panic disorder

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Related to Panic disorders: Phobias, anxiety, anxiety attack

Panic Disorder

 

Definition

A panic attack is a sudden, intense experience of fear coupled with an overwhelming feeling of danger, accompanied by physical symptoms of anxiety, such as a pounding heart, sweating, and rapid breathing. A person with panic disorder may have repeated panic attacks (at least several a month) and feel severe anxiety about having another attack.

Description

Each year, panic disorder affects one out of 63 Americans. While many people experience moments of anxiety, panic attacks are sudden and unprovoked, having little to do with real danger.
Panic disorder is a chronic, debilitating condition that can have a devastating impact on a person's family, work, and social life. Typically, the first attack strikes without warning. A person might be walking down the street, driving a car, or riding an escalator when suddenly panic strikes. Pounding heart, sweating palms, and an overwhelming feeling of impending doom are common features. While the attack may last only seconds or minutes, the experience can be profoundly disturbing. A person who has had one panic attack typically worries that another one may occur at any time.
As the fear of future panic attacks deepens, the person begins to avoid situations in which panic occurred in the past. In severe cases of panic disorder, the victim refuses to leave the house for fear of having a panic attack. This fear of being in exposed places is often called agoraphobia.
People with untreated panic disorder may have problems getting to work or staying on the job. As the person's world narrows, untreated panic disorder can lead to depression, substance abuse, and in rare instances, suicide.

Causes and symptoms

Scientists are not sure what causes panic disorder, but they suspect the tendency to develop the condition can be inherited. Some experts think that people with panic disorder may have a hypersensitive nervous system that unnecessarily responds to nonexistent threats. Research suggests that people with panic disorder may not be able to make proper use of their body's normal stress-reducing chemicals.
People with panic disorder usually have their first panic attack in their 20s. Four or more of the following symptoms during panic attacks would indicate panic disorder if no medical, drug-related, neurologic, or other psychiatric disorder is found:
  • pounding, skipping or palpitating heartbeat
  • shortness of breath or the sensation of smothering
  • dizziness or lightheadedness
  • nausea or stomach problems
  • chest pains or pressure
  • choking sensation or a "lump in the throat"
  • chills or hot flashes
  • sweating
  • fear of dying
  • feelings of unreality or being detached
  • tingling or numbness
  • shaking and trembling
  • fear of losing control or going crazy
A panic attack is often accompanied by the urge to escape, together with a feeling of certainty that death is imminent. Others are convinced they are about to have a heart attack, suffocate, lose control, or "go crazy." Once people experience a panic attack, they tend to worry so much about having another attack that they avoid the place or situation associated with the original episode.

Diagnosis

Because its physical symptoms are easily confused with other conditions, panic disorder often goes undiagnosed. A thorough physical examination is needed to rule out a medical condition. Because the physical symptoms are so pronounced and frightening, panic attacks can be mistaken for a heart problem. Some people experiencing a panic attack go to an emergency room and endure batteries of tests until a diagnosis is made.
Once a medical condition is ruled out, a mental health professional is the best person to diagnose panic attack and panic disorder, taking into account not just the actual episodes, but how the patient feels about the attacks, and how they affect everyday life.
Most health insurance policies include some limited amount of mental health coverage, although few completely cover outpatient mental health care.

Treatment

Most patients with panic disorder respond best to a combination of cognitive-behavioral therapy and medication. Cognitive-behavioral therapy usually runs from 12-15 sessions. It teaches patients:
  • how to identify and alter thought patterns so as not to misconstrue bodily sensations, events, or situations as catastrophic
  • how to prepare for the situations and physical symptoms that trigger a panic attack
  • how to identify and change unrealistic self-talk (such as "I'm going to die!") that can worsen a panic attack
  • how to calm down and learn breathing exercises to counteract the physical symptoms of panic
  • how to gradually confront the frightening situation step by step until it becomes less terrifying
  • how to "desensitize" themselves to their own physical sensations, such as rapid heart rate
At the same time, many people find that medications can help reduce or prevent panic attacks by changing the way certain chemicals interact in the brain. People with panic disorder usually notice whether or not the drug is effective within two months, but most people take medication for at least six months to a year.
Several kinds of drugs can reduce or prevent panic attacks, including:
  • selective serotonin reuptake inhibitor (SSRI) antidepressants like paroxetine (Paxil) or fluoxetine (Prozac), are approved specifically for the treatment of panic
  • tricyclic antidepressants such as clomipramine (Anafranil)
  • benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin)
Finally, patients can make certain lifestyle changes to help keep panic at bay, such as eliminating caffeine and alcohol, cocaine, amphetamines, and marijuana.

