Poliklinikte Panik Atak ile Gelen Hastanın Yönetim
Özet
Panik atak, aniden başlayıp doruğa ulaşan yoğun korku nöbetleriyken; panik bozukluk, bu atakların tekrarlamasıyla oluşan işlev kaybı ve beklenti kaygısı durumudur. Ataklar esnasında taşikardi, nefes darlığı, ölüm ve kontrolü kaybetme korkusu gibi bedensel ve zihinsel belirtiler görülür. Birçok tıbbi hastalıkta panik atak tablosu eşlik edebildiğinden, birinci basamakta miyokard enfarktüsü ve hipertiroidi gibi organik nedenlerin tespiti için EKG ve laboratuvar tetkikleriyle ayırıcı tanı yapılması kritiktir. Etyolojisinde genetik, çevresel ve nörokimyasal faktörler rol oynar. Tedavide ilk seçenek, yan etkileri düşük olan SSRI grubu antidepresanlardır; ancak etkinlik başlayana dek ilk haftalarda benzodiyazepinler de kısa süreli eklenebilir. İlaç tedavisinin yanı sıra, katastrofik yorumları ve kaçınma davranışlarını ortadan kaldırmayı hedefleyen Bilişsel Davranışçı Terapi başta olmak üzere psikoterapiler ve poliklinikte uygulanabilecek solunum-gevşeme egzersizleri hastanın yönetiminde anlamlı iyileşme sağlar. Standart tedavilere yanıt vermeyen, intihar riski taşıyan veya ek psikiyatrik hastalığı olan vakalar uzmana yönlendirilmelidir.
Panic attacks are intense bouts of fear that start suddenly and peak, while panic disorder is a state of functional loss and anticipatory anxiety caused by the recurrence of these attacks. During attacks, physical and mental symptoms such as tachycardia, shortness of breath, and fear of death or losing control are observed. Since panic attacks can accompany many medical illnesses, it is critical to perform differential diagnosis with ECG and laboratory tests in primary care to detect organic causes such as myocardial infarction and hyperthyroidism. Genetic, environmental, and neurochemical factors play a role in its etiology. The first choice in treatment is SSRI group antidepressants, which have low side effects; however, benzodiazepines can also be added for a short period in the first weeks until efficacy begins. In addition to pharmacotherapy, psychotherapies—primarily Cognitive Behavioral Therapy, which aims to eliminate catastrophic interpretations and avoidance behaviors—and breathing-relaxation exercises that can be applied in outpatient clinics provide significant improvement in patient management. Cases that do not respond to standard treatments, carry a risk of suicide, or have comorbid psychiatric illnesses must be referred to a specialist.
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