Panic disorder

Characterized by sudden episodes of acute apprehension or intense fear that occur without apparent cause.

Panic attacks are characterized by discrete episodes of fear, including at least for physical (palpitations, shortness of breath) and/or cognitive (fear of dying or losing control) symptoms that peak within minutes.

An anxiety disorder characterized by recurring severe panic attacks.

They may occur in response to specific stressful events, or are part of any anxiety disorder.

The occur as recurrent unexpected panic attacks, at least once a month, persistent worry about future attacks, worry about consequences of attacks or behavioral changes related to attacks.

May include significant behavioral change lasting at least a month and concerns about having other attacks, called anticipatory attacks.

Attacks cannot be predicted, and patients become stressed, anxious or worried wondering when the next panic attack will occur.

Panic attacks occur suddenly, are brief and intense, compared to anxiety attacks which have stressors that build to less severe reactions and can last for weeks or months.

Panic attacks can occur in children.

Potentially disabling proces, but can be controlled and treated.

Death rates in panic disorder patients exceeds those in the general population.

Panic disorders associated with increase risks of suicide.

Three types of panic attacks exists: unexpected, situationally bounded and situationally predisposed.

Attacks can wax and wane for a period of hours

The intensity and specific symptoms of panic may vary over the duration.

Common symptoms include: rapid heartbeat, perspiration, dizziness, dyspnea, trembling, uncontrollable fear.

Patients may fear of losing control and going crazy, of dying and hyperventilation, sweating, shortness of breath, sensation of choking, chest pain, nausea, numbness or tingling, chills or hot flashes,faintness and some sense of altered reality.

Lifetime prevalence of panic attacks range from 15-45%.

It typically begins in early adulthood.

Approximately half of all people who have panic disorder develop the condition before age 24.

Some specialists indicate the majority of young people affected for the first time are between the ages of 25 and 30.

Early onset occurs especially in those person subjected to a traumatic experience.

Women are twice as likely as men to develop pani disorder.

Diagnostic criteria include: Palpitations, or accelerated heart rate, sweating, trembling or shaking, shortness of breath or smothering sensation, feeling of choking, chest pain or discomfort, nausea or abdominal distress, dizziness, unsteadiness, lightheadedness, faint, derealization, fear of losing control or going crazy, fear of dying, paresthesias, chills or hot flushes.

Patients often have thoughts of impending doom.

Experiencing an episode is associated often with a strong wish of escaping from the situation that provoked the attack.

Its anxiety is particularly severe and noticeably episodic compared to that from generalized anxiety disorder.

Attacks may be provoked by adverse stimuli.

Panic attacks are often associated within negative social experiences, such as embarrassment, social stigma, and social isolation.

Panic disorder has been found to run in families, and suggests that inheritance plays a strong role.

Exists as a co-morbid condition with many hereditary disorders, such as bipolar disorder, and a genetic predisposition to alcoholism.

Psychological factors, stressful life events, life transitions, and the environment play a role in the onset of panic disorder.

Initial attacks may be triggered by physical illnesses, major stress, or certain medications.

Panic attacks may develop in individuals with excessive responsibilities.

Post-traumatic stress disorder (PTSD) patients have a much higher rate of panic disorder than the general population.

Medical processes such as hypoglycemia, hyperthyroidism, mitral valve prolapse, labyrinthitis, pheochromocytoma and respiratory conditions can cause or aggravate panic disorder.

Stimulants, including excess caffeine, are a common cause for panic attacks.

SSRIs also have stimulant side-effects during the initiation of treatment which may exacerbate panic.

SSRIs can cause first-time panic attacks in otherwise healthy individuals being treated for depression.

It is suspected to be a process with chemical imbalance in the limbic system and the regulatory chemical GABAA

A reduction in GABAA provides false information to the amygdala which regulates the body’s stress response, manifesting the physiological symptoms that lead to the panic disorder.