Alternative treatment

One approach used in several medical centers focuses on teaching patients how to accept their fear instead of dreading it. In this method, the therapist repeatedly stimulates a person's body sensations (such as a pounding heartbeat) that can trigger fear. Eventually, the patient gets used to these sensations and learns not to be afraid of them. Patients who respond report almost complete absence of panic attacks.
A variety of other atlernative therapies may be helpful in treating panic attacks. Neurolinguistic programming and hypnotherapy can be beneificial, since these techniques can help bring an awareness of the root cause of the attacks to the conscious mind. Herbal remedies, including lemon balm (Melissa officinalis), oat straw (Avena sativa), passionflower (Passiflora incarnata), and skullcap (Scutellaria lateriflora), may help significantly by strengthening the nervous system. Homeopathic medicine, nutritional supplementation (especially with B vitamins, magnesium, and antioxidant vitamins), creative visualization, guided imagery, and relaxation techniques may help some people experiencing panic attacks. Hydrotherapies, especially hot epsom salt baths or baths with essential oil of lavender (Lavandula officinalis), can help patients relax.

Prognosis

While there may be occasional periods of improvement, the episodes of panic rarely disappear on their own. Fortunately, panic disorder responds very well to treatment; panic attacks decrease in up to 90% of people after 6-8 weeks of a combination of cognitive-behavioral therapy and medication.
Unfortunately, many people with panic disorder never get the help they need. If untreated, panic disorder can last for years and may become so severe that a normal life is impossible. Many people who struggle with untreated panic disorder and try to hide their symptoms end up losing their friends, family, and jobs.

Prevention

There is no way to prevent the initial onset of panic attacks. Antidepressant drugs or benzodiazepines can prevent future panic attacks, especially when combined with cognitive-behavioral therapy. There is some suggestion that avoiding stimulants (including caffeine, alcohol, or over-the-counter cold medicines) may help prevent attacks as well.

Resources

Organizations

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. (888) 357-7924. http://www.psych.org.
Anxiety Disorders Association of America. 11900 Park Lawn Drive, Ste. 100, Rockville, MD 20852. (800) 545-7367. http://www.adaa.org.
Freedom From Fear. 308 Seaview Ave., Staten Island, NY 10305. (718) 351-1717.
National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.
National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272-7166. http://www.lexington-online.com/naf.html.
National Institute of Mental Health, Panic Campaign. Rm 15C-05, 5600 Fishers Lane, Rockville, MD 20857. (800) 647-2642. http://www.nimh.nih.gov.
National Mental Health Association. 1021 Prince St., Alexandria, VA 22314. (703) 684-7722. http://www.nmha.org.

Other

The Anxiety and Panic Internet Resource. http://www.algy.com/anxiety.
Anxiety Network Page. http://www.anxietynetwork.com.
National Institute of Mental Health Page. http://www.nimh.nih.gov.
"Panic Disorder." Internet Mental Health Page. http://www.mentalhealth.com.

Key terms

Agoraphobia — Fear of open spaces.
Benzodiazepines — A class of drugs that have a hypnotic and sedative action, used mainly as tranquilizers to control symptoms of anxiety or panic.
Cognitive-behavioral therapy — A type of psychotherapy used to treat anxiety disorders (including panic disorder) that emphasizes behavioral change together with alteration of negative thought patterns.
Selective serotonin reuptake inhibitors (SSRIs) — A class of antidepressants used to treat panic that affects mood by boosting the levels of the brain chemical serotonin.
Tricyclic antidepressants — A class of antidepressants named for their three-ring structure that increase the levels of serotonin and other brain chemicals. They are used to treat depression and anxiety disorders, but have more side effects than the newer class of antidepressants called SSRIs.

