We asked Natalia Rivkina, a psychiatrist, psychotherapist, head of the Clinic for Psychiatry and Psychotherapy EMC, to talk about how to cope with the most common mental disorder and stop being afraid.
Photo: Natalya Rivkina
- Panic attacks (in psychiatry we use this term more often) is a condition accompanied by feelings of anxiety, panic and fear for one’s life. We are talking about unmotivated fear - a person has no apparent reason for anxiety. Sometimes these conditions can be associated with all sorts of unpleasant thoughts, for example, a fear of contracting a disease or the expectation of unpleasant events. Moreover, panic attacks are often accompanied by physical symptoms - palpitations, trembling hands, sweating, high blood pressure, nausea, dizziness.
That is why many people confuse panic attacks with various somatic diseases. By its structure, seizures can last from several minutes to several hours, be repeated regularly, up to several times a day, or happen extremely rarely. In psychiatry, there is a separate diagnosis for this condition - anxiety or panic disorder.
Fear is a protective function of our body, and if a person for any reason, ceases to experience this feeling, then he could be in serious danger. There are structures in the brain that include the hypothalamic system responsible for recognizing danger.
These are ancient structures in ontogenesis - any living creature has a system that scans reality, evaluates it as dangerous or safe, so that in case of a threat it sends a signal of fear. It is fear that makes a living being act in order to survive.
It is important to understand that people who are subject to panic attacks initially experience anxiety in those situations in which absolutely any person experiences it. Agree, flying on a plane or speaking to a large audience for each of us can be a disturbing event. But if anxiety disadapts a person and he refuses to fly, avoids public speaking, or he has to make inhuman efforts to do this, then about, it is possible that such behavior is a manifestation of the disease, anxiety disorder.
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Of course, if you once got scared of something, deciding that it is something more dangerous than it really is, then this is not means you have an anxiety disorder. Of course not. But if similar situations are repeated and tend to chronic, then the question of the presence of pathology already arises. Disadaptation in this case is a key indicator.
If anxiety prevents you from realizing your plans and achieving your goals, then, undoubtedly, you should pay close attention to it and think about what you can do about it.
Sometimes anxiety can be part of other painful conditions. So, a person with a diagnosis of “anxiety depression”, along with apathy, depression and lowered mood, is prone to panic attacks, and people with acute reactions to stress, with disorders of adaptive reactions (prolonged exposure to a state of emotional stress) in crisis situations may also experience panic states. This is due to the peculiarity of the functioning of the brain - in such states, due to excessive excitation, incorrect processing of impulses occurs, and a person receives a message that he is in danger.
Studies using neuroimaging , which over the past decades have been used to determine the nature of certain brain diseases, show that in people with anxiety disorders, the transmission of impulses in the sections responsible for recognizing situations as dangerous or safe changes. Accordingly, the brain begins to signal danger where it does not exist.
Similar disturbances occur in people who have experienced traumatic events in life related to a threat to life, or unexpected stressful situations - foci of excessive excitation in the brain persist, and at certain points the brain is associative, due to various factors (smells) , colors or environments), begins to scan the situation as dangerous. Nevertheless, not all people affected by panic attacks experienced serious emotional upheavals in the past. This confirms the fact that such impaired functioning of the brain is found only in people with a predisposition to such an imbalance.
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Often panic attacks occur unexpectedly - they can not always be predicted. Yes, some people know in advance in what situations they can occur, and without knowing it, they become carriers of the waiting syndrome. They feel alarmed that an attack can, in principle, happen. For example, if a person has a panic state associated with a rapid heartbeat, then he will constantly listen to himself, measure his pulse and interpret normal episodes of heart rhythm as the beginning of a new attack.
And so it turns out: he is nervous because his heart is allegedly rapidly contracting. His anxiety leads to an increase in heart rate - he again listens and begins to become even more nervous. As a snowball clings to one another, and in the end he gets a pronounced panic attack.
Moreover, most people with anxiety disorders have the so-called analogs of anxiety, for example, palpitations, increased blood pressure, dizziness, and nausea. At the same time, they may not experience anxiety per se — patients of this kind go to somatic doctors for a long time and look for some physical reason for their conditions.
For reference: with panic attacks, blood pressure really rises, but it has long been proven that its increase in these cases is safe for humans. Nevertheless, many patients go a long way before getting to their psychiatrist with their problem.
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It is important to understand that Anxiety disorder is a physiological problem. The point here is not the lack of willpower, as is often believed, or the lack of self-control skills.
