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).