panic

 [pan´ik]
acute, extreme anxiety with disorganization of personality and function; panic attacks are characteristic of panic disorder (see anxiety disorders) and may also occur in other mental disorders.
panic disorder an anxiety disorder characterized by recurrent attacks of panic, episodes of intense apprehension, fear, or terror associated with somatic symptoms such as dyspnea, palpitations, dizziness, vertigo, faintness, or shakiness and with psychological symptoms such as feelings of unreality, fear of dying, going crazy, or losing control; there is usually chronic nervousness between attacks. It is almost always associated with agoraphobia and is officially classified as either panic disorder with agoraphobia or panic disorder without agoraphobia. This disorder does not include panic attacks that may occur in phobias when the patient is exposed to the phobic stimulus.
homosexual panic a severe episode of anxiety due to unconscious conflicts involving sexual identity; see also homosexual panic.

pan·ic dis·or·der

[MIM*167870]
recurrent panic attacks that occur unpredictably. See: generalized anxiety disorder.

panic disorder

n.
An anxiety disorder characterized by recurrent panic attacks and fear of further attacks. The panic attacks are typically not triggered by any specific situation, but some people also experience attacks that are associated with specific triggers.

panic disorder

panic disorder

Atypical depression, polysystemic dysautonomia Psychiatry An idiopathic psychogenic complex affecting 1.5% of US, characterized by recurrent and unpredictable episodes–panic attacks of sudden, extreme apprehension, fear, autonomic nervous system hyperactivity Clinical Dyspnea, palpitations, chest pain, choking sensation, tachycardia, vertigo, loss of reality sense, paresthesias, hot/cold flashes, sweating, faintness, trembling, a fear of dying or of 'going crazy'; fear of an attack in public may cause functional agoraphobia; Pts with PD have an 18-fold ↑ risk of suicidal ideation than a mentally 'fit' population. See Agoraphobia. Cf Panic attack.

pan·ic dis·or·der

(pan'ik dis-ōr'dĕr)
Recurrent panic attacks that occur unpredictably.
See: generalized anxiety disorder

panic disorder

A condition featuring recurrent brief episodes of acute distress, mental confusion and fear of impending death. The heart beats rapidly, breathing is deep and fast and sweating occurs. Overbreathing (hyperventilation) often makes the attack worse. These attacks usually occur about twice a week but may be more frequent and they are especially common in people with AGORAPHOBIA. The condition tends to run in families and appears to be an ORGANIC disorder with a strong psychological component. Treatment is with antidepressant drugs, especially the tricyclic group, and MONOAMINE OXIDASE INHIBITORS. Cognitive behaviour therapy can also be helpful.

pan·ic dis·or·der

(pan'ik dis-ōr'dĕr) [MIM*167870]
Recurrent panic attacks that occur unpredictably.

Patient discussion about panic disorder

Q. I’ve read somewhere that asthma attacks and panic attacks have similar symptoms. so how can you know tell if what you are experiencing is one or the other?

A. brandon is right, but people who have asthma sometimes panic when they are having an attack because they are affaid,scared.

Q. Is there any herb good for panic attacks that work right away?

A. I am not familiar with any herbs that can solve panic attacks. Panic attack is a medical condtion and if you are experiencing it often you should seek medical care, in order to provide you with proper treatment, either behavioural or with medications. There are good medications out there that can work fast and help you with panic attack symptoms.

More discussions about panic disorder
References in periodicals archive ?
The present study aimed to determine the incidence rate of pregnancy-onset panic disorder (POPD) among Turkish pregnant women using a diagnostic interview.
3 times the odds of having major depressive disorder and nearly five times the odds of panic disorder as the one-fifth with the lowest lead levels (0.
Evaluations conducted by a psychologist blinded to randomization showed that immediately after treatment, the 13 patients treated with CBT showed less panic symptom severity on the Panic Disorder Severity Scale and by self-report than the 22 patients treated with PFPP.
While panic attacks and panic disorder can significantly affect your quality of life, medications, psychotherapy and relaxation techniques can prevent or control them effectively.
Subjects in the 6 diagnostic groups had significantly higher work, social, and family disability scores than control subjects, with the exception of the social phobia and panic disorder subjects' scores for family disability.
This article presents current research information on the treatment of panic disorder.
DENVER -- Patients with orthostatic hypotension might constitute an important new subgroup of patients with panic disorder, Dr.
A: Because panic disorders are generated internally, outside influences usually have no effect.
This report provides an overview of the Panic Disorders therapeutic pipeline.
Many types of behavioral approaches to treating panic disorders do work.
Shipko, who runs the Panic Disorders Institute and Web site, said the condition is hardly a new phenomenon.