The partial pressure of carbon dioxide, mediates the relationship between panic disorder and anxiety sensitivity: breathing training affects the partial pressure of carbon dioxide in a patient’s arterial blood, lowering anxiety sensitivity.

Anxiety sensitivity affects hypochondriacal concerns which affects panic symptoms.

One’s perceived threat control is a moderator of a panic disorder.

Variations in the gene coding for galanin moderates the relationship between females suffering from panic disorder and the level of severity of panic disorder.

There is a link between substance abuse and panic disorder.

Cigarette smoking increases the risk of panic attacks and panic disorder in young people, perhaps by changes in respiratory function.

Children with respiratory abnormalities have high levels of anxiety, which may make them susceptible to panic attacks.

The stimulant nicotine may contribute to panic attacks, as can its withdrawal.

The stimulant drugs of caffeine, nicotine, and cocaine are expected to worsen the condition, since they directly increase the symptoms of panic, such as heart rate.

About 30% of people with panic disorder use alcohol and 17% use other psychoactive drugs.

The use of recreational drugs or alcohol generally make panic symptoms worse.

Alcohol initially helps ease panic disorder symptoms, but medium- or long-term alcohol abuse can cause panic disorder to develop or worsen during alcohol intoxication.

Chonic alcohol misuse worsens panic disorder due to distortion of the brain chemistry and function.

This is especially true during alcohol withdrawal syndrome.

Panic attacks can also occur with long term use of drugs which have a similar mechanism of action to alcohol such as the benzodiazepines.

Benzodiazepines are not recommended for the long term treatment of anxiety disorders due to a range of problems associated with such use.

Diagnostic criteria: requires unexpected, recurrent panic attacks, followed in at least one instance by at least a month of a significant and related behavior change, a persistent concern of more attacks, or a worry about the attack’s consequences.

Two types of panic attacks exist, one with and one without agoraphobia.

Panic attack diagnosis is excluded by attacks due to a drug or medical condition, or to a mental disorder.

The treatment of choice is cognitive behavioural therapy.

When cognitive behavioral therapy is not an option pharmacotherapy can be used, with SSRIs are considered a first line pharmacotherapeutic option.

Comorbid clinical depression, personality disorders and alcohol abuse are factors that make treatment less successful.

Support structure of family and friends can increase the rate of recovery.

A number of randomized clinical trials have shown that cognitive behavioral therapy achieves reported panic-free status in 70-90% of patients.

Clinically, a combination of psychotherapy and medication can improve the effectiveness of medication, reduce the likelihood of relapse for someone who has discontinued medication, and offer help for people with panic disorder who do not respond at all to medication.

Cognitive behavior therapy helps a patient reorganize thinking processes and anxious thoughts regarding an experience that provokes panic.

For panic disorder involves agoraphobia, the traditional cognitive therapy approach has been in vivo exposure, in which the affected individual, is gradually exposed to the actual situation that provokes panic.

Panic-focused psychodynamic psychotherapy focuses on the role of dependency, separation anxiety, and anger in causing panic disorder.

Muscle relaxation techniques and breathing exercises are not efficacious in reducing panic attacks.

Treatment can prevent panic attacks or substantially reduce their severity and frequency.

Medication treatment of panic makes phobia treatment far easier.

Medications can include:

Antidepressants (SSRIs, MAOIs, tricyclic antidepressants)

Use of benzodiazepines for panic disorder is controversial: risk of developing a benzodiazepine tolerance and dependence.

No known cure exists.

Its duration can continue for months or even years, depending on how and when treatment is sought.

It may worsen so that a person’s life is seriously affected by panic attacks and by attempts to avoid or conceal the condition.

Many individuals may experience a cessation of symptoms naturally later in life.

40% of adult panic disorder patients reported that their disorder began before the age of 20.

The anxiety disorders co-exist with high numbers of other mental disorders in adults.

Children with panic disorder have a higher rates of comorbid major depressive disorder and bipolar disorder.

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