Sympathoadrenal crisis Wikipedia

A sympatho-adrenal crisis, also called a panic attack, is one of the manifestations of VSD (vegetative-vascular dystonia) of the hypertensive type.

This condition is not a disease, but a condition that manifests itself in the form of an acute attack, which is accompanied by an increase in heart rate, chest pain, a sharp rise in blood pressure, as well as an emotional feeling of fear.

The most common time for a crisis to occur is the second half of the day or night.

This fact is explained simply - during the day the body accumulates both physical and emotional fatigue, which can cause a panic attack.

Read more about panic attacks in our materials:

According to statistics, symptoms of a panic attack occur in 45–70% of the world's population, which is an impressive figure. And often the first.

Sudden panic attacks can greatly complicate the lives of their victims. Many people develop depression as a result of such conditions.

A vegetative crisis is an incomprehensible, unpleasant state of anxiety for a person with fear and various somatic manifestations. Application of specialists.

What happens during a crisis

Let's take a closer look at what happens during the onset of a sympatho-adrenal crisis.

Physical manifestations: a headache occurs, breathing becomes difficult, a feeling of lack of air appears, trembling occurs throughout the body, the sensitivity of the skin may be impaired, even a light touch causes pain, the limbs become cold, the body temperature rises.

In addition, as mentioned above, the heart rate increases and blood pressure rises.

Emotional manifestations: the patient develops a feeling of fear, often the person experiences fear of imminent death, unreasonable horror, ceases to trust others and believes that he is in danger.

As a rule, the duration of a crisis does not exceed 1-2 hours , although some patients claim that in fact a panic attack lasts much longer - up to 8 hours. However, even in such a short period, the body is subjected to a colossal test and experiences great stress.

The end of the attack occurs suddenly and is characterized by a feeling of powerlessness and weakness.

The intense work of the kidneys during a crisis results in copious urination, and the urine becomes very light.

At the moment, medical practice shows that the treatment of sympathoadrenal crises is quite successful.

Modern techniques and medications, selected by a professional doctor, have a positive effect and help cope with this condition. However, without the desire of the patient himself to overcome the panic state, the specialist will not be able to help fully.

Therefore, only through interaction between the doctor and the patient can the maximum effect be achieved and individual factors that provoke the development of a sympatho-adrenal crisis be overcome.

Sympathoadrenal crisis | Panic Attack | Treatment Kyiv

Sympathoadrenal crisis has several identical names: autonomic-vascular crisis, cerebral autonomic crisis, panic attack, autonomic storm, autonomic seizures, autonomic crises, etc.

International classification of diseases ICD-10

According to the ICD-10 classification , sympathoadrenal crisis is classified as “recurrent attacks of severe anxiety (panic), which are not limited to any particular situation or set of circumstances and, therefore, are unpredictable.”

Symptoms of sympathoadrenal crisis

The main symptom of a sympathoadrenal crisis is attacks of fear that roll in like an avalanche.

Fear is unmotivated, unreasonable, with violent emotional reactions and changes in behavior. Panic is accompanied by unaccountable anxiety, paralyzing fear of death.

Internal tension is accompanied by a feeling of impending disaster. But not only. Other diencephalic disorders also occur.

Sympathoadrenal crisis depends on the state of the functional state of the diencephalic region of the brain

Neurological manifestations during sympathoadrenal crisis concern exclusively the autonomic part of the nervous system. The central representation of all autonomic functions is located in the diencephalic region of the brain . Therefore, sympathoadrenal crisis is called diencephalic crisis.

The diencephalic ( intermediate ) region of the brain (see figure below) is the concentration of all autonomic neurological representations of the body. Vegetative means autonomous, not dependent on consciousness. It is almost impossible to control.

Moreover, this area of the brain is very sensitive to changes in blood flow.

The diencephalic part of the brain has a direct connection with the pituitary gland , which in turn is connected with the adrenal glands. The adrenal glands are the only organ in the body that synthesizes stress hormones.

During a sympathoadrenal crisis, the diencephalic region of the brain is excited, activating the pituitary gland, which, in turn, gives commands to the adrenal glands. The adrenal glands release adrenaline into the blood, causing an adrenal crisis. Hence such a flow of stress reactions, emotional and vegetative reactions.

Diencephalic (sympathoadrenal) crisis. Neurological symptoms

Neurological disorders during sympathoadrenal crisis are vegetative in nature. Vegetative manifestations are as follows.

Sympathoadrenal crisis lasts from 20 minutes to several hours and manifests itself in the form of unmotivated growing fear in combination with autonomic disorders (vegetative storm).

Autonomic disorders affect almost all parts of the sympathetic nervous system, and behavior changes noticeably.

Such a crisis is characterized by causeless anxiety, a sinking heart, fear of death, and an unreasonable premonition of trouble.

Characterized by shortness of breath, difficulty breathing, a feeling of lack of air, tachycardia or bradycardia, pain in the heart, which makes you think about myocardial infarction, this increases stress. Attacks of rage.

There may be discomfort in the upper abdomen (literally – “pulling in the pit of the stomach”). Belching, fever or chills, and trembling may occur.

Sympathoadrenal crisis is manifested by vascular reactions from the brain - dizziness, headache, tinnitus, numbness or “crawling” (paresthesia) in the extremities, numbness of the tongue, lips.

Often such an attack ends with excessive urination or diarrhea.

Depending on which area of the hypothalamus is more involved, a sympathoadrenal and vagoinsular ( parasympathetic ) crisis .

This division is arbitrary, since when analyzing the manifestations of a sympathoadrenal crisis, it turns out that there are manifestations from both the sympathetic and parasympathetic parts of the nervous system - a mixed crisis. Persons with neuroses are prone to sympathoadrenal crises.

Although, neuroses themselves are initial deviations in the emotional sphere, caused by the diencephalic (hypothalamic) region.

A crisis can be triggered by stress, even minimal stress; dissatisfaction with something, other psychogenic factors. Crises occur when the endocrine balance changes, especially in women with hormonal changes in premenopause and menopause. These crises are more similar to vagoinsular ones.

Initial hypothalamic-endocrine disorders worsen during menstruation, pregnancy, lactation... A crisis is often provoked by certain types of physical activity, especially intense ones with increased intracranial pressure.

Autonomic crises in the form of hyperexcitability syndrome are also common in children with functional disorders of the central nervous system and consequences of birth auma.

Treatment of sympathoadrenal crises

Research conducted at the Institute of Neurology and Musculoskeletal Medicine has shown that people prone to vegetative crises have characteristic abnormalities in cerebral blood flow. In this case, certain structural features of the brain are often diagnosed.

A pool of nuclei in the diencephalic region was also identified, exposure to which during sympathoadrenal crises led to stable remission.

Certain MRI technologies can reveal some changes in the pituitary gland, which are characteristic of persons with sympathoadrenal crises and panic attacks.

To treat sympathoadrenal crises, not only medications are used, but also the so-called. vegetotropic methods. Considering that sympathoadrenal and vagoinsular crises occur with pathology of the hypothalamus, one of such methods is acupuncture. A method that can normalize the autonomic functions of the hypothalamus.

