Panic Disorder – Neuropsychiatric Profile

Czech version

Authors: prof. MUDr. Peter Kukumberg, PhD.
Authors‘ workplace: II. Neurologická klinika FNsP a LF UK Bratislava
Published in: Cesk Slov Neurol N 2007; 70/103(1): 6-15
Category: Minimonography

Venované pamiatke nestora československej neurológie akademikovi Jozefovi Černáčkovi, DrSc.: V krušných posledných rokoch jeho života mi otváral byt z vozíčka, aby som spoznával jeho udivujúci ľudský rozmer – symbiózu stoickej múdrosti a neutíchajúcej všestrannej zvedavosti, vzácnu harmóniu rozumu a citu a nerezignujúci postoj k nepriazni osudu. Autor

Overview

Dominant specific fear (panic) classifies panic disorder to quad vitam benign and quad sanationem chronic psychiatric diseases. A panic attack is a cardinal symptom complex: about 30-minutes’ mostly spontaneous repeating paroxysm of panic with various manifestations of neurovegetative excess. Anticipation fear and agoraphobia develop in more severe or unrecognized cases. Similar organicly conditioned situations (e.g., myocardial infarction) as well as independent neurological affections (neurogenic tetanic syndrome, hyperventilation syndrome) must be eliminated. There is about 8% prevalence in population, and it culminates in the middle age. Congenital (genetically bound) neurotransmitter dysfunction (especially noradrenergic and serotogenic one) in predilection sites of the brainstem, limbic structures, cortical areas with apt neurophysiological (EEG, evoked potentials, etc.) and imaging (CT, MRI, PET, etc.) correlates has been suggested. From the view of pathophysiology, hypersensitivity of respiration centres in the brainstem has been considered. The so-called catastrophic processing of innocent body sensations represents a psychogenic pathogenetic impulse. A panic attack may be also provoked (modelled) in many ways (sodium lactate, CO2, etc.). The early combination of focused pharmacotherapy and psychotherapy gives the best effects. A panic disorder also appears to be a noticeable ethalon of neuropsychiatric disharmony probably rudimentary or deliberated protective archetype – a pattern of man (not associated with a classical stress reaction).

Key words:
panic disorder – panic attack – neurovegetative excess - anticipation fear – agoraphobia – locus coeruleus – neurotransmitters – hypersensitivity of respiration centres – sodium lactate

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