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작성자	조은호 (2003-11-24 12:13:55)

제목	<한방/정신과> 공황장애

오늘은 공황장애라는 질환에 대해 말씀 드리고자 합니다.

공황장애는 잘 알려지지 않은 병에 속한 질환이긴 하지만 100명 중 1.5-3명 정도에서 발생하는 상당히 흔한 질환입니다. 그럼에도 불구하고 이 질환이 잘 알려지지 않으므로 인해 다른 질환으로 오인하여 이 병명으로 진단받기까지 답답해 하며 고생하는 경우가 종종 발생하게 됩니다.

공황장애의 증상은 공황발작이라고 하는데 대개 한 시간 이내의 짧은 시간 동안 숨을 멎을 정도로 강렬한 불안이나 죽음에 대한 공포가 나타나는 것으로, 이 때 심계항진, 빈맥, 호흡곤란, 발한 등과 같은 자율 신경계의 이상 증상들이 함께 나타나게 됩니다. 발작이 있는 동안 환자는 심장마비나 호흡장애로 죽지나 않을까 하는 공포가 엄습하게 되는데 이러한 증상은 대개 20-30분 정도 지속이 되며 1시간 이내에 점차적으로 사라지거나 갑자기 사라지게 됩니다. 이렇게 공황발작인 예고없이 자연적으로 발생하는 것을 공황장애라고 합니다. 이러한 공황발작을 경험한 환자들은 흔히 먼저 내과를 방문하게 되는데 단순한 스트레스나 히스테리성 증상 등으로 오진받기도 합니다. 대개 이러한 갑작스런 발작을 경험한 환자들은 다시 이러한 발작이 나타나는 것을 불안해 하는데 이러한 불안을 ‘예기불안’이라고 합니다. 발작이 있는 동안 호흡수가 빨라지고 심장박동이 증가되므로 자신이 죽을 것을 두려워 하여 응급실을 찾는 경우가 많은데 이러한 경우 20% 정도의 환자들이 실제로 공포로 인해 실신하기도 합니다. 또한 많은 환자들이 지나치게 호흡이 가빠져서 과호흡을 하게 되어 숨이 차게 되는 과호흡 증후군 증상을 나타내게 되는데 이 때에는 한쪽만 트인 비닐 봉지나 종이 봉지 혹은 종이를 고깔처럼 말아 입에 대 주면 도움이 될 수 있습니다.

일반적으로 공황발작에서 발견되는 증상을 말씀 드리겠습니다. 다음의 13 가지 증상 중 4가지 증상이 갑자기 나타나면 공황발작을 의심할 수 있습니다.

첫 번째 갑자기 심장이 두근거리거나 빨라진다.
두 번째 갑자기 땀이 많이 난다.
세 번째 갑자기 손, 발 혹은 몸이 떨린다.
네 번째 갑자기 숨이 막히거나 답답한 느낌이 있다.
다섯 번째 갑자기 질식할 것 같은 느낌이 있다.
여섯 번째 갑자기 가슴이 아프거나 압박감이 있다.
일곱 번째 갑자기 메스껍거나 뱃속이 불편하다.
여덟 번째 갑자기 어지럽거나 쓰러질 것 같은 느낌이 있다.
아홉 번째 갑자기 비현실적인 느낌 또는 이인증이라고 하는 자신이 달라진 느낌이 있다.
열 번째 갑자기 미쳐 버리거나, 자제력을 잃어버릴 것 같은 두려움이 있다.
열 한 번째 갑자기 죽을 것 같은 두려움이 생긴다.
열 두 번째 갑자기 둔하거나 따끔거리는 느낌이 있다.
열 세 번째 갑자기 몸에서 열이 오르거나, 오한이 난다.

위의 증상 중 4가지 증상이 갑자기 나타난다면 공황장애를 의심할 필요가 있으며 전문 치료 기관을 방문하여 진단받고 치료에 임해야 할 것입니다. 개인 마다 나타나는 증상은 각기 다르게 나타나므로 주의 깊은 관찰이 필요합니다.

현대의학에서는 공황장애가 심리적이거나 정신적인 원인에서 기인하기 보다 생물학적인 원인에 의해 발생한다고 알려져 있는데, 두뇌의 신경 전달물질인 노르에피네프린, 세로토닌, 가바(GABA) 등의 이상으로 변연계(limbic sys)나 전전두엽(prefrontal cortex)의 기능 이상을 유발하여 나타나는 질환으로 판단하고 있습니다. 변연계 이상은 불안으로, 전전두엽 이상은 공포의 형태로 나타나는 것으로 보여 집니다. 이러한 생물학적인 원인외에도 유전적인 요인도 작용하는 것으로 받아들여지고 있으며 정신적이고 심리적인 요인에 대해서도 어느 정도 인정하고 있는 편이라고 할 수 있습니다.

공황장애와 함께 동반되는 증상으로 광장공포증 혹은 임소공포증이라는 것이 있습니다. 이것은 자신이 남에게 도움을 받을 수 없다고 판단되는 장소를 가지 않으려는 공포증입니다. 특히 의료진의 진료를 급히 받을 수 없는 곳을 가지 않으려는 경향이 있습니다. 번잡한 거리나 혹은 터널, 다리나 승강기 등의 밀폐된 공간, 지하철, 버스, 비행기 등의 밀폐된 차량 등에 가거나 이용하는 것을 꺼려하거나 친구나 가족 등과 같이 하려는 경향이 심합니다. 그것은 자신이 처한 그곳에서 갑자기 공황발작을 일으켜 죽을 것 같은 상황이 되면 자신에게 도움을 줄 수 있는 사람이 아무도 없기 때문에 가지 않으려는 것입니다.

현대의학에서의 치료는 일반적으로 약물 요법이 주된 치료법이 됩니다. 다양한 항우울제와, 베조다이아제핀 등이 효과적인 것으로 알려져 있습니다. 대개 1년 정도 치료를 지속하는데 재발이 많은 편입니다. 30-90%는 약물 중단 후 다시 재발되었다고 보고 되고 있습니다. 또한 인지행동 치료도 효과적인데 이는 이 질환에 대한 바른 인식을 가지게 하여 자신이 느끼는 두려움과 공포를 잘 극복할 수 있게 도움을 주며 발작시 호흡 등을 통제할 수 있는 호흡 훈련 등을 시키기도 합니다.

한의학적으로는 이러한 공황장애는 체질적이고 기질적인 원인과 감정적인 원인에 의해 발생한다고 봅니다. 이는 인간이 기쁘거나 노하거나 두렵거나 슬프거나 하는 등의 여러 가지 감정 중 한가지 감정에만 오래 노출 된다든지 혹은 소음인이나 소양인과 같이 쉽게 예민하거나 소심해 질 수 있는 소인을 가진 사람에게서 많이 나타난다고 봅니다. 따라서 치료법은 각 개인에 맞는 침 치료와 한약 등을 병행하면서 상담치료를 병행하게 됩니다.

오늘은 공황장애에 대해 알아 보았습니다. 감사합니다.


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