It should be noted that classical Chinese acupuncture in most cases copes with the problem. But, subject to adequate correction of blood flow and liquor flow in the area of the hypothalamus and pituitary gland (diencephalic area of the brain).

Causes of crises

The very concept of “crisis” in the name of the condition under consideration indicates the presence of an extreme situation for the body, which leads to a negative reaction. What reasons can provoke sympathoadrenal crises?

These can be either internal psychological or physical problems, or external factors that cause emotional disorders.

Internal psychological reasons

People who are used to suppressing their emotions often suffer from panic attacks.

They cannot allow themselves to fully experience any shocks, both positive and negative, and as a result live in a state of stress.

However, emotions accumulated over a long period can negatively affect not only a person’s moral state, but also the body, finding a way out in a sympatho-adrenal attack.

Bad habits can also be included in this category of influencing factors.

Internal physical reasons

These include various health disorders that can provoke a sympatho-adrenal crisis.

Among them:

a neoplasm (tumor) in the adrenal medulla, which contributes to the release of a high volume of adrenaline into the blood (and regardless of the psychological state of the patient);
disorders that increase stimulation of the central part of the sympathetic system in the spinal cord (tumor of the spinal cord, spine, ischemia);
the presence of pathological impulses of areas of the brain associated with the sympathetic system and hypothalamus (similar to epileptic seizures);
the presence of a neuroinfection, as well as a past illness associated with a neuroinfection;
suffered traumatic brain injuries;
disruption of the normal balance of hormones in the body;
some disturbances in the functioning of the cardiovascular system;
some diseases of the gastrointestinal tract and digestive system.

External factors

First of all, this category of reasons includes emotional stress arising as a result of any events affecting the patient.

They can be both positive and negative (more often they provoke a panic attack).

With a strong psychological shock, the brain gives the adrenal glands a command to release large amounts of adrenaline, which leads to a sympatho-adrenal crisis.

In addition, an external factor may be the tendency of close relatives to have panic attacks, which can cause a hereditary predisposition.

It should be noted that in one patient a sympatho-adrenal crisis can be provoked by different factors, and they will not always be the same during repeated attacks.

Clinical picture and diagnostic criteria

People with panic disorder typically experience a series of intense episodes of extreme (and usually unexplained) anxiety called panic attacks. Panic attacks usually last about 10 minutes, but can be short-term - about 1-5 minutes, and long-lasting - up to 30 minutes, while the feeling of anxiety can persist for 1 hour. Panic attacks can vary in the set of symptoms or be of the same type (that is, tachycardia, sweating, dizziness, shortness of breath, tremors, experiencing uncontrollable fear, etc.). In some patients, these conditions are observed regularly - sometimes daily or weekly. The external symptoms of a panic attack often lead to negative social consequences (eg, embarrassment, social stigma, social isolation). However, patients who are aware of their illness can often have intense panic attacks with very little external manifestations of this condition.

A special scale is used to determine the severity of panic disorder; it also exists in the form of a self-esteem questionnaire as a test for panic attacks[2][3].

Diagnostic criteria ICD-10

Repeated, unpredictable attacks (not limited to any specific situation) of severe anxiety (panic).
Autonomic pain symptoms accompanying anxiety, derealization and depersonalization.
Secondary fears of death and madness.
Secondary avoidance of any situation in which the panic attack first occurred.
Secondary fears of loneliness, crowded places, repeated panic attacks.
Panic disorder is the primary diagnosis in the absence of any phobia as a primary disorder ( otherwise, a panic attack is considered a sign of a full-blown phobia
).
A reliable diagnosis of panic disorder requires that several severe anxiety attacks
observed at least
within one month
and met the following requirements:
Panic disorder is not limited to a known, predictable situation.
Availability of anxiety-free periods between attacks.

DSM-IV Diagnostic Criteria

Recurrent panic attacks.
At least one attack occurred for 1 month (or more) with the following additional symptoms:
Worry about the consequences of the attack (for example, fear of loss of self-control, myocardial infarction, fear of going crazy).
Significant changes in behavior associated with attacks.

B. Presence (or absence) of agoraphobia.
C. Symptoms are not due to direct physiological effects of a substance (eg, drug abuse, medication) or a medical condition (eg, hypertension, hyperthyroidism, pheochromocytoma, etc.).
Symptoms cannot be explained by the presence of another mental or behavioral disorder, such as somatoform autonomic dysfunction of the heart and cardiovascular system, hypochondriasis, social phobia, other phobias, obsessive-compulsive disorder, post-traumatic stress disorder, or separation anxiety disorder.

According to the Diagnostic and Statistical Manual DSM-IV-TR, panic attacks are not considered as a separate disease, but are coded as part of the diagnosis of other anxiety disorders[4].

Differential diagnosis

Panic disorder must be distinguished from a number of somatic diseases and conditions, which include cardiovascular disorders, chronic obstructive pulmonary diseases, some endocrine and metabolic disorders (Cushing's disease, electrolyte disorders, hyperthyroidism, hyperglycemia, diseases of the parathyroid glands), epilepsy, especially temporal; peptic ulcer, pheochromocytoma, pulmonary embolism[5], vestibulopathies, central nervous system tumors, bronchial asthma, effects of certain drugs and narcotic substances[6], conditions after severe burns and extensive surgical interventions.

In addition, panic disorder should be distinguished from other mental disorders that cause panic attacks: for example, identified phobic disorders (F40.x), post-traumatic stress disorder, obsessive-compulsive disorder, somatoform disorders (F4x.x) and other similar disorders. Panic attacks may be secondary to depressive anxiety spectrum disorders, especially in men, and if criteria for depressive disorder are met, panic disorder should not be established as the primary diagnosis.

Characteristic symptoms and signs

The sympatho-adrenal crisis develops quite rapidly, and, as a rule, the symptoms appear in aggregate.

Sympathetic adrenal crisis has the following characteristic symptoms:

difficulty breathing, feeling of heaviness, tightness in the chest;
feeling of cold or heat, the appearance of tremors of the limbs;
paleness of the skin;
a sharp increase in blood pressure, vasospasm;
headache, throbbing sensation;
increased heart rate, arrhythmia;
dry mouth;
emotional feeling of groundless horror, fear of death.

