Author/Editor		Rebolj, Klemen
Title		Bolnik s panično motnjo v ambulanti družinskega zdravnika
Translated title		Patients with panic disorders in a family practitioner's office
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 45, št. Suppl 1
Publication year		2006
Volume		str. 29-35
Language		slo
Abstract		Anxiety disorders are the most frequent among mental disorders seen in clinical practice. They are very often interwoven with other mental disorders, especially depression. Family doctors (general practitioners) should be able to recognize anxiety with multi-layered symptoms in various combinations and to discern them from other mental or somatic disorders. Panic attacks with prominent fears and many physical or cognitive symptoms represent the most severe form of anxiety. Panic disorder is defined as unexpected and repetitive panic attacks for at least one month. They may overwhelm the patient with a strong fear of further attacks, so that his or her life becomes markedly changed. Many patients with panic disorder have concurrent agoraphobia, i. e. a specific fear of situations and places where escape is difficult or impossible, and help seems improbable. Through examination, general practitioners should exclude somatic disorders, diagnose panic disorder and start appropriate treatment as soon as possible. SSRIs (selective serotonin reuptake inhibitors) are the first-choice treatment for panic disorder. Treatment is initiated with a low dose of an SSRI, which is then slowly increased. The final doses are usually higher than those for treating depression. Treatment of panic disorder with an SSRI antidepressant may last up to 2 years. If anxiety is significantly increased during the first few weeks of treatment, a benzodiazepine is introduced and its dose is then soon reduced. If the patient does not respond within a few weeks or if comorbidity is evident, he or she should be referred for (sub)specialist treatment of anxiety disorders by a psychiatrist.
Summary		Anksiozne motnje so v klinični praksi najpogostejše duševne motnje, pri katerih večkrat opazujemo medsebojno prepletanje, neredko pa se jim pridruži tudi depresija. Družinski zdravnik naj bi v svoji ambulanti prepoznal anksioznost (tesnobo, bojazen) z mnogoterimi, različno kombiniranimi simptomi, ter jo ločil od drugih duševnih motenj in različnih telesnih obolenj. Panični napad z izrazitim občutkom strahu ter številnimi možnimi telesnimi in kognitivnimi simptomi anksioznosti predstavlja največjo možno tesnobo. Bolnik, ki ima nepričakovane, ponavljajoče panične napade vsaj en mesec, je že vnaprej zaskrbljen za vse napade, ki bi jih še lahko imel in se mu zaradi omenjenega spremeni življenje, ima panično motnjo. Mnogo bolnikov s panično motnjo ima pridruženo agorafobijo. Zanjo je značilen strah pred situacijami oz. prostori, iz katerih je odhod otežen ali nemogoč oz. je pomoč v njih težko dostopna. Osebni zdravnik naj bi po pregledu in izključitvi pomembnejših telesnih obolenj diagnosticiral panično motnjo in bolnika čim prej začel ustrezno zdraviti. SSRI-ji (angl. selective serotonin reuptahe inhibitors), selektivni zaviralci ponovnega privzema serotonina, so danes zdravilo prvega izbora za zdravljenje panične motnje; zdravljenje začnemo z nizkim odmerkom SSRI-ja, ki ga postopoma višamo, končni terapevtski odmerek pa je običajno višji od odmerka za zdravljenje depresije. Zdravljenje panične motnje z antidepresivom traja običajno do dve leti. Predvsem v prvih tednih zdravljenja bolnikom, pri katerih je izražena povečana tesnoba, dodajamo benzodizepin, katerega odmerek postopoma manjšamo. Če bolnik v nekaj tednih ne odreagira na ustrezno medikamentozno zdravljenje oz. je očitna komorbidnost z drugimi duševnimi motnjami, naj ga osebni zdravnik napoti v (sub)specialistično obravnavo anksioznih motenj k psihiatru.
Descriptors		PANIC DISORDER FAMILY PRACTICE AGORAPHOBIA