Objective. In medical practice in general, the co-morbidity of mental and somatic diseases is very common. The aim of this paper is to point out the importance of holistic approach and differential diagnostics with the complete diagnostics of the procedure of all somatic symptoms in a patient, taking into account the experience of a panic disorder in relation to the existence of somatic symptoms. Methods. The examination was conducted in the service of psychiatry of the General Hospital Sabac in Sabac, in the period from 01/03/2017 until 31/05/2017. The analysis of the results was obtained by monitoring 48 patients with the basic diagnosis of panic disorder (F41.0). The study was based on the anamnesis and clinical picture of the disease and the use of the test-Beck's anxiety inventory for the assessment of panic disorder, and answers were given using the Likert scale. The somatic symptoms of panic attack were addressed by Spearman's correlation analysis within the group of symptoms classified by body systems, and the statistical significance of correlation analysis was estimated at the level of 0.05. Consultative examinations of somatic medicine specialists were performed, with diagnostic procedure from the necessary areas. Results. By analyzing the demographic characteristics of the patients included in the examination, the results show that somatic symptoms of panic attack more commonly occur in women 64.52%, in patients who are in the marital union 56.25% and who are engaged 39.58%. The average age of the patients in the sample was 33.3 years. The frequency of physical symptoms of panic attacks indicates that the most common are cardiac symptoms 97.92%, respiratory symptoms 95.83%, balance disorders 81.25% and gastroenterological disorders 77.08%. The symptom of heart skipping a beat has a statistically significant correlation with the symptom of palpitation or accelerated cardiac activity, but not with other symptoms in this group, while all symptoms of respiratory and gastroenterological disorders show a statistically significant correlation between them. Symptoms that indicate neurootologic symptoms showed a statistically significant correlation, except for the symptoms of fainting and instability. Conclusion. Significant correlations of somatic symptoms and of panic attacks indicate that they may occur in groups that correspond to particular organ systems. Early detection of panic disorder and adequate treatment exclude long-lasting diagnostic procedures and economic exhaustion in order to confirm or exclude somatic illness. On the other hand, it is not necessary to ignore the detailed treatment of the patient in relation to physical problems in addition to having psychic ones or if the patient is a psychiatric patient.

ABSTRACT

Psihosomatske bolesti ukazuju na uzročnu povezanost mentalnih i somatskih oboljenja u kliničkoj praksi. Sindrom "slomljenog srca" ili takotsubo kardiomiopatija je novijeg datuma i prvi put su je opisali 1991. godinejapanski lekari. Sindrom se 9 puta češće javlja kod žena, a karakteristično je da kod preko 60% bolesnika, nastanku simptoma predhodi snažan emocionalni stres.Ovo stanje oponaša simptome srčanog infarkta, te se često u takvom stanju pacijentu postavlja pogrešna dijagnoza. PRIKAZ SLUČAJA: Pacijent ranije nije lečen kao kardiološki i psihijatrijski bolesnik. Sedam dana pre pojave akutnih kardioloških tegoba, predhodila je stresna situacija-smrt supruge pacijenta. Primljen je kao hitan slučaj u koronarnu jedinicu internog odeljenja Opšte Bolnice Šabac, a sledećeg dana, zbog kliničkog nalaza, upućen u Opštu Bolnicu u Valjevu na hitnu koronarografiju. Zaključak nalaza koronarografije: na koronarnim arterijama angiografski se ne uočavaju značajne stenoze. Predložena je dalja internistička i psihijatrijska medikamentna terapija u nadležnoj bolnici. ZAKLJUČAK: Cilj nam je bio da ukažemo na neophodnost holističkog pristupa svakom pacijentnu od strane svakog lekara, jer jedini adekvatni tretman kod psihosomatskih bolesnika je istovremeno lečenje somatskog oboljenja i primena psihofarmaka. Akutni stres zbog emocionalnog gubitka uz dalje prisutnu anksioznost je izazvao akutne kardiološke tegobe, koje će se za dalje sprečiti i redovnim psihijatrijskim lečenjem. KLJUČNE REČI: sindrom "slomljenog srca" ili takotsubo kardiomiopatija, akutni stres, psihosomatika, žena.