People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They cannot predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next attack will strike.
Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you’re riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.
Panic Attack
- The person suddenly develops a severe fear or discomfort that peaks within 10 minutes.
- During this discrete episode, 4 or more of the following symptoms occur:
Chest pain or other chest discomfort
Chills or hot flashes
Choking sensation
Derealization (feeling unreal) or depersonalization (feeling detached from self)
Dizzy, lightheaded, faint or unsteady
Fear of dying
Fears of loss of control or becoming insane
Heart pounds, races or skips beats
Nausea or other abdominal discomfort
Numbness or tingling
Sweating
Shortness of breath or smothering sensation
Trembling
Panic Disorder With Agoraphobia
- The person has recurrent panic attacks that are not expected.
- For a month or more after at least 1 of these attacks, the person has had 1 or more of:
Ongoing concern that there will be more attacks.
Worry as to the significance of the attack or its consequences.
Material change in behavior, such as doing something to avoidance.
The patient also has agoraphobia. - The panic attacks are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
- The panic attacks are not better explained by another Anxiety or Mental Disorder.
Panic Disorder Without Agoraphobia
- The person has recurrent panic attacks that are not expected.
- For a month or more after at least 1 of these attacks, the patient has had 1 or more of:
Ongoing concern that there will be more attacks.
Worry as to the significance of the attack or its consequences.
Material change in behavior, such as avoidance. - The person does not have agoraphobia
- The panic attacks are not directly caused by a general medical condition or by substance use, including medications and drugs of abuse.
- The panic attacks are not better explained by another Anxiety or Mental Disorder.
Associated Features:
Depressed Mood
Somatic or Sexual Dysfunction
Addiction
Anxious or Fearful or Dependent Personality
Differential Diagnosis:
Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.
Conduct Disorder;
Mood Disorders;
Psychotic Disorders;
Attention-Deficit/Hyperactivity Disorder;
Mental Retardation; impaired language comprehension;
Typical feature of certain developmental stages.
Cause:
The exact cause of panic disorder is unknown. There may be a temporal lobe dysfunction, or the disorder may develop as a persistent pattern of maladaptive behavior acquired by learning. The most common age of onset is middle teens and early adulthood; however, panic disorder may onset at any time. A common pattern of onset is the occurrence of occasional unexpected panic attacks that then increase in frequency and are associated with mounting fears of having subsequent attacks. Over time there is often a pattern of spreading fearful avoidance and therefore can be the result of the action of a person’s ‘Automatic Learning Processes’. Stimulants, such as caffeine and cocaine, or alcohol may induce the symptoms.
Treatment:
Several different classes of treatment have been shown to be clinically effective, including cognitive and behavioral, pharmacologic, and combinations of the two.
Counseling and Psychotherapy [ See Therapy Section ]:
The most commonly used behavioral approach is graduated exposure, aimed primarily at reducing phobic avoidance and anticipatory anxiety. Cognitive-behavioral approaches, developed more recently, also treat panic attacks directly. These treatments involve cognitive restructuring, that is, changing of maladaptive thought processes and are generally used in combination with a variety of behavioral techniques, including breathing retraining and activities that target exposure to bodily sensations and external phobic situations. Among the various psychotherapeutic approaches, combined treatments that include cognitive therapy in addition to other techniques appear to be most effective, especially in reducing panic attacks. Longer term follow-up of these interventions suggests a low relapse rate.
Pharmacotherapy [ See Psychopharmacology Section ] :
Selective Serotonin Reuptake Inhibitors (SSRIs) are the drugs of choice (currently only Paxil is FDA approved for this indication).
Tricyclic Antidepressants (TCAs).
Benzodiazepines.
Monamine Oxidase Inhibitors (MAOIs).
Propanolol (Inderal).
Buspirone (Buspar).