Theories about the origin of the disease

Serotonin theory
- data on the role of serotonin in the pathogenesis of panic disorders were obtained in pharmacological studies. Studies of neuroendocrine reactions in response to the administration of serotonergic drugs have revealed certain changes in patients with panic disorders (changes in cortisol secretion in response to the administration of fenfluramine and meta-chlorophenylpiperazine). It is possible that platelet levels of serotonin-related protein are altered in patients with panic disorder. Research has also been conducted on the connection between panic disorder and the production of antibodies to serotonin. The interaction of the serotonergic and other neurotransmitter systems is important. The connection between the serotonergic and noradrenergic systems helps explain the disruption of autonomic regulation in panic disorder. SSRIs may also reduce symptoms of panic disorder indirectly through their effects on the noradrenergic system. For example, fluoxetine can normalize the MHPG response to clonidine in patients with panic disorder.
Respiratory theories
— explain the occurrence of panic disorder by a failure in the regulation of breathing and the occurrence of an “emergency” reaction. A panic attack is triggered by excessive breathing through the activation of the supposed “center of suffocation.”
Genetic hypotheses
- an attempt to determine the genetic loci responsible for the development of panic disorder remains unsuccessful to this day. Panic disorder often occurs in close relatives, which may indicate the role of heredity. Comorbidity with diseases such as bipolar affective disorder and alcoholism was also established.
Autonomic theories
are based on the study of cardiac indicators of the interaction of the parasympathetic and sympathetic systems and reactions to noradrenergic drugs (studies with clonidine). In adult patients, a flattening of the growth hormone secretion curve in response to the administration of clonidine was found, which indicates a decrease in the sensitivity of hypothalamic α2-adrenergic receptors; an increase in blood pressure and MHPG levels was also observed. With successful treatment of panic disorder, the normal response is restored in the form of a decrease in MHPG in response to clonidine administration.
Conditioned reflex theory
- presumably, any anxiety reaction arises as a result of the interaction of the amygdala with brainstem structures, the basal ganglia, the hypothalamus and cortical pathways. Internal stimuli are considered as conditioned stimuli that can trigger a panic attack. A panic attack occurs as a result of activation of neural pathways that provide a conditioned reflex phobic reaction in response to normal fluctuations in physiological functions. This theory is also confirmed by the fact that a conditioned reflex can be developed based on the respiratory and physiological response to inhaling carbon dioxide.
Cognitive theories
- A number of cognitive factors are hypothesized to influence the development of panic attacks. Patients with panic disorder experience increased anxiety sensitivity and a decreased threshold for perceiving signals from internal organs. These people report more symptoms when anxiety is provoked by exercise.

Treatment of sympatho-adrenal crisis

The treatment process usually combines the use of medications and psychotherapy . Preventive measures and the patient’s compliance with certain rules of life are also important.

Emergency assistance during a seizure

Usually, emergency care for a sympathoadrenal crisis is not required, because when an attack approaches, the patient can cope with it independently, taking control of his psycho-emotional state.

However, in difficult cases, it is possible to use sedatives , which quickly relieve the symptoms of a crisis, or other effects according to the symptoms (for example, using a drug to lower blood pressure).

Drug treatment

For treatment at the first symptoms of sympatho-adrenal crisis, the following groups of drugs are used :

Tranquilizers. For example, alprazolam, phenazepam. Used to reduce the excitability of the central nervous system (CNS). Drugs in this group are also prescribed for the prevention of attacks. However, you should know that tranquilizers do not eliminate the cause of the crisis, but only relieve symptoms, so long-term use of such drugs is not recommended. As a rule, they are prescribed at the beginning of treatment, before the causes of panic attacks are identified.
Beta blockers. Drugs in this group neutralize the effect of adrenaline, therefore they are used to stop an attack or prevent a crisis when the first symptoms appear. Such drugs include atenolol, anaprilin.
Antidepressants (Paxil, Cipralex). To obtain a positive effect, such drugs are recommended to be used for a long period (6-12 months). However, after discontinuation of antidepressants, a relapse of sympathoadrenal crisis is possible.
Herbal medicines that have a sedative effect (sage, motherwort, valerian and others). Used as an alternative to complex sedatives. A positive effect is achieved after taking a course lasting from 6 to 12 months.

Vegetative crisis

Autonomic crisis or panic attack are paroxysmal states of a non-epileptic nature, characterized by polymorphic autonomic disorders, which, in turn, are caused by the activation of central (subsegmental) autonomic structures. The disease is characterized by the most striking manifestations of autonomic dysfunction syndrome. The disease is expressed in the form of a painful and inexplicable attack of severe anxiety and fear for the patient, accompanied by various somatic symptoms.

The use by domestic doctors of the terms “vegetative crisis”, “neurocirculatory dystonia”, “cardioneurosis”, “vegetative-vascular dystonia with a crisis course”, “sympathoadrenal crisis” reflected a view of the disease from the point of view of autonomic disorders with an emphasis on the involvement of the cardiovascular system.

According to the “International Statistical Classification of Diseases and Nosological Problems; 10th revision" (ICD-10) the disease is considered within the framework of somatoform autonomic dysfunction with an emphasis on the psychogenically caused syndrome of autonomic dystonia.

The terms “panic attack” and “panic disorder” were introduced in ICD-10 and are used throughout the world.

Classification

There is no single classification. Vegetative crisis is classified according to severity and symptoms, divided into types depending on changes in blood pressure and the cardiovascular system.

According to severity they are distinguished:

lungs: last 10-15 minutes with pronounced vegetative changes and monosymptomatic manifestations in the absence of post-crisis asthenia.
moderate severity: last from 15-20 minutes to 1 hour with polysymptomatic manifestations and severe post-crisis asthenia up to 24-36 hours.
severe: polysymptomatic crises in combination with hyperkinesis, convulsions lasting more than 1 hour and asthenia lasting up to several days.

According to symptoms there are:

sympathoadrenal
vagoinsular
mixed

Symptoms

Most often, the disease debuts at the age of 20–30 years, cases are very rare before 15 years and after 65 years. In women, the disease is diagnosed 2–3 times more often than in men.

The clinical picture of a panic attack consists of 2/3 of vegetative symptoms affecting various systems of the body, the rest is a picture of emotional and affective disorders. To determine the severity of attacks, a panic disorder severity scale is used. It is also used as a questionnaire.

During sympathoadrenal crises, the following symptoms are observed:

severe headaches
sensation of pulsation in the head
sensations of irregularities in the heart and palpitations
pale and dry skin
increase in body temperature
numbness and trembling of the limbs
chill-like tremor
feeling of anxiety and fear
increased levels of glucose and leukocytes in the blood

The end of the crisis is sudden, with the characteristic release of a large amount of urine with low specific gravity. A state of asthenia develops.

Vagoinsular crises are characterized by:

feeling of fading and interruptions in the heart area
feeling of lack of air
difficulty breathing
dizziness
rare pulse
moist, hyperemic skin
pain in the stomach, urge to defecate, flatulence, increased peristalsis

Mixed types of crises are characterized by combinations of signs of the vagoinsular and sympathoadrenal types of the disease.

In general, an attack of fear, anxiety or panic is characteristic, combined with four or more items from the list associated with the disease. At the psychosomatic level, a feeling of derealization, depersonalization, fear of committing an uncontrollable act, losing one’s mind, and fear of death may arise.

Vegetative crisis can be caused by the following conditions:

stress or neurotic disorders: the easiest to treat
consequences of birth injuries, concussions, residual pathology of the central nervous system
constant irritation of peripheral vegetative structures (for example, with premenstrual syndrome, urolithiasis, cervical dorsopathy)
endocrine changes in the body (for example, during puberty), disruption of the endocrine glands
taking any medications (for example, Erespal)

Diagnosis and treatment

Diagnosis is not difficult. But it is worth excluding the possibility of serious nervous and mental, somatic and endocrine diseases.

Vegetative crisis is diagnosed according to three criteria:

by paroxysmal nature and time limitation
by the presence of multisystem autonomic disorders
by the presence of emotional and affective states

Treatment of panic disorder involves the use of pharmacological, psychosocial, and psychotherapeutic measures.

