Disease Panic
Article by Sabados Catheryn
Disease Panic
Origin in the word “Panic”It really is from the Greek “panikon” whose meaning fright or dread repetitive.In Greek mythology the god Pan, who had horns and goat feet, excited regarding his appearance inside the horror shepherds and peasants.Thus the word has in our language madness of fear or dread violent and repetitive.In Athens, are actually erected about the Acropolis a temple towards the God Pan, near the Agora, the marketplace square the location where the popular assembly met to debate the issues in the city, then derived the phrase agoraphobia, used in psychiatry and possesses meaning asthe nervous about open spaces.SynonymyDisorder, Disease, Syndrome, Anxiety attacks.IntroductionPanic Disorder (PD) is a clinical entity recently and used to be called neurasthenia or cardiocirculatory disease in the heart from the soldier ( “irritable heart” designation distributed by Da Costa in 1860 throughout the American Civil War), even though the first description with the symptomatology hasbeen manufactured by Freud, who classified as anxious neurosis.Until 1980, there is grouped underneath the heading of “anxiety neurosis” now this same group was separated into Disease Anxiety and panic Disorder or Acute Generalized.The clinical differences, which is why the derived subdivision with the gang of acute anxiety reactions and TP, lie within the undeniable fact that the standards generating the very first are motivated by external agents that threaten a specific and consistent individual’s life such as disastercrashes in planes, trains, vehicles, fires in theaters and movies among others.In the disorder which induces the “panic attack” outside agents often is absent along with the threat was in the patient’s own (endogenous).Both disorders is combined with great stimulus autonomic nerves seen as an dry mouth, rapid heartbeat, palpitations, paleness, sweating and shortness of breath.This set of events describes what is called “alarm reaction” adapting the organism to situations of flight, fight or imminent danger.These findings constitute principle elements for cogitena possibility that individuals are facing someone with PD.The TP is often a frequent cause of interest in psychiatrists and psychotherapists which is considered a disease of modernity associated with day stress.This is a real condition (some label as freshness) and disabling symptoms this can extremely unpleasant.Only those being affected by PD is always that he appreciates the intensity of their symptoms.The important ProblemThis can be due largely to the deficiency of TP by general practitioners (not psychiatrists) which determines the delay in diagnosis of true along with the consequent growth and development of undesirable complications.Nearly all patients because the prevalence of symptoms related to the heart are treated in emergency rooms for clinical cardiology and cardiologists and helped by drugs that are not capable of block the “crisis or panic disorder.”As the crisis were only available in, without which patients observe improvement, leads to insecurity and despair.Examinations in many cases are held without reaching a conclusive diagnosis and symptoms caused by general situations as fatigue, nervousness, weakness or phrases such as “Mr (a) don’t have anything.”Etiology (cause)Are considered possible 3 basic assumptions: hyperactivity or dysfunction of systems linked to neurotransmitters (chemicals accountable for transmitting nerve signaling between cells) related brain with various elements of early warning systems, reaction and defense with the central nervous system (CNS). change is not well-established in the CNS sensitivity to sudden modifications in pH and CO2 concentrations intracerebral as well as hypersensitivity of postsynaptic receptors (distal zone of contact between two nerve cells), 5 hydroxytryptamine mixed up in the brain aversive system. geneticEpidemiologyResearch in the us show for each 1000 individuals about One to three suffer from TP.In Brazil, unfortunately, the data are inconclusive.It happens mainly in adults aged between 20 and 45 a lot of both sexes, which has a predominance of females in a very 3:1 ratio.With this age bracket patients will be in the fullness of the potential to work and earn the sickness are generated disastrous consequences facing both the professional and social.Diagnostic Criteria of PDThe verification will depend on the following criteria on the Diagnostic and Statistical of Mental Disorders (DSM-IV) American Psychiatric Association:Recurrent panic and anxiety attacks and unexpected.Criteria for Panic or anxiety attack:A brief period of intense fear or discomfort by which 4 or higher of the following symptoms appear abruptly and peak within Ten mins. sweating palpitations and tachycardia (rapid heartbeat) trembling or shaking feeling lacking breath or smothering a sense choking nausea or abdominal discomfort sense of instability, vertigo, dizziness or fainting a feeling of unreality (derealization) or depersonalization (estardistante itself) fear of dying concern with losing control over your situation or go crazy paresthesia (sensation of tingling or anesthesia) chills or menopausal flashesA minumum of one in the attacks have been followed for 30 days or more than one or higher of the following conditions: persistent fear of having another attack concern about the implications from the attack or its consequences (ie, losing control, experiencing a heart attack, going insane) a substantial difference in behavior related to attacksThe Anxiety attack just isn’t because of the direct physiological effects desubstncias (drug or drugs) and alcohol, yohimbine, cocaine, crack cocaine, caffeine, ecstasy or other general problem (hyperthyroidism, pheochromocytoma, etc …)The attacks should not be reaction of another mental illness, such as Social Phobia (experience of social situations that generate fear), Specific Phobia (nervous about flying, lift, etc. …), Obsessive-Compulsive Disorder, Post-traumatic orSeparation.The Attack and the TPWe ought to be aware that you’ll find diagnostic criteria for classifying a patient as being affected by PD and they must be well-established.A sequence of panic or anxiety attack alone won’t fulfill the conditions essential for detecting PD.The symptoms that characterize the attack has to be recurrent and never precipitated by an event or situation.Differential DiagnosisIf your diagnostic criteria are met there’s great possibility that people are dealing with a case of TP, so how many indicators overlap with those of other organic diseases and psychiatric