PANIC DISORDER


Individuals diagnosed with Panic Disorder suffer repeated feelings of terror, fear, or bodily discomfort for a specific durations of time, lasting from a few minutes up to an hour, in which a set of symptoms appears without warning. Following the attack, the individual has a constant concern another episode will occur and/or the individual makes changes in behavior to prevent another episode from occurring. A panic attack can happen when an individual is anxious or peaceful, causing the person additional confusion about etiology and how to prepare for or prevent a future episode. Symptoms include acceleration in heart rate, heart "pounding", chest pain, feeling sweaty, cold or hot flashes, numbness or "pins and needles" in the extremities, trembling hands or body, sense of unreality, fear of death, fear of losing one's mind, or belief one is having a heart attack or stroke. A minimum of four symptoms are necessary to meet criteria for a panic attack. The symptoms are not better attributed to a substance, such as caffeine, cocaine, or nicotine, or another medical condition, such as hypertension. If a panic attack occurs only in the context of another mental disorder or a specific circumstance (such as Specific Phobia, Social Phobia, separation from an attachment figure, trigger related to trauma, obsession as part of OCD, or learning of the death of a loved one), it should not be documented as Panic Disorder.


There appears to be a genetic component to Panic Disorder, with 15% of first-degree relatives and 30% of monozygotic twins suffering from the disorder. Common co-morbid conditions include Major Depressive Disorder, Social and Specific Phobias, and Alcohol Use Disorder. The disorder occurs twice as often in females than in males.


The theoretical approaches used in this disorder are behavioral, cognitive-behavioral, psychoeducation, and psychodynamic.


Helping the individual to understand his/or her physical complaints generally will help reduce the patient's fears. Moving the personal explanation from medical concerns is tantamount to successful treatment. Sometimes taking a look at what triggers the attack can be helpful, too. However, since panic attacks often come without apparent triggers, this is often difficult. The somatic component is so powerful that it may be difficult to convince the patient that he/or she is not close to death when having an attack.


One of the the goals in treating Panic Disorder is to reduce the symptoms that the patient is experiencing. Another goal is to teach the patient better coping abilities in response to the anxiety. Types of interventions used are relaxation therapy, recognizing the bodily sensations the individual is experiencing, and providing techniques for effective breathing before the attack is in full force. For an insightful patient, you will want to identify triggers and look at the meanings of the attacks.


Cognitive-behavioral therapy and psychopharmocotherapy are shown to be most effective and have been widely accepted due to significant empirical research. Systematic desensitization and exposure either in vivo or imaginal are shown to be quite effective in modifying panic response. Medication, including SSRIs, tricyclics, and benzodiazapines are also quite effective. Medication should be used in conjunction with cognitive-behavioral treatment. Often, medication is used for six months with cognitive-behavioral treatments, then the patient is slowly weaned off the medication. However, relapse is high and may require "half dose" maintenance.