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
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.
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).
