Panic Disorder: Panic Attacks and Agoraphobia

Alternative name :- Panic attacks

Panic disorder represents anxiety in its most severe form. It's an anxiety disorder characterized by unexpected and recurrent episodes of intense apprehension, terror, and impending doom, usually accompanied by physical symptoms that mimic a heart attack or other serious medical condition. Initially unpredictable, panic attacks may later become associated with specific situations, places or tasks. As the attacks become more frequent, the person commonly develops agoraphobia, also known as phobic avoidance the avoidance of those situations, places, or tasks that trigger the attacks, rendering the person unable to leave a known safe surrounding such as her home because of intense fear and anxiety. Panic disorder may also coexist with other disorders, such as depression and substance abuse.

Panic disorder typically has an onset in late adolescence or early adulthood, commonly in response to a sudden loss. It may also be triggered by severe separation anxiety experienced during early childhood. Panic disorder is twice as common in women as men and even higher for panic disorder with agoraphobia. In addition, women who experience more severe symptoms are more likely to have recurrences after wellness and experience the illness for a longer period. Without treatment, panic disorder can persist for years with alternating exacerbations and remissions.

What causes Panic attacks?

Although the exact cause of panic disorder isn't known, many investigators theorize that, as in other anxiety disorders, panic disorder may stem from a combination of physical. psychological and biological factors, including heredity. For example, some studies emphasize the role of stressful events or unconscious conflicts that occur early in childhood. Another study found that children of parents with panic disorder were (themselves) more likely to suffer from panic attacks.

Recent evidence indicates that alterations in brain biochemistry, especially in norepinephrine, serotonin and gamma-aminobutyric acid activity, may also contribute to panic disorder. Another area of research for the treatment of panic disorder focuses on the amygdala, a very small and complicated structure inside the brain that controls the body's response to fear. Recent research suggests that the abnormal activation of the amygdala is associated with anxiety disorders.

Signs and symptoms of Panic attacks

The patient with panic disorder typically complains of repeated episodes of unexpected apprehension, fear or, in rare cases, intense discomfort. These panic attacks may last for minutes or hours and leave the patient shaken, fearful, and exhausted. They may occur several times per week sometimes even daily. Because the attacks may initially occur spontaneously without exposure to a known anxiety-producing situation, place, or task, the patient generally worries between attacks about when the next episode will occur.

Physical examination of the patient during a panic attack may reveal signs of intense anxiety, such as hyperventilation, tachycardia, palpitations, dizziness, trembling and profuse sweating. She may also complain of difficulty breathing, digestive disturbances, and chest pain.

Diagnosis information

For specific Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) findings in patients with panic disorder. Because many medical conditions can mimic panic disorder. additional tests may be ordered to rule out an organic basis for symptoms. For example, an electrocardiogram (ECG) can rule out a myocardial infarction; tests for serum glucose levels rule out hypoglycemia; studies of urine catecholamines and vanillylmandelic acid rule out pheochromocytoma; and thyroid function tests rule out hyperthyroidism. Urine and serum toxicology tests may reveal the presence of psychoactive substances that can precipitate panic attacks, including barbiturates, caffeine and amphetamines.

Treatment of Panic attacks

Panic disorder may respond to behavioral-cognitive therapy, supportive psychotherapy, or drug therapy, or a combination of these treatments. Behavioral-cognitive therapy works best when agoraphobia accompanies panic disorder because identifying the anxiety-inducing situation is easier.

Supportive psychotherapy commonly uses cognitive techniques to enable the patient to view anxiety provoking situations more realistically and to recognize panic symptoms as a misinterpretation of essentially harmless physical sensations.

Drug therapy includes anti anxiety drugs, such as diazepam, alprazolam, and clonazepam, and beta-adrenergic blockers such as propranolol to provide symptomatic relief. Antidepressants, including tricyclic antidepressants, selective serotonin reuptake inhibitors (specifically paroxetine and sertraline) and monoamine oxidase (MAD) inhibitors, are also effective.

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Complications   

Possible complications of this condition include avoidance of situations or places that might bring on an attack, and an increased likelihood for other anxiety and mood disorders.

Dependence on anti-anxiety medications is a possible complication of treatment. Dependence involves needing a medication to be able to function and to avoid withdrawal symptoms. It is not the same as addiction, which involves the compulsive use of a substance despite negative consequences. Dependence and addiction often occur together, but dependence itself is not always a problem.

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Special considerations and Prevention

• If the patient is experiencing an acute panic attack, stay with the patient until the attack subsides. If left alone, she may become even more anxious.
• Maintain a calm, serene approach. Statements such as, "I won't let anything here hurt you," and, ''I'll stay with you," can assure the patient that you're in control of the immediate situation. Avoid giving her insincere expressions of reassurance.
• The patient's perceptual field may be narrowed; excessive stimuli may cause her to feel overwhelmed. Dim or brighten lights as necessary.
• The combination of both counseling and medicine seems to be an effective treatment for panic disorder.
• If the patient loses control, move her to a smaller, quieter space.
• The patient may be so overwhelmed that she can't follow lengthy or complicated instructions. Speak in short, simple sentences and slowly give one direction at a time. Avoid giving lengthy explanations and asking too many questions.
• Allow the patient to pace around the room (if she isn't in danger of hurting herself or anyone else) to help expend energy. Show her how to take slow, deep breaths if she's hyperventilating.
• Avoid touching the patient until you've established rapport. Unless she trusts you, she may be too stimulated or frightened to find touch reassuring.
• Administer appropriate medication as prescribed.
• During and after a panic attack, encourage the patient to express her feelings. Discuss her fears and help her identify situations or events that trigger the attacks.
• Teach the patient relaxation techniques and how she can use them to relieve stress or avoid a panic attack.
• Avoid stimulants such as caffeine and cocaine and avoid alcohol use if you are prone to panic attacks.
• Review with the patient the adverse effects of the drugs she'11 be taking. Caution her to notify the physician before discontinuing the medication because abrupt withdrawal could cause severe symptoms.