Features of the pathogenesis, diagnosis, and treatment of panic attacks in young people

Objective: to investigate the features of the pathogenesis, diagnosis, and treatment of panic attacks (PAs) in young people.

Patients and methods. A total of 39 outpatients (27 females and 12 males) aged 19 to 38 years with PAs were examined. The Panic Disorder Severity Scale (PDSS) was used to measure the severity of clinical manifestations of PAs; the Covey Anxiety Scale was employed to identify an anxiety state. In order to exclude depressed patients from being examined, the Montgomery—Аsberg rating scale was applied to assess the severity of depression. All the patients were divided into two groups: 1) 22 patients with PAs who received standard therapy and the alpha-adrenoblocker proroxan (Vegetrox) as a 15-mg tablet thrice daily for 8 weeks; 2) 17 patients who were prescribed only standard therapy. The patients were examined twice before and 4 weeks after the end of an 8-week vegetrox therapy cycle.

Results and discussion. In the patients of both groups with PAs, the total score ranged from 3 to 11, with the median PDSS score of 7. According to the Covey anxiety scale, an anxiety state developed in 33 patients; only the symptoms of anxiety were detected in 6. There was a direct significant correlation between the PDSS and Covey anxiety scale values; Spearman's rank correlation coefficient was 0.681 (p<0.01). The PA severity indexes proved to be significantly lower after incorporating Vegetrox into the standard therapy. Comparing the anxiety scale values in the patients of Groups 1 and 2 after the treatment cycle revealed a significant decrease in the level of anxiety in the patients receiving standard therapy and Vegetrox. This effect of the latter may be explained by the fact that it blocks postsynaptic α₁-adrenoceptors and presynaptic α₂-adrenoceptors and decreases the stimulation intensity of the hypothalamic structures that are closely connected with the limbicoreticular system.

Conclusion. The severity of PAs in young people depends on the level of anxiety. Vegetrox has a significant positive effect on the values of PDSS and the Covey anxiety scale in PAs.

1. Vorob'eva OV, Rusaya VV. Vegetative disfunction, associated with anxiety disorders. Effektivnaya farmakoterapiya. 2011;(1):46-50. (In Russ.).

2. Orlova IN, Orlov FV, Golenkov AV. Psychoautonomic syndromes in neurological patients. Vrach. 2019;(12):18-21. (In Russ.).

3. Elias GJB, Giacobbe P, Boutet A, et al. Probing the circuitry of panic with deep brain stimulation: Connectomic analysis and review of the literature. Brain Stimul. 2020 Jan-Feb; 13(1):10-14. doi: 10.1016/j.brs.2019.09.010. Epub 2019 Sep 25.

4. Kuzyukova AA, Rachin AP. Panic attacks in neurological practice. Russkii meditsinskii zhurnal. 2017;(13):986—91. (In Russ.).

5. Shikov AS, Yakupov EZ. The features of panic attack differential diagnosis in admission department. Vestnik sovremennoi klinicheskoi meditsiny. 2018;(5):135-9. (In Russ.).

6. Parfenov VA, Golovacheva VA. Khronicheskaya bol' i ee lechenie v nevrologii [Chronic pain and its treatment in neurology]. Moscow: GEOTAR-Media; 2018. 288 p.

7. Foldes-Busque G, Denis I, Poitras J, et al. A closer look at the relationships between panic attacks, emergency department visits and noncardiac chest pain. J Health Psychol. 2019 May; 24(6):717-25. doi: 10.1177/1359105316683785. Epub 2017 Jan 5.

8. Steimer T. The biology of fear — and anxiety-related behaviors. Dialogues Clin Neurosci. 2002 Sep;4(3):231-49.

9. Viana TG, Bastos JR, Costa RB, et al. Hypothalamic endocannabinoid signalling modulates aversive responses related to panic attacks. Neuropharmacology. 2019 Apr;148:284-90. doi: 10.1016/j.neuropharm.2019.01.022. Epub 2019 Jan 21.

10. Molosh AI, Dustrude ET, Lukkes JL, et al. Panic results in unique molecular and network changes in the amygdala that facilitate fear responses. Mol Psychiatry. 2020 Feb;25(2):442-60. doi: 10.1038/s41380-018-0119-0. Epub 2018 Aug 14.

11. Bobrov AE, Agamamedova IN, Kuznetsova NA. Paroxetin: treatment of panic disorders in the setting of neurological department at the general hospital (a randomized open study). Psikhicheskie rasstroistva v obshchei meditsine. 2007;(3):3-6. (In Russ.).

12. Balon R, Starcevic V. Role of Benzodiazepines in Anxiety Disorders. Adv Exp Med Biol. 2020;1191:367-88. doi: 10.1007/978-981-32-9705-0_20.

13. Bykov YuV, Bekker RA. Pyrroxane: a broad efficacy in psychiatry and neurology. Part II. Psikhiatriya i psikhofarmakoterapiya im. P.B. Gannushkina. 2017;19(6):55-61. (In Russ.).

14. Sergeev II, Lakosina ND, Pankova OF. Psikhiatriya i narkologiya [Psychiatry and narcology]. Moscow: MED-press inform; 2009. 752 p.

15. Vein MA, editor. Vegetativnye rasstroistva: klini-ka, diagnostika, lechenie [Vegetative disorders: clinical picture, diagnosis, treatment]. Moscow: MIA; 1998. 752 p.

16. Shear M, Brown T, Barlow D, et al. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997 Nov;154(11):1571-5.

17. Ivanov IV, Bondarenko RA. Individual approach to the use of medications to normalize situational anxiety under the psycho-emotional stress. Aviakosmicheskaya i ekologicheskaya meditsina. 2015;(2):32-5. (In Russ.).

18. Kundashev UK, Salenko YuA, Morozov IS, et al. Effect of mediator-type drugs on human psychophysiological status during model operator activity. Eksperimental'naya i klinicheskaya farmakologiya. 2016;(2):9-13. (In Russ.).

19. Kazennykh TV, Epanchintseva EM, Ivanova AA, et al. Technology for rehabilitation of the patients with episodic paroxysmal anxiety. Sovremennye problemy nauki i obrazovaniya. 2006;(4):43. (In Russ.)].