Panic attacks are distinct periods of intense fear and discomfort. Panic disorder occurs when these attacks continue over a period of time. Panic attacks are a common occurrence. Almost everyone at one time or another has felt the pounding heartbeat, sweating, trembling, and other symptoms of a panic attack. These attacks, which are the hallmark of panic disorder, are thought to occur when the brain’s normal mechanism for reacting to a threat—the so-called “fight or flight" response—becomes too easily triggered. Most panic attacks are short-lived, and are usually caused by a specific event.
Panic disorders are characterized by the spontaneous and unexpected return of these attacks over a period of time. At least four attacks must occur within a four-week period, or the panic attacks must be followed by a fear of having another attack, continuing for at least a month before the diagnosis can be made.
In some cases the person begins to worry about panic attacks even before they happen. They may begin to avoid places such as crowds or theatres where escape would be difficult should an attack occur. In its most extreme form, called agoraphobia (“fear of the marketplace”), the person may be afraid to leave the house or to be alone.
The causes of panic attacks are not well understood. The causes of panic disorder are still unknown. Family and twin studies, however, have shown that panic disorder has a strong genetic component.
Some believe that the nervous system in those who have panic attacks is more hyperactive, and thus responds more easily to stimuli. There are also indications that the brains of people with panic disorders may respond differently to certain neurotransmitters.
Some medications and illnesses can cause symptoms similar to those of a panic attack. Among the medical conditions that mimic the symptoms of panic disorder are irregular heart rhythms, an overactive thyroid gland, seizure disorders, and some respiratory diseases such as asthma. Theophylline (for asthma) and steroids can also cause panic-like symptoms, as can cocaine, amphetamines, and too much caffeine. Withdrawal from drugs such as alcohol, barbiturates, and benzodiazepines can also produce similar symptoms.
A panic attack is a discrete period of intense fear or discomfort characterized by four or more defining symptoms. The symptoms appear without warning, and usually peak within ten minutes Table 01. Panic attacks are episodes of intense fear associated with a number of physical symptoms. Among these are palpitations (feeling your heartbeat), sweating, trembling, shortness of breath, chest pain, and dizziness. There are almost always feelings of impending doom or death. Numbness or tingling sensations in the hands and feet (parathesias), stomach aches or discomfort, and feelings of unreality are usually present as well.
Panic disorder is characterized by recurring and unpredictable panic attacks. A person is considered to suffer from panic disorder if he or she suffers at least four separate panic attacks in a one-month period. At least one of these attacks must have occurred spontaneously, often described by patients as “coming out of the blue”. One or more of these attacks must be followed by feelings of fear about having another one. These concerns must last for at least a month.
In most cases, the frequency of panic attacks varies for unknown reasons. A number of panic attacks may occur over a period of days or even hours, after which may follow a period of many months during which no further attacks occur.
For some people, panic disorder becomes progressively more severe. Some patients with panic disorder become disabled by the fear that a panic attack could happen at any time. These people often avoid going places where getting help or escaping would be difficult or embarrassing should an attack occur.
As symptoms worsen, the person will start showing signs of agoraphobia. They will begin to have anxiety when faced with such everyday tasks as being outside the house alone or being in crowded areas, and will try to avoid places like tunnels or theatres where escape would be difficult. This avoidant behavior may become so severe that the person is unable to leave the house or be left alone.
Panic disorder can only be diagnosed after several diseases and drug effects have been eliminated as possible causes for the symptoms. A variety of problems with the cardiac, respiratory, hormonal, and neurological systems can produce the signs and symptoms of panic disorder.
Your doctor will have to rule out low blood sugar, an overactive thyroid or parathyroid gland, asthma, and some kinds of irregular heart rhythms before making a diagnosis of panic disorder. Pheochromocytoma, a tumor of the adrenal glands, can also cause many of the symptoms of a panic attack, although this condition is very rare.
Certain drugs can cause symptoms of a panic attack. For example, theophylline (a medication used to treat asthma), amphetamines (speed), cocaine, and high blood pressure medications can all produce panic attack symptoms. Opiate or alcohol withdrawl can also trigger symptoms of a panic attack.
It is not unusual for a person with panic disorder to suffer from another psychiatric problem (most notably depression or alcoholism).
Table 1. Panic Attack Symptoms
Pounding heart Chest pains Lightheadedness or dizziness Nausea or stomach problems Flushes or chills Shortness of breath or a feeling of smothering or choking Tingling or numbness Shaking or trembling Feelings of unreality Terror A feeling of being out of control or going crazy Fear of dying Sweating
The best-known risk factor for panic disorder is a positive family history. Having a close relative with panic disorder is the most commonly noted risk factor in newly diagnosed patients. There is a seven- to eight-fold increase in the occurrence of panic disorder in patients who have a relative with the disorder when compared with a control group.
Adults with panic disorder and agoraphobia often describe themselves as having been shy as a child. Adults who report having been shy also frequently recall that they got anxious as children when separated from their family, even for short periods of time such as the duration of the school day.
Women are two to three times more likely to suffer from panic disorder than are men.
Panic disorder can be associated with a recent history of divorce or separation.
Your doctor will take a careful history before diagnosing panic disorder. Your doctor will ask you what symptoms have been troubling you the most. Your doctor will also discuss your family history with you, since having a close relative with panic disorder greatly increases your chances of developing the disorder.
Your doctor will ask about any other medical conditions or medications you may be taking that could trigger symptoms similar to those of a panic attack.
Your doctor may order some tests