What causes panic attacks?

Panic attack, also known as acute anxiety attack. The patient suddenly has severe discomfort, including chest tightness, breathlessness, palpitation, sweating, stomach discomfort, trembling, numbness of hands and feet, feeling of dying, madness or out of control, and each attack lasts about 15 minutes. The attack may have no obvious reason or special circumstances. Others have seizures in some special circumstances, such as crowds, shops and buses. The latter is called panic attack agoraphobia.

For example, a 26-year-old woman was bitten by a poisonous snake on her left leg a year ago. At that time, she was swollen badly, flustered and unconscious, and recovered after being rescued. However, since then, there have often been fears, chest tightness, breathlessness, numbness in hands and feet, body trembling and trembling, and there is a feeling of "dying". It occurs 1 ~ 2 times a day, and each time it relieves for about 15 minutes. Seeing things like ropes and belts can also induce epilepsy.

What is a panic attack?

Panic attack is a manifestation of anxiety disorder, which is characterized by repeated intense panic attacks, frequent sense of death or panic, and serious autonomic nervous symptoms. Have the following clinical manifestations:

1. Panic attack

Typically, when patients are engaged in daily activities, such as reading, eating, walking, meeting or doing housework, they will suddenly have a strong fear, as if they are about to die. This kind of tension is unbearable for patients. At the same time, the patient feels palpitation, as if his heart is about to jump out; Chest tightness and compression in the chest area; Or breathing difficulties, throat blockage, as if to breathe, suffocating. Therefore, patients will scream, call for help or run out of the room, running around, and some will have autonomic nervous symptoms such as hyperventilation, dizziness, facial flushing, sweating, unsteady gait, tremor, numbness of hands and feet, gastrointestinal discomfort, exercise anxiety, etc. This kind of attack usually takes 5-20 minutes, and can be relieved by itself in a short time. After remission, the patient feels all right, but may suddenly relapse soon.

2.premonition anxiety

In the intermittent period after repeated panic attacks, most patients are often worried about the recurrence of the disease, so they are nervous and may have some symptoms of autonomic neuropathy.

3. Help-seeking and avoidance behavior

When panic attacks occur, patients are unbearable because of strong fear and often seek emergency help immediately. During the intermission, 60% patients actively avoid some activities, such as refusing to go out alone, not going to crowded places, not traveling by car, and being accompanied by others when going out.

Panic attack is not a heart attack.

Mr. Liu is engaged in trade. Half a year ago, when he was reading a book, he suddenly felt his heart beating very high, he had difficulty breathing, he felt chest tightness and he was shaking all over. An idea came to my mind: I might die suddenly. I immediately called 120 for emergency treatment, but when I got to the hospital, the symptoms such as palpitation disappeared in a short time. I checked my heart and other vital organs, and everything was all right. In the later days, Mr. Liu was still afraid of heart problems and repeatedly checked. Although all the doctors assured him that his heart was healthy, it didn't help. He was introduced to my psychological counseling room for treatment.

Symptoms like Mr. Liu are called "panic attacks" in medical psychology, which is a manifestation of anxiety. Its typical symptom is 1. Often patients will suddenly have a strong sense of fear in their daily activities, as if they are going to die (feeling of dying) or lose their senses (feeling of losing control), which makes them unbearable. At the same time, the patient feels palpitation, as if his heart is about to jump out of his mouth, chest tightness, chest pain, shortness of breath, throat obstruction and suffocation. So scream, call for help, or run outside. Some patients have obvious autonomic nervous symptoms, such as hyperventilation, dizziness, hyperhidrosis, facial flushing or pallor, tremor, numbness of hands and feet, gastrointestinal discomfort, etc. 2, the attack is sudden, reaching a peak within 10 minutes, generally not more than one hour. Be conscious when you work, and you can recall the episode afterwards. Although the duration of this attack is short, usually 5- 10 minutes, and rarely exceeds 1 hour, it can be relieved by itself, but it can also suddenly recur soon. Patients have frequent attacks, at least three times in 1 month, or the anxiety of fear of recurrence after the first typical attack often lasts for more than 1 month. 3. Most patients will take the initiative to avoid some activities, such as unwilling to go out alone, unwilling to go to crowded places, unwilling to travel by car, etc. Or be accompanied by others when you go out (at this time, you have agoraphobia). Patients with panic attacks may also have depressive symptoms, and some may have suicidal tendencies.

There are many reasons for this mental illness, the most important of which is related to his personality, such as the pursuit of absolute perfection and absolute security, so that his attitude towards some things is not afraid of 10 thousand, but just in case. Be too sensitive and worry about your health.