This problem is associated with a feature of the functioning of the brain. Unfortunately, if you are not an enlightened yogi, then you are unlikely to be able to regulate the heart rate and control the hypothalamic-pituitary system. If panic attacks are repeated several times a week and at the same time are accompanied by motor anxiety and fear of death, then it's time to make an appointment with the doctor.
In psychology, different variants of the development of this disease are described, and just like depression, panic attacks tend to relapse - periods of improvement are replaced by periods of worsening. Since the moments of remission can be quite long, sometimes the patient has the illusion that he was cured.
But after some time, the symptoms may appear again.
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We can’t talk about that anxiety disorder is a pure social disease. According to statistics, we have a certain percentage of people who suffer from myocardial infarction, gastritis, depression and anxiety disorders. But the frequency of anxiety disorders associated with post-stress conditions can be higher in areas where there are wars, natural disasters and economic crises.
The environment is a trigger, but predisposition is a loaded gun. If a person has a predisposition to diabetes, then in an environment that is stressful, he will get diabetes, and not an anxiety disorder.
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Aerophobia is one of the most famous types of anxiety disorders. Moreover, for most people, fear is associated precisely with the moments of take-off or landing.
Panic disorders such as claustrophobia (fear of confined spaces) and agoraphobia (fear of open spaces and large crowds) are also widespread. Such attacks prevent a person from functioning normally and living a full life.Some people become isolated in themselves and their fears and, in principle, stop leaving their homes. In this matter, it is very important to seek help in time and not to allow seizures to begin to make quality adjustments to your life. In addition, modern medicine has all the means to save a person from this disease.
Yes, panic attacks do not destroy the brain and do not affect intelligence, but they can lead to the fact that a person simply ceases to interact with the outside world and lead an active lifestyle. Social deprivation - as a sad result.
If the patient has an attack accompanied by physical symptoms, then according to the rules we have no right to talk about anxiety disorder until we rule out somatic pathology. If a person comes with complaints of nausea, dizziness, visual impairment, then the doctor’s duty is to conduct a full examination. Even if we are talking about a professional athlete who, it would seem, is constantly under medical control, the psychiatrist should still send him to somatic doctors - cardiologists, neurologists, therapists.
The percentage of patients with anxiety disorder is very high - the problem is that people do not seek help, believing that they can cope with it on their own. They are convinced: any person can fly on a plane and speak in public, and if he can’t, then he is weak. There is a widespread opinion in society that panic attacks are a psychological problem. The result of fatigue - you need to sleep and everything will pass. It will not work.
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Another reason people don’t ask for help is because psychiatrists are primarily concerned with panic conditions. There is a pronounced stigma in our society regarding who psychiatrists are, how they work, and whom they treat. And finally, the stereotype that psychotropic drugs have a lot of side effects and turn normal people into "vegetables" scares away a lot of people. We will determine right away: yes, this judgment is true for some drugs, but false for everyone.
Moreover, first-line drugs for treating anxiety belong to the group of activating antidepressants - on the contrary, they give a feeling of energy and strength. The truth is that benzodiazepine tranquilizers do cause addiction. And the truth is that many people take the same phenazepam and the same benzodiazepine tranquilizers from their friends and acquaintances (it helped them) and start taking them uncontrollably. As a result, we get a patient with panic disorders - tranquilizers simply remove the symptoms, but do not treat them - and with drug dependence. And in older people, cases of poisoning and overdose with these drugs are often found.
The gold standard in the treatment of anxiety disorders is a combination of drug therapy and psychotherapy. Drug therapy means taking antidepressants - they do not cause addiction, and in the remission stage they can be easily abandoned. Many of them, by the way, are permissible in the first trimester of pregnancy, contrary to the common stereotype. Nevertheless, when treating certain groups of patients, doctors are forced to confine themselves only to psychotherapy - we are talking about pregnant women in the late stages or with individual contraindications, people with severe somatic diseases, for example cancer patients, about athletes who, due to certain restrictions, can not take medicine .
The essence of psychotherapy is to teach a person to control his condition at the time of the attack: the patient is taught the principles of self-regulation and self-relaxation, the technique of proper breathing, conduct behavioral training - how to behave when attacks occur, how to analyze situations that the brain treats as dangerous, and reformat them to safe ones. For example, a well-known therapy of aerophobia is the study of the principles of operation of an airplane. Also, an important element of therapy is biological feedback: patients are shown on the monitor the electrical activity of the brain, heart and muscle contractions and are taught how they can independently use the various functional capabilities of the body. But again, with a certain severity of the disease, psychotherapy can only work in combination with drugs.