Clinical and psychophysiological analysis of panic attacks in patients with various mental diseases

The fact that the unilateral approach to studying panic attacks (PA) is unsound has presently become evident in the context of one specialty - neurology or psychiatry.

Subjects and methods. One hundred and ninety-three patients with PA, among whom 80 (30 men and 50 women; mean age 31.5±9.66 years) fully met the inclusion-exclusion criteria, were examined. A control group comprised 36 healthy individuals (16 men and 20 women; mean age 25.9±6.73 years). The interdisciplinary approach integrating two (neurological and psychiatric) paradigms was applied to investigate PA. Clinical, psychological, and neurophysiological studies were employed.

Results and discussion. The clinical picture of PA and an interattack interval was shown to encompass similar autonomic and different psychopathological manifestations caused by varying pathogenic mechanisms. The clinical manifestations of the latter most frequently correspond to neurotic, specific personality, and schizotypal disorders. It was ascertained that each group of patients with PA, which was identified by the nosological principle, was characterized by the pattern of clinical and psychophysiological characteristics and the trend in PA in addition to general manifestations. The neurophysiological signs of mental disease, in whose picture PA developed, corresponded to the progression of psychopathological and personality manifestations of PA in each consecutive group. The determinant of the pathogenesis and clinical presentation of PA in various mental diseases is psychodynamic processes, the specific features of which need to be taken into account when making diagnostic, therapeutic, prognostic, and expert decisions.

1. <div><p>Воробьева О.В. Общие церебральные механизмы развития пароксизмальных эпилептических и неэпилептических расстройств. Дис. … докт. мед. наук. М., 2001.</p><p>Попов Ю.В., Вид В.Д. Современная клиническая психиатрия. М.: Экспертное бюро-М, 1997;164-282.</p><p>Давиденков С.Н. Неврозы. Л.: Медгиз, 1963;271 с.</p><p>Свядощ А.М. Неврозы и их лечение. М.: Медицина, 1971;356 с.</p><p>Тиганов А.С. Руководство по психиатрии. Т.1. М.: Медицина, 1999;705 с.</p><p>Viaud-Delmon I., Warusfel O., Seguelas A. et al. High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality. Eur Psychiatry 2006;21(7):501-8.</p><p>Данилов А.Б. Сегментарные вегетативные механизмы в патогенезе и синдромообразовании психовегетативных пароксизмальных расстройств. Дис. … докт. мед. наук. М., 1994.</p><p>Aronson T.A., Bogue C.I. Phenomenology of panic attacks: descriptive study of panic disorders patient self-reports. Clin Psychiatry 1988;49(1):8-13.</p><p>Klein D.F. The delineation of two drug-responsive anxiety syndromes. Psychopharmacology 1964;5:397-408.</p><p>Kushner M.G., Beitman B.D. Panic attacks without fear: an overview. Behav Res Ther 1990;28(6):469-79.</p><p>Вейн А.М., Дюкова Г.М., Воробьева О.В. и др. Панические атаки. СПб.: Ин-т мед. маркетинга, 1997;304 с.</p><p>Горшков И.В., Горинов В.В. Расстройство личности и агрессия. Рос психиатр журн 1998;5:68-73.</p><p>Карвасарский Б.Д. Неврозы. М.: Медицина, 1980;448 с.</p><p>Егоров Б.Е., Тутер Н.В. и др. Классика русского психоанализа и психотерапии. М.: Изд-во СИП РИА, 2004;400 с.</p><p>Аведисова А.С. Особенности психофармакотерапии больных с пограничными психическими расстройствами. Дис. … докт. мед. наук. М., 1999.</p><p>Shear M.K., Cooper A.M., Klerman G.L. et al. A psychodynamic model of panic disorder. Am J Psychiatry 1993;150(6):859-66.</p><p>Гнездицкий В.В., Генрихс Е.Е., Киликовский В.В. и др. Построение решающего правила для оценки риска вегетативных пароксизмов по данным кожно-симпатических вызванных потенциалов. Клин информатика и телемед 2004;2.</p><p>Тутер Н.В., Гнездицкий В.В. Компрессионно-спектральный анализ ЭЭГ при панических расстройствах, возникающих у пациентов с различными психическими заболеваниями. Журн неврол и психиатр им. С.С. Корсакова 2008;3:53-61.</p><p>Орлова В.А., Савина Т.Д., Трубников В.И. и др. Структурные особенности мозга (по данным МРТ) и их функциональные связи в семьях больных шизофренией. Рос психиатр журн 1998;6:48-56.</p><p>Charney D.S. Related Articles, Links Neuroanatomical circuits modulating fear and anxiety behaviors. Acta Psychiatr Scand 2003;(Suppl.)417:38-50.</p><p>Ghisolfi E.S., Heldt E., Zanardo A.P. et al. Links P50 sensory gating in panic disorder. J Psychiatr Res 2006;40(6):535-40.</p></div><br />