Often, patients, observed by general practitioners, receive treatment aimed at relieving autonomic and somatic disorders. This most often does not bring the expected effect.

Nowadays, a generally accepted method of treatment is the use of psychotropic drugs in combination with rational psychotherapy.

Traditional medicine recommends including bananas in the menu in combination with any nuts and using various infusions: dill seeds and valerian, immortelle, hawthorn, motherwort, etc.

Prevention measures

Factors such as diet, daily routine, and physical activity are not decisive for overcoming attacks. However, following simple preventive measures will reduce the frequency of crises and soften their course.

Prevention measures include:

walks in the fresh air, moderate but regular physical activity;
good sleep;
proper nutrition, taking the necessary vitamins and minerals, it is advisable to divide food into smaller portions, but increase the number of meals;
refusal of alcoholic drinks and energy drinks;
reduce the time spent watching TV and reading news on the Internet to reduce the risk of negative emotions;
It is recommended to avoid stressful situations if possible.

Video: Panic attacks - what are they?

Panic attacks or sympathoadrenal crisis are a very common problem. Many people undertake to treat them, but not all achieve positive results.

Sympatho-adrenal crisis is a sudden manifestation of vegetative-vascular dystonia, the main symptoms of which are a sharp headache, heart rhythm disturbances, numbness of the extremities, and increased body temperature. In addition, a person develops a very strong and disturbing feeling of inexplicable fear and panic. Such a state ends as unexpectedly as it begins. After the experience, a person usually feels very tired, lethargic and completely powerless.

A sympathoadrenal crisis is also called a panic attack. Most often, this illness overtakes a person in the afternoon or at night, and there is a fairly simple explanation for this - over the course of a whole day, the human body becomes very tired, both physically and emotionally, which leads to panic attacks.

So what are these sympathoadrenal crises and what is their main cause? What are the main signs of this disease? How can you provide first aid if a person suddenly has this crisis? Are there currently effective treatment methods?

Sympathoadrenal crisis ICD 10

A sympathoadrenal crisis is one of the types of manifestations of VSD, which is expressed in the form of a panic attack with a rapid pulse, a surge in pressure, pain in the heart and the mastery of fear. It appears in the second half of the day or at night, due to accumulated physical and psycho-emotional fatigue during the day.

Symptoms

The first signs of the disease may appear as a result of stress, overwork at work or after intense physical activity; in women this can be caused by premenstrual syndrome. During a crisis, the body experiences urine retention, which is then released in full after the attack ends. The main signs of the disease may be:

unpleasant painful sensations in the heart area, pressure in the chest;
fluctuations in body temperature;
arrhythmia, irregular heartbeat;
high blood pressure;
frequent squeezing headaches;
feeling of chills;
cold extremities, slight tingling;
dry mouth, constant thirst;
bulging eyes;
excessive sweating;
fear of approaching death, panic and horror.

How does a crisis happen?

The attack appears suddenly for a person and, already with the first manifestations of symptoms, quickly gains momentum, reaching a peak. In this condition, blood pressure levels can reach levels of more than 200/100, while the heart rate exceeds 150 beats per minute.

Due to high blood pressure, the patient experiences not very pleasant sensations:

severe bursting headache;
pulsation in the head;
a feeling of stopping the rhythm, irregularities in the heart pulse;
pain in the chest area.

The person’s face immediately turns pale, one can notice his trembling and sticky sweat. At this point, he will feel chills and numbness in his arms and legs.

The fear of death takes over a person completely, it seems to him that his death is inevitable, he is lost in reality, he does not understand what is happening.

In this state, even the most collected person cannot give an objective assessment of reality; all surrounding things seem implausible.

After an attack, no one can describe the reasons for such sensations; the crisis causes mixed feelings. At the end of the attack, there is a strong desire to urinate.

Duration of crisis

The attack lasts about a couple of hours, no more. It may have a shorter duration, but the symptoms are more pronounced, so this condition is much more difficult to tolerate.

After a crisis, a person may experience severe exhaustion, loss of strength and apathy.

To remove fear and prevent the risk of another attack, you need to distract yourself from anxious thoughts and switch to something positive.

Diagnostics

Before prescribing competent treatment, it is necessary to diagnose the causes of the disease, determine the severity and develop a rehabilitation strategy. This is a rather lengthy process that can last for years.

In order for the treatment to be effective and bear fruit, you need to undergo the following examinations:

Ultrasound of the heart, cardiogram;
examination by a neurologist;
examination of the spinal cord, identification of damage;
You may need an ultrasound of the adrenal glands and thyroid gland;
CT and MRI.

Before treating a crisis, the doctor needs to make sure that there is no hereditary predisposition for its development, study the patient’s habits, find out the medical history, and the presence of chronic pathologies.

If instrumental examination methods do not reveal any abnormalities, a consultation with a psychotherapist is mandatory.

The healing process

The treatment is complex; such an illness cannot be overcome solely with medications or psychological influence. Both are necessary. Prevention of subsequent attacks is no less important, because the crisis may not completely subside, so you need to learn how to deal with it, master your emotions and states.

Sometimes a person does not need emergency help, because he knows the techniques of self-control and at the first manifestations of a crisis, he knows how to take control over them, balancing a normal psycho-emotional state. But there are difficult cases in which it is impossible to do without taking sedative sedatives, which will quickly combat the negative manifestations of the attack.

Source: https://urokrisunka.ru/info/simpatoadrenalovyj-kriz-mkb-10/

Symptoms

What happens to a person who has a sympatho-adrenal crisis? Physically, a person immediately experiences the following symptoms:

a very severe headache;

trembling throughout the body;

breathing failure;

pallor of the skin is observed;

possible vasospasm;

increased sweating;

feeling of dry mouth.

In addition to these initial signs, there is severe sensitivity of the skin, and even a slight touch can cause severe pain. The patient's body temperature rises sharply and all extremities become cold.

In addition to all of the above, some people are bothered by symptoms such as rapid heartbeat and high blood pressure.

In terms of emotional manifestation, a person is tormented by an exorbitantly strong feeling of fear and anxiety. In some cases, a person is visited by a completely unreasonable fear of death, and sometimes people refuse to believe and trust others. In such a state, they are constantly visited by the thought that they are in danger and that something evil threatens them.

Such symptoms can last for 1 or 2 hours, although, as many patients who have experienced this condition unanimously state, this condition lasts much longer and this period is approximately 8 hours. However, it is worth noting that what the human body experiences during a sympatho-adrenal crisis is very serious, and even in such a short period it experiences incredibly great stress.

Then the symptoms subside, but even after this the person feels strong apathy and powerlessness. In addition, the patient begins to produce copious amounts of urine, very light, almost transparent.

If we compare the symptoms of a sympatho-adrenal crisis, we can come to the conclusion that they are very similar to a hypertensive crisis.

Sympathetic adrenal crises can have a very strong negative effect on the human body, therefore, in order to avoid its recurrence, a person needs to calm down and not be nervous. It is very important to distract yourself from dark thoughts and try to forget about what you experienced. A very good way is to keep yourself busy with something and remain completely calm.

