VEGETATIVE CRISES

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

VEGETATIVE CRISES - paroxysmal states of a non-epileptic nature, which manifest themselves in polymorphic vegetative disorders associated with the activation of central (nasegmental) vegetative structures. In a small part of cases, crises can be associated with an organic lesion of the hypothalamus or the structures of the limbic-reticular complex (in this case they usually arise not in isolation but in the background of other neurologic or neuroendocrinal disorders). Sometimes crises occur in mental, somatic, endocrine disorders, under the influence of medicines. But in the overwhelming majority of cases, vegetative crises are accompanied by distinct mental disorders (psychovegetative paroxysms), represent a special form of neurotic disorder, which in the International Classification of Diseases of the 10th revision is designated as panic disorder. Panic disorder is a variant of anxiety disorders and manifests itself mainly by repeated psycho-vegetative paroxysms, or panic attacks. In the origin of panic disorder, along with psychogenic factors, hereditary predisposition and dysfunction of peripheral vegetative structures play an important role.

Vegetative crises usually occur between the ages of 20 to 40 and 2 times more often in women. The first crisis often occurs against a background of complete health and manifests itself in several minutes of anxiety and a set of vegetative disorders: a feeling of lack of air, palpitations, tachycardia, pain or discomfort in the left half of the chest, chill-like tremor, hyperhidrosis, heat waves or cold, crawling , Faintness, dizziness, pre-patchy condition, discomfort or pain in the abdomen, nausea or vomiting, frequent urination. A significant increase in blood pressure is not typical for a vegetative crisis, although sometimes, especially during the first crisis, significant hypertension is possible . Functional neurological (hysterical) symptoms (lump in the throat, weakness or numbness in the extremities, mutism, loss of vision), peculiar psychic phenomena, such as depersonalization (alienation from one's own personality) or derealization (a sense of unreality of what is happening) may also be noted. Sometimes during a crisis, dizziness and other vestibular symptoms appear. Anxiety during a crisis is often of a diffuse, deep nature, but sometimes acquires a certain direction in the form of fear of death, fear of losing control over oneself, etc. The duration of the crisis usually does not exceed 20-40 minutes.

Crises often tend to repeat, with their frequency varying from several times a year to several times a day. As the crises recur, many patients experience obsessive anxiety about the expectation of new crises. Patients begin to avoid places where they think they will not be able to get help or where they can not get out if they have a crisis, especially in crowded places and public transport (especially the metro). This fear is referred to as agoraphobia.

The diagnosis of vegetative crises primarily requires the elimination of serious somatic, endocrine, neurological and mental diseases: epilepsy, coronary heart disease, cardiac rhythm disturbances, bronchial asthma, syncope, migraine, vestibulopathy, insulinoma, pheochromocytoma. It should be borne in mind that vegetative crises can be the first manifestation of schizophrenia, endogenous depression , special or social phobias, in which psychovegetative paroxysms occur in strictly defined situations, for example, when crossing the bridge. In these cases, the patient should be referred to a psychiatrist.

Treatment. A thorough examination and comprehensive research not only excludes organic diseases, but also allows you to establish a trusted relationship with the patient. It is important to relieve the patient of fear of having a life-threatening illness and explain in detail the essence of his suffering. There are two groups of drugs that can prevent the emergence of crises: antidepressants (amitriptyline, clomipramine , doxepin, melipramine, fluvoxamine , sertraline , tianeptine) and benzodiazepines (alprazolam, clonazepam , lorazepam). Antidepressants are slow (their effect occurs after 2 to 3 weeks after reaching the effective dose), sometimes through transient deterioration. Benzodiazepines begin to act more quickly - after a few days, but when they are used, there is a danger of developing tolerance and drug dependence, which forces them to limit the duration of their appointment. Treatment is often started with a combination of antidepressant and benzodiazepine, then benzodiazepine is gradually withdrawn and treated with an antidepressant. Long-term maintenance therapy is often needed. Wegetotropes are used as additional agents. More often, beta-blockers are used - propranolol (anaprilin) ​​20 - 40 mg 3 times a day, nadolol (corgard) 40 to 80 mg once a day, oxprenolol (tracicore) 20 mg 3 times a day, which can reduce tachycardia , Caused by tricyclic antidepressants, or alpha-adrenoblockers (pyrroxane 15 mg, phentolamine 20 mg 3 times a day). As an additional tool, butyroxane 10 mg or belloid (bellataminal) is sometimes used for 1 dragee 3 times, and with pronounced vestibular symptoms (rotational dizziness accompanied by nausea or vomiting) - cinnarizine , tourecan.

To stop the crisis, it is usually enough to take 1-2 tablets of diazepam (Relanium) and 1 tablet (40 mg) of propranolol (anaprilin), sometimes in combination with 20 drops of valocardin or corvalolum, under the tongue or chew. The slow deep breathing, the use of a paper bag into which the patient exhales, and from there inhales air, enriched in this way with carbon dioxide, contribute to the crisis relief. The patient, who has learned to independently cope with the crisis, significantly reduces the anxiety of waiting for new crises and thereby improves the state as a whole. It should avoid the formation of the patient's "dependence on the injection", which strengthens his belief in the presence of a serious disease.