conditions, implies the requirement to establish the differential diagnosis:1.Organic Diseasea.hyperthyroidism and hypothyroidismb.hiperpatireoidismoc.mitral valve prolapsed.arrhythmiase.coronaryfepilepsy (especially temporal lobe)g.pheochromocytomah.hypoglycemiai.labyrinthitis, neurological injuriesj.abstinence from alcohol and / or other drugsBeing assessed these diseases is extremely important clinical background and clinical evaluation, along with become necessary laboratory tests (blood glucose levels, hormones, cidovanil-mandelic acid, etc. …), graphic (ECG, exercise test,Holter, EEG baseline with photo stimulation, hyperventilation, lack of sleep and sleep, etc …) and imaging (CT, MRI, echocardiography, etc. …).SPECT (Single Photon Emission Computed Tomography), to consider atualmenterealizado studies (scintigraphy since the regional cerebral the flow of blood, marked with radioactive contrast) has reveladoassimetria (right> left) in the lobostemporais gyrus along with the orbitofrontal cortex in the preprefrontal dospacientes PD patients.Another important fact is that about 36 to 40% of patients with PD have associated mitral valve prolapse, revealed on echocardiography.2.Psychiatric Disorders generalized anxiety depression depersonalization somatoform schizophrenia characterComplications and Interferences socio-economic and familyThe complications of repeated panic attacks induce excessive spending by patients with medical and laboratory tests, often dispensable.Far from work, absences, wherewithal to accept promotion (for nervous about assuming greater responsibility), and even resignations are situations in everyday life of the patients, particularly if the TP is just not diagnosed early and is together with agoraphobia (nervous about going placespublic and open).Contributing to these facts there is a gradual economic deterioration.Socially, the successive refusals to invitations generate clearance and decrease of social contacts.Pertaining to family relationship, the person initially receives the concern of relatives more closely involved.After several “pilgrimages” to doctors’ offices, the place that the tests repeatedly show no palpable disease, loved ones adopt an attitude of encouragement for your patient to get out of the crisis.However, as time passes, this same patient turns into a target of criticisms paid not merely your family and also friends who, unfortunately, only are designed to exacerbate the situation.The creation of agoraphobia occurs because patients arrived at the final of suffering another attack of panic the place that the previous you’ve got already happened (theater or cinema for example).It must even be remembered as “anticipatory anxiety” (I’ll have crisenovamente?) Reported by patients in performing complex tasks so easy as I take your car or truck and drive to function.In the event the diagnosis and effective treatment aren’t established early greater isolation along with the tendency to not leave.Iose weight is often observed.Treatment TPThe principal element in the initiation of treatment solutions are effective blocking attacks or decrease in the regularity and intensity through the use of drugs along with using this method (minus the suffering the attacks) to allow anything else.It’s important to create a great doctor-patient relationship, a therapeutic relationship and knowledge.The data by patients of these disease, evolution, possible unwanted effects of medicine, the requirement for continued utilization of medication (dosage adjustment capable to block attacks terque be done) by the time needed for the control over symptoms is imperative.Negative effects of medications needs to be informed that there is no reason at all for frustration or guilt in close relationships.A.Drug PanicAlthough disconcerting, but considered to be effective, the mechanism of action of the drugs apparently exert their effects through actions occasionally seemingly antagonistic on the degree of brain neurotransmitter systems, especially the noradrenergic and serotonin (neurotransmitters).The drugs boost the transmission of such substances anvel brain as well as the decrease of its uptake.No treatment methods are proven to use drugs that block the panic and anxiety attacks as benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors deserotonina and selective serotonin and norepinephrine.Benzodiazepines: alprazolam and clonazepamTricyclic antidepressants (TCAs): imipramine, clorimipramina, amitriptyline, nortriptylineInhibitors of monoamine oxidase (MAO) inhibitors: tranylcypromine, moclobemideInhibitors Selective serotonin reuptake inhibitors: sertraline, fluoxetine, paroxetine, fluvoxamine and citalopramSelective serotonin reuptake inhibitors of serotonin and norepinephrine: venlafaxineAll medicines should be given by doctors because they have efeitoscolaterais.There is considerable controversy in regards to the time needed for maintenance treatment.Most authors admit to become the optimal duration between Six months and 2 years later with all the gradual withdrawal in the drugs and review if the panic and anxiety attacks recur.Although these criteria adopted the relapse rate after discontinuation from the drug varies between 20 and 50%.The patient needs to be informed that the onset of symptom improvement usually takes several weeks and is dependent upon the adjustment of doses necessary to block the attacks, in addition to its faithful adherence to therapy.This needs to be clear for the patient towards the patient with PD try not to be anxious or depressed with all the expectation of immediate improvement.B.PsychotherapeuticIt is also of fundamental importance.Is aimed at maintaining adherence to therapy and guidance for the development and combat-related complications.The cognitive-behavioral techniques seem seras more potent with this direction, including increasing the reaction to medications.As the panic disorder to succeed the individual develops hypochondria, phobias associated directly or indirectly using the circumstances the location where the crisis has experienced, at baseline and anticipatory anxiety, agoraphobia, self-deprecation, depression, demoralization, alcoholism or drug usoabusivo.Any combination is achievable and is independent of the characteristics even though they are dependent on the severity and frequency of crises, along with delay in diagnosis.The person must be encouraged gradually (as soon as the attacks blocked pharmacologically) to handle places or situations in which the attack by going by doing this and gaining self-confidence to handle their adversities.
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