As for first emergency care, in principle, a person does not need it, since with the initial signs he can cope with the symptoms on his own, pulling himself together and calming down. However, in some cases, a person will still need to be given some kind of sedative that can suppress the symptoms that appear in a short time and help the person.

Causes of the disease

The reasons that can lead to a sympatho-adrenal crisis are varied, but the main one is a panic attack, which usually occurs as a result of strong feelings, stress, anxiety, emotional shock or psychological trauma.

However, there is the following number of reasons leading to the crisis:

a person has bad habits, such as smoking or drinking alcohol;

hormonal imbalance in the body;

dysfunction in the stomach or intestines;

traumatic brain injuries;

genetic predisposition.

As numerous studies by leading scientists show, people who are accustomed to not showing their emotions, hiding, and suppressing their grievances, anger, and experiences somewhere deep in their souls fall into a special risk group. As a result, a person spends a certain amount of time in a state of very deep stress, which at one point ends in a sympatho-adrenal crisis.

Effective therapies

Treatment of sympatho-adrenal crisis is not an easy task, requiring enormous patience and the desire of the patient himself to achieve positive results. And, as a rule, it certainly includes both taking certain prescribed medications and undergoing psychological therapy. But before considering the basic principles of treating this not entirely simple disease, you should pay a little attention to its diagnosis.

Sometimes diagnosing a disease such as sympathoadrenal crisis takes a very long time and can last for years. Finding out the root cause of this disease can be very, very difficult. During this period, doctors, as a rule, prescribe medications for patients with hypertension. These drugs normalize the nervous system and reduce high blood pressure. To find out what causes a sympathoadrenal crisis, the patient must undergo the following examinations:

cardiogram of the cardiac system;

Ultrasound of the heart and thyroid gland;

full examination by a neurologist;

diagnosis of the spinal cord.

In this case, the doctor must necessarily examine the patient for the presence of bad habits or hereditary predisposition to this disease. It is important to study the conditions where the patient lives, his usual way of life and the general psychological environment in which the patient constantly finds himself.

The treatment process begins with establishing a daily routine and rest. It is also necessary to streamline mental and physical stress. The patient is also advised to avoid those situations and circumstances that can lead to stress, anxiety and worry.

With a disease such as sympathoadrenal crisis, it is very important to monitor your diet. Often, a doctor prescribes a person with a similar disease to follow a strict diet.

It is recommended to play sports and lead a more active lifestyle. Visiting the pool has a huge positive impact.

There are some cases where a person, following all the above recommendations and prescriptions, got rid of the need to take any medications. In many cases, playing sports and leading a healthy lifestyle helped patients cope with their problem.

Drug treatment

If a relapse occurs, then there is no way to do without medication and psychological therapy. What does drug therapy aimed at combating sympatho-adrenal crisis mean?

Preparations containing herbal ingredients. It can be St. John's wort, sage, motherwort, hawthorn. If the patient takes them correctly and in moderation, then in many cases this helps to avoid taking more serious medications. In the case of a positive effect of herbal medicines, the patient takes them throughout the year.

Antagonists are used to eliminate a crisis that has already occurred or for preventive purposes.

Tranquilizers are also taken for preventive or therapeutic purposes. However, their use continues strictly until the time prescribed by the doctor. The drugs have side effects.

Sympathoadrenal crisis is not a disease, but completely ignoring this disease can lead to quite serious complications.

Therefore, to prevent this from happening, prevention and adherence to the following simple recommendations are very important:

A full and healthy sleep is necessary;

you should try to go for walks in the fresh air every day;

maintain an active lifestyle;

eat food in small portions;

avoid stressful situations.

It is very important to seek help from a doctor at the first signs of a sympathoadrenal crisis so that serious complications and negative consequences can be avoided.

Vegetative-vascular dystonia causes many problems to carriers of this syndrome and deprives them of a normal, fulfilling life. One of its most severe manifestations is a sympatho-adrenal crisis. This condition begins suddenly, the typical time is the second half of the day or night. The attack is accompanied by sharp fluctuations in blood pressure and panic, uncontrollable fear of sudden death. The sympatho-adrenal crisis also ends suddenly, completely depriving a person of strength for several hours.

Nature of manifestation

For people who have experienced what it is like at least once, a sympathoadrenal crisis leaves a very difficult impression and a painful fear of a repeat attack. The manifestation of sympathoadrenal crises, or, as they are commonly called in the international classification of diseases, panic attacks, is widespread. Their diagnosis and therapy can be lengthy and complex, but a combination of medication and psychotherapeutic measures can achieve positive results.

Important! A sympatho-adrenal crisis is not an indicator of a disease of the internal organs, but ignoring its symptoms and not treating the disorder on time can cause serious complications in the body.

At the moment of the onset of a sympathoadrenal crisis, a large amount of adrenaline is released into the blood, a kind of overdose of this hormone occurs. When an adrenal crisis occurs, both physical and emotional signs are always noted. The following is physically observed:

blood pressure rises sharply;
heart rate increases;
there is a lack of air, often shortness of breath;
sudden headache begins;
the body is trembling;
hands and feet become cold;
body temperature rises;
The sensitivity of the skin increases, even to the point of pain.

From the side of emotions the following are manifested:

panic fear, usually associated with a feeling of imminent death;
unreasonable feelings of terror and danger;
distrust of others.

The duration of a sympatho-adrenal crisis usually does not exceed two hours, and can be very short, just a few minutes. But even in a short period of time, the body experiences such colossal stress that a person emerges from an attack physically exhausted and frightened, emotionally devastated.

Symptoms of a sympathoadrenal crisis also include excessive urination after the end of the attack. This is explained by the intense work of the kidneys under the influence of high blood pressure during a crisis.

