and statics (ataxia);
Most often these symptoms develop against the background of already existing mental disorders. As a rule, this is conversion personality disorder or, as it is also called, a hysterical neurosis.
How to help a person during a panic attack?
• emotional support;
• distracting techniques;
• medical assistance.
Emotional help to a person during a panic attack:
Being near a person who experiences a panic attack, you should try to convince him that the attack will not do him harm. We must not give in to panic and express calmness and confidence in the appearance, actions, tone of voice. Become in front of the patient and, if he will, take him by the hand. Look into the person’s eyes and say in a confident voice: “Everything that happens to you is not dangerous to life. I will help you cope with this condition. ” Begin to breathe deeply and make sure that the patient repeats your actions.
Medication for panic attacks:
To stop the attack itself, anti-panic drugs with a quick mechanism of action are used. These drugs include tranquilizers from the benzodiazepine group. At an attack they can be accepted both in the tablet form, and in injections.
Psychotherapy in the treatment of anxiety attacks
The psychotherapeutic method is an integral (and sometimes basic) in the treatment of anxiety attacks.
The psychotherapy of attacks is based on various methods, the appropriateness of which is determined by the attending physician in view of the history of the disease.
Psychotherapeutic methods of treatment of anxiety attack:
• cognitive-behavioral therapy;
• psychoanalytic methods;
• Hypnosis (classical and ericsson);
• Body-oriented psychotherapy;
• Systemic family psychotherapy;
• Neuro-linguistic programming (NLP);
• Gestalt therapy.
Cognitive-behavioral psychotherapy in the treatment of panic attacks:
Cognitive-behavioral psychotherapy is one of the most common treatments for panic attacks. Therapy consists of several stages, the purpose of which is to change the patient’s thinking and attitude to anxious states. The doctor explains the pattern of panic attacks, which allows the patient to understand the mechanism of the phenomena occurring with him. The therapist teaches the patient to control anxiety and the attendant symptoms. The course of treatment is from 8 to 20 sessions.