At present, there are several methods to treat panic attacks: 1. Cognitive behavioral therapy: do what you are afraid of. Panic attack is a psychological feeling, and its real symptoms are very mild. The more you are afraid of going out, the more you are afraid of fainting, the more you have to do it, and the more you want to go to the hospital for examination, you will find that your worry is so redundant. 2. Running therapy: it is to guide patients to run regularly step by step. Generally speaking, running therapy is slower than drug therapy, and the withdrawal rate is higher, but the effect is equivalent. It is particularly important to note that it is quite difficult for patients to start running regularly in the first four weeks, and they can only carry out an exercise plan with their relatives. With the implementation of the exercise program, most patients can stick to it and achieve satisfactory results. 3. Drugs have obvious effect on panic disorder. For patients with rare and limited seizures, short-term use of anti-anxiety drugs will be helpful. For example, alprazolam has a good anti-panic effect and is effective for mild to moderate depression. Clonazepam can be used for patients with severe anxiety. Because panic disorder is a paroxysmal disorder, treatment must be stopped after 3 ~ 4 months of symptom control, but such a long period of treatment will affect drug withdrawal, because rapid drug withdrawal will cause rebound anxiety.

Panic attack (acute anxiety attack)

Male, 2 1 year old, unmarried, Han nationality, graduated from university. He was admitted to the hospital for 2 years in June1987165438+1October1.

1during the final exam in July, 985, the patient suddenly experienced unexplained fear and palpitation, and his heart rate reached more than 100 beats per minute, and disappeared after exceeding 10 minutes. After the attack 10 times, the time and place were irregular and there was no warning. The mind is clear when the attack occurs, and there is no corresponding terrible thing or scene in the objective environment. Life and study are normal when there is no attack.

When I went shopping in the mall in August of the same year, I suddenly felt inexplicable fear and tension. Trembling all over, and at the same time feeling palpitation, chest tightness, dyspnea and chest tightness. He felt that he was "dying", "dying" and "going crazy", and quickly left the mall and ran to school. After half an hour, the above performance disappeared. Can clearly recall the process of the attack. It often happens afterwards, and the interval is different. Frequent attacks, 1 2 ~ 3 times a week. There is no reason to check every attack. During the attack, all patients were accompanied by palpitation, rapid heartbeat, reaching 140 ~ 180 times per minute, shortness of breath and oppression. The attack lasted for 30 ~ 60 minutes, and the longest attack exceeded 1 hour. When it doesn't attack, the fear disappears. But after that, I dare not stay indoors alone, dare not go out alone, and dare not take a car alone. I asked my classmates to stay with me in case I got sick and no one treated me. I have seen the school doctor many times and thought it was "neurasthenia". I was prescribed sleeping pills, but the effect was not good, and I also had seizures from time to time. Therefore, I am worried and have suicidal thoughts. I once said to my classmates, "It's really painful to live. If I hadn't thought of my parents, I would have died long ago. "

The patient was treated with diazepam, clonidine and propranolol after admission, and no panic attack occurred again. But I still think this kind of worry is necessary and reasonable, and I take the initiative to ask for a separate room to see if there is any fear. Results Self-consciousness was good and there was no panic attack. After 42 days in hospital, he was discharged from the hospital and his condition improved significantly.

The patient's anxiety and fear attacks have the following characteristics:

1. Symptoms are paroxysmal, not persistent.

2. Fear is not caused by objective things, situations and situations, but occurs inexplicably for no reason.

3. Fear has no specific content and no direction.

4. The attack is accompanied by obvious autonomic symptoms: palpitation, dyspnea, chest tightness, oppression, dizziness, swelling of the head, and chills in hands and feet.

5. Episode fashion is accompanied by some special experiences, such as the sense of dying, the sense of losing control, the sense of madness, and the sense that the end is coming.

6. The seizure frequency is as high as 1 2-3 times a week, as low as 1 month or several times a month.

7. The course of disease has reached 4 years.

8. Seriously affect their social functions such as life, study and social interaction.

According to the above characteristics, this case is clinically diagnosed as panic attack, that is, acute anxiety attack.

The main difficulty in differential diagnosis is to distinguish it from phobia. The differences between panic attacks and phobias are as follows:

(1) The anxiety and fear of phobia are caused by exact objective things or situations. Although such an object or situation is not dangerous, patients will feel fear as long as they see or face it. Panic attacks of anxiety disorder are not caused by objects or situations, but occur for no reason.

(2) Phobia patients take evasive actions against objects, and there is no fear without corresponding objects. Fear attack is not spontaneous and conditional, and only happens when facing the object of fear. However, patients with panic attacks do not avoid the object, and the attack has nothing to do with the situation and is unpredictable.