Notes

World Health Organization.
F4 Neurotic, stress-related, and somatoform disorders // International Classification of Diseases (10th revision). Class V: Mental and behavioral disorders (F00-F99) (adapted for use in the Russian Federation). - Rostov-on-Don: Phoenix, 1999. - P. 175-176. — ISBN 5-86727-005-8.
Shear MK, Brown TA, Barlow DH, Money R., Sholomskas DE, Woods SW, Gorman JM, Papp LA
Multicenter collaborative panic disorder severity scale. (English) // The American Journal Of Psychiatry. - 1997. - November (vol. 154, no. 11). — P. 1571—1575. - doi:10.1176/ajp.154.11.1571. - PMID 9356566. []
https://goodmedicine.org.uk/files/panic,%20assessment%20pdss.pdf
APA Diagnostic Classification DSM-IV-TR
↑ 1 2 3 Kasper Z., Zohar J., Stein D.
Decision making in psychopharmacotherapy / Transl. from English V. Shtengelov. - Kyiv: Sfera, 2006. - 136 p. — ISBN 966-8782-24-0.
↑ 123
Pharmacotherapy in neurology and psychiatry: [Trans. from English] / Ed. S. D. Enna and J. T. Coyle. - Moscow: LLC: "Medical Information Agency", 2007. - 800 pp.: ill. With. — 4000 copies. — ISBN 5-89481-501-0.
Kaczkurkin AN, Foa EB
Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. (English) // Dialogues In Clinical Neuroscience. — 2020. — September (vol. 17, no. 3). - P. 337-346. — PMID 26487814. []
↑ 1 2 Gorodnichev A.V.
Current trends in the treatment of anxiety disorders: from scientific data to clinical recommendations // Biological methods of treatment of mental disorders (evidence-based medicine - clinical practice) / Ed. S.N. Mosolova. - Moscow: Publishing House "Social and Political Thought", 2012. - P. 643-668. — 1080 s. — 1000 copies. — ISBN 978-5-91579-075-8.
Hedman E., Ljótsson B., Rück C., Bergström J., Andersson G., Kaldo V., Jansson L., Andersson E., Andersson E., Blom K., El Alaoui S., Falk L., Ivarsson J., Nasri B., Rydh S., Lindefors N.
Effectiveness of internet-based cognitive behavior therapy for panic disorder in routine psychiatric care. (English) // Acta Psychiatrica Scandinavica. — 2013. — December (vol. 128, no. 6). - P. 457-467. - doi:10.1111/acps.12079. — PMID 23406572. []
Kholmogorova A. B., Garanyan N. G., Nikitina I. V., Pugovkina O. D.
Scientific research into the process of psychotherapy and its effectiveness: the current state of the problem. Part 1 // Social and clinical psychiatry. - 2009. - T. XIX, No. 3. - P. 92-100.
Otto MW, Hong JJ, Safren SA
Benzodiazepine discontinuation difficulties in panic disorder: conceptual model and outcome for cognitive-behavior therapy. (English) // Current Pharmaceutical Design. - 2002. - Vol. 8, no. 1. - P. 75-80. - doi:10.2174/1381612023396726. — PMID 11812251. []
Martha Davis, Elizabeth Robbins Eshelman, Matthew McKay.
The relaxation & stress reduction workbook. - Oakland, USA: New Harbiner Publications Inc., 2008. - 294 p. — ISBN 1-57224-214-0.
↑ 1 2 3 Garanyan N. G.
Practical aspects of cognitive psychotherapy // Moscow Psychotherapeutic Journal. - 1996. - No. 3.

Causes of crises

The causes of sympathoadrenal crises lie both within a person - physiology, psychology, and in the external surrounding world.

Psychological reasons include a person’s tendency to suppress their emotions. Anyone who is not used to or does not allow himself to fully experience a shock, good or bad, accumulates stress and comes to terms with life in this state. As emotions accumulate, they negatively affect the body and seek a way out in a sympatho-adrenal crisis.

Alcohol, smoking, drugs, as well as various, often very selectively influencing, external factors have an adverse effect on the regulatory function of the nervous system. For example, moving to a different climate zone, intense solar radiation, something else. There is a theory about a hereditary predisposition to the appearance of symptoms of adrenal crisis, in particular, behavioral characteristics - selfish, demonstrative, as well as an anxious personality type.

Among the internal physical reasons that can provoke a sympathoadrenal crisis are the following health problems:

adrenal tumors that cause uncontrolled adrenaline release into the blood;
tumors of the spinal cord, spine, ischemia;
existing or past neuroinfection;
suffered traumatic brain injuries;
disruptions in the functioning of the cardiovascular system;
hormonal disorders - puberty in adolescents, pregnancy, menopause, premenstrual syndrome in women, sexual dysfunctions;
diseases of the digestive system, gastrointestinal tract.

Sympathoadrenal crisis symptoms – Information that surprises

The sympatho-adrenal crisis develops quite rapidly, and, as a rule, the symptoms appear in aggregate.
Sympathetic adrenal crisis has the following characteristic symptoms:

difficulty breathing, feeling of heaviness, tightness in the chest;
feeling of cold or heat, the appearance of tremors of the limbs;
paleness of the skin;
a sharp increase in blood pressure, vasospasm;
headache, throbbing sensation;
increased heart rate, arrhythmia;
dry mouth;
emotional feeling of groundless horror, fear of death.

Vegetative-vascular dystonia causes many problems to carriers of this syndrome and deprives them of a normal, fulfilling life. One of its most severe manifestations is a sympatho-adrenal crisis.

This condition begins suddenly, the typical time is the second half of the day or night. The attack is accompanied by sharp fluctuations in blood pressure and panic, uncontrollable fear of sudden death.

The sympatho-adrenal crisis also ends suddenly, completely depriving a person of strength for several hours.

Important! A sympatho-adrenal crisis is not an indicator of a disease of the internal organs, but ignoring its symptoms and not treating the disorder on time can cause serious complications in the body.

blood pressure rises sharply;
heart rate increases;
there is a lack of air, often shortness of breath;
sudden headache begins;
the body is trembling;
hands and feet become cold;
body temperature rises;
The sensitivity of the skin increases, even to the point of pain.

From the side of emotions the following are manifested:

panic fear, usually associated with a feeling of imminent death;
unreasonable feelings of terror and danger;
distrust of others.

Vegetative-vascular dystonia causes many problems to carriers of this syndrome and deprives them of a normal, fulfilling life. One of its most severe manifestations is a sympatho-adrenal crisis.

This condition begins suddenly, the typical time is the second half of the day or night. The attack is accompanied by sharp fluctuations in blood pressure and panic, uncontrollable fear of sudden death.

The sympatho-adrenal crisis also ends suddenly, completely depriving a person of strength for several hours.

Signs

Symptoms of a sympathoadrenal crisis (panic attack) are as follows:

state of anxiety, inexplicable fear of death;
feeling of lack of air, suffocation; state on the verge of fainting;
heaviness in the chest;
cardiopalmus;
slightly increased blood pressure;
moist palms and/or heavy sweating;
tremor, chills, numbness of the limbs.

The listed reactions of the body can be combined with each other or manifest themselves most intensely only one at a time.

The duration of the attack ranges from several minutes to half an hour. The frequency varies from several episodes a day to a couple of times a month. People aged 25 to 65 years are more susceptible to the disease.

Often, a state of panic attack develops before some alarming event, which a person associates with unpleasant memories, or as an expectation of something exciting (a performance on stage, a trip in a crowded transport, before an important meeting, after a scandal).

Sometimes the patient does not realize that his illness is associated precisely with panic attack syndrome, and is not the cause of a true disease of a particular organ or system.

Fear of developing unpleasant symptoms causes new crises (sympatho-adrenal).

A vicious circle is formed and such a person tries to avoid all situations and places to which he exhibits panic attack reactions, even to the point of withdrawing into himself, depression and refusal to leave his home.

The main cause of PA is stress and chronic fatigue in the modern world. Each person’s reaction to nervous overstrain depends on his individual psychotype. Sometimes the cause of panic attacks is diencephalic syndrome, that is, dysfunction of the hypothalamus.

If, based on the listed symptoms, a person assumes that he periodically develops a sympathoadrenal crisis, treatment should begin not with a visit to a gastroenterologist, cardiologist, endocrinologist and other highly specialized specialists, but only with a visit to a psychotherapist.

Without a correct diagnosis of PA, a person will be treated for other life-threatening diseases, crises will become more frequent, and the “alarmist” will receive an ineffective drug load on the body.

Causes

Sympatho-adrenal crisis is a manifestation of vegetative-vascular dysfunction of the hypertensive type. This condition is also called a panic attack. It develops more often in the afternoon and at night. Sympatho-adrenal crisis is not a disease, but a syndrome that appears sharply in the form of an acute sudden attack and is accompanied by an increase in blood pressure.

Sympatho-adrenal crisis is a manifestation of vegetative-vascular dysfunction of the hypertensive type. This condition is also called a panic attack.

It develops more often in the afternoon and at night.

Sympatho-adrenal crisis is not a disease, but a syndrome that appears sharply in the form of an acute sudden attack and is accompanied by an increase in blood pressure.

These can be either internal psychological or physical problems, or external factors that cause emotional disorders.

The causes of sympathoadrenal crises lie both within a person - physiology, psychology, and in the external surrounding world.

Alcohol, smoking, drugs, as well as various, often very selectively influencing, external factors have an adverse effect on the regulatory function of the nervous system.

For example, moving to a different climate zone, intense solar radiation, something else.

There is a theory about a hereditary predisposition to the appearance of symptoms of adrenal crisis, in particular, behavioral characteristics - selfish, demonstrative, as well as an anxious personality type.

Among the internal physical reasons that can provoke a sympathoadrenal crisis are the following health problems:

adrenal tumors that cause uncontrolled adrenaline release into the blood;
tumors of the spinal cord, spine, ischemia;
existing or past neuroinfection;
suffered traumatic brain injuries;
disruptions in the functioning of the cardiovascular system;
hormonal disorders - puberty in adolescents, pregnancy, menopause, premenstrual syndrome in women, sexual dysfunctions;
diseases of the digestive system, gastrointestinal tract.

This disease is a borderline condition, which is associated with the functioning of the central nervous system, endocrine glands, heart and blood vessels. Its development is explained by several groups of factors:

genetic predisposition;
increased work of the adrenal glands, which produce stress hormones - adrenaline, cortisol;
lack of psychological protection of the brain from the unconscious feeling of anxiety (inability to cope with stress).

The most reliable theory is about false recognition of signals that arise for the following reasons:

past infectious diseases;
chronic sluggish inflammatory processes;
hormonal changes in the body - puberty, pregnancy, childbirth, menopause;
use of medications, especially uncontrolled addiction to tonics or sedatives, sleeping pills;
overwork;
insufficient sleep duration;
overheating, excessive exposure to the sun;
change of weather, climate;
psycho-emotional stress;
drinking alcohol or large amounts of coffee.

Against the background of such irritants, the body experiences rapid heartbeat, headache, dizziness, and breathing problems.

The cerebral cortex perceives them as a threat to life, through the pituitary gland and hypothalamus it gives commands to the adrenal glands to release the danger hormone - adrenaline.

At the same time, pathological sensations increase many times over, and fear of death, panic, anxiety, thoughts of death, and madness are added to them.

Such a vegetative storm is called a panic attack. A sympathoadrenal crisis forces the patient to look for the reasons for the sensations that are quite difficult for him.

Patients begin to turn to doctors, vividly describing their feelings and do not calm down, since no diseases are found in them.

A pathological fixation on the slightest changes in well-being appears, which is accompanied by an increase in panic attacks.

Psychologists identify a number of personality traits that often cause sympathoadrenal crises:

inability to relax;
ignoring social contacts, loneliness;
lack of attention in childhood;
tendency to be the center of attention;
excessive demands on others;
increased sensitivity, touchiness, dependence on other people's opinions;
excessive concern for health, hypochondria.

And here is more information about the crisis with pheochromocytoma.

There can be many predisposing factors and causes for a crisis to occur in the sympathetic system. The main trigger is the release of adrenaline into the bloodstream due to a malfunction in the peripheral nervous system.

negative habits - abuse of alcohol and tobacco products;
psycho-emotional stress;
severe stressful situations;
hormonal fluctuations - in adolescents, in elderly people;
human neuroinfections;
pathologies of the digestive and urinary system;
cardiovascular diseases;
vascular diseases – atherosclerosis;
obesity;
Personal characteristics – increased anxiety;
history of traumatic brain injury;
negative hereditary predisposition.

Some of the reasons a person can prevent are high cholesterol levels and physical inactivity. While others, for example, endocrine diseases of the adrenal cortex, are not amenable to preventive measures.

The first adrenal crisis requires immediate consultation with a doctor and a comprehensive medical examination. Once precipitating conditions are identified and addressed, the incidence of ill health can be minimized.

Source: https://nevrolog-info.ru/simpatoadrenalovyy-kriz/

Diagnosis of pathology

It is necessary to diagnose a sympatho-adrenal crisis based on its manifestations. To confirm the diagnosis of adrenal crisis, a detailed study of the anamnesis is carried out, and the likelihood of hereditary causes of this disorder is determined. The doctor asks about bad habits, diet, and the psychological environment in which the patient exists. Sympathoadrenal crisis has many symptoms, so it was necessary to develop diagnostic criteria:

attacks are repeated, periodic, spontaneous, unpredictable;
there is no real threat or specific reason;
there are vegetative symptoms in the form of tachycardia, hypertension;
there is uncontrollable anxiety, fear of repeated attacks, as well as places and situations associated with attacks;
There are no pathologies with a similar clinical picture.

It is important to distinguish a sympathoadrenal crisis from diseases that are caused by disorders of the cardiovascular, endocrine systems, and metabolic disorders. For this purpose, differentiated diagnostics is carried out with a number of diseases:

hyperthyroidism;
pathology of the adrenal glands caused by Addison's disease and primary adrenal crisis;
tumors of the central nervous system;
certain forms of epilepsy;
bronchial asthma with severe breathing disorders;
presence of mental illness, phobias;
post-traumatic stress.

To diagnose adrenal crisis, doctors prescribe a comprehensive examination - an electrocardiogram and ultrasound examination of the heart, adrenal glands, and thyroid gland. The patient is prescribed a brain tomography, spinal cord examination, and consultation with a neurologist.

First aid for an attack

Emergency care for sympatho-adrenal crisis is most often not necessary. A person can overcome an attack on their own, especially if they are able to take control of their condition. An attack requires the correct response from those around the patient. Excessive attention and anxiety about health can fix unwanted behavior. It is important to act in such a way as not to increase a person’s anxiety and experiences.

If an adrenal crisis has begun, you need to calm the patient, ensure a sufficient flow of fresh air, and unfasten constricting clothing. Can be laid horizontally. Of the sedatives, it is worth using Corvalol or Validol, Captopril. It is advisable to measure the pressure. For high blood pressure, you can give medicine that the patient usually uses to control hypertension.

If there is no improvement after 15–20 minutes, it’s time to call an ambulance. The arriving doctor will inject Relanium. To slow down the excessive activity of the sympathoadrenal system, it may be suggested to administer Obzidan or Verapamil.

Therapy for sympathoadrenal crisis

Adrenal crisis has symptoms of both autonomic dysfunction in the body and emotional disorders, so treatment must be comprehensive - medication and psychotherapy, and an individual treatment regimen for each patient is important. But the healing process must begin with a complete revision of the patient’s lifestyle.

You need to establish a rhythm of life: get enough rest (get at least 7–8 hours of sleep, go to bed before midnight), avoid physical and mental overload. The diet will also have to be changed: minimize fatty foods, drinks that excite the nervous system, and enrich the diet as much as possible. Avoid stressful and traumatic situations, any negative external influences. Increase physical activity, especially outdoors. Learn to relax and “work through” emotions.

Many techniques for working on your character can be found on the Internet. For example, the advice of Nikita Valerievich Baturin, a specialist in combating fears and psychosomatics, will be useful.

Treatment with medications

Drug treatment of sympathoadrenal crises is indicated primarily for moderate and severe degrees of the disease. The following groups of drugs can be prescribed by a doctor:

Tranquilizers reduce the excitability of the central nervous system. Medicines of this series relieve symptoms, but do not eliminate the causes of adrenal crises. Apply for a short period at the beginning of treatment.
Beta blockers can neutralize the effect of adrenaline and thus stop or prevent an attack.
Antidepressants are prescribed for a long time (from six months to a year), but after discontinuation, relapse is still possible.
Sedative herbal medicines based on sage, motherwort, valerian, and hawthorn are an alternative to complex sedatives. The course of treatment is long - 6–12 months.
To improve blood supply to tissues, especially in the presence of ischemia, Cinnarizine and Cavinton are prescribed.
Nootropic drugs improve the metabolism of nerve tissue.

Attention! Independent selection of medications is strictly prohibited. Prescription of medications for the treatment of sympathoadrenal crisis is carried out only by a qualified specialist.

Psychotherapeutic treatment

Observation and treatment by a psychotherapist can reduce the symptoms of sympathoadrenal crises already at the beginning of therapy. During individual or group psychotherapeutic sessions for the treatment of sympathoadrenal crisis, two goals must be achieved:

Convince the patient that an adrenal crisis should not be expected to pose a threat to life or complications, and that it is not a sign of severe internal illness.
Change the patient’s existing stereotype of behavior, his attitude towards people around him and the world, as well as towards himself.

In the course of working with a psychotherapist, psychological conflicts are identified that have not found a way out and are not recognized by the patient. In case of relapse of attacks, repeated courses of psychotherapy are effective.

The patient’s independent work on his character, the development of self-control, and the ability to relax will bring closer the desired result in overcoming the disorder. Useful information and specific advice can be found on the channel of psychologist Nikita Valerievich Baturin

Treatment

Despite the obligatory presence of autonomic dysfunction in an attack and the often implicit nature of emotional disorders, the main methods of treating panic disorder are psychotherapy and psychopharmacology.

Psychopharmacology

SSRI antidepressants are used for a long time, at least 6 months; as well as tranquilizers (alprazolam, clonazepam) for a short course - up to 14 days.

For some time, highly potent benzodiazepines such as alprazolam and clonazepam were considered the first choice drugs for the treatment of panic disorder. But their lack of effectiveness against symptoms of depression, which often co-occurs with panic attacks, and significant side effects have reduced their popularity. SSRIs have become the first-line drugs of choice.[5]

In patients with a history of manic states, the use of benzodiazepines is preferable, since, unlike antidepressants, they do not provoke mania[6].

The use of so-called vegetotropic drugs (anaprilin, pyrroxan, belloid, bellaspon) in combination with vascular-metabolic therapy (cinnarizine, cavinton, trental, nootropil, piracetam, cerebrolysin) is ineffective, which undermines faith in the possibility of a cure and contributes to the chronicity of the disease.

Not all classes of psychotropic medications are equally effective against panic. With the right approach, panic disorder is highly treatable. An individual treatment plan is required for each patient, which should be developed by the patient together with his attending physician.

Psychotherapy

Psychotherapeutic help (help from a psychotherapist or psychologist) for panic disorder can help to understand the psychological problem, see ways to solve it, and work through the psychological conflict.

Cognitive-behavioral psychotherapy has been proven effective in treating panic disorder[7][5][6][8] (including cognitive-behavioral psychotherapy delivered via the Internet[9]). According to a meta-analysis, in the treatment of panic attacks, cognitive behavioral psychotherapy had a higher effect size compared with pharmacological treatment and combination treatment (that is, psychopharmacotherapy in combination with psychotherapy). When using cognitive behavioral psychotherapy, fewer patients discontinued treatment compared to pharmacological and combination treatments[10]. There is evidence of greater anti-relapse activity of cognitive behavioral psychotherapy for panic disorder compared to pharmacotherapy[8]. Cognitive-behavioral psychotherapy also promotes successful discontinuation of benzodiazepines in patients with panic disorder and helps them maintain therapeutic benefits without resorting to medications[11].

In particular, within the framework of cognitive behavioral psychotherapy, the “thought stopping” method can be used to eliminate anxious thoughts that cause a panic attack [12]. A technique such as symptom replication in laboratory conditions can also be used[13]. The technique of symptom replication in the laboratory is that, using various techniques (Clark hyperventilation, the use of caffeine, or quickly climbing stairs), some of the physiological components of a panic attack are reproduced - sweating, rapid heartbeat, etc. Then the interpretations that arise in the patient are revealed these physical sensations and emotional reactions. If the patient correctly interprets the sensations that have arisen, the psychotherapist draws his attention to the connection between the interpretation and the emotional state (“You now explain the heartbeat as running up the stairs, and not as a heart attack, and you are absolutely calm”). The therapist also suggests that the patient look for an alternative explanation for the palpitations in everyday life, instead of believing that the palpitations are a clear sign of a heart attack, and rely on laboratory experience in doing so.[13]

As part of cognitive behavioral psychotherapy, the patient may also be taught relaxation skills and Clark's controlled breathing techniques during therapeutic sessions, after which the patient is recommended to use these skills in the intervals between sessions, during episodes of intense anxiety [13].

Psychoanalysis is also used in the treatment of panic disorder. From the point of view of psychoanalysts, the main cause of panic disorder is considered to be repressed psychological conflicts that do not find a way out and cannot be recognized and resolved by a person due to various reasons.

Prevention of pathology

After successful treatment, it is important to strengthen the body’s ability to resist the sympatho-adrenal crisis. Preventive measures may not be a decisive factor in eliminating attacks, but they help reduce the frequency of recurrence and soften the course. What you need to make a good habit:

establish good sleep, which allows you to completely rest and wake up refreshed;
remove fatty, spicy foods from the diet, eat more vegetables, fruits, cereals, and dairy products;
give up alcoholic drinks, energy drinks, reduce coffee consumption;
spend more time outdoors, especially before bedtime;
watch less TV, sit in front of the computer, limit the flow of negative information;
A contrast shower strengthens the nervous system;
if you have problems with the spine, it is useful to consult a massage therapist or chiropractor;
play sports (without overload) or at least increase physical activity;
practice breathing exercises, meditation;
avoid stressful situations, unpleasant emotions;
train self-control, try to always control yourself in a stressful situation or when an attack occurs.

The path to complete relief from the symptoms of adrenal crises sometimes requires a person to radically change their lifestyle, part with their favorite habits, many of which simply destroy the body. But anyone who has experienced such an attack more than once will probably choose the latter between life in constant fear and life with reasonable restrictions. And he will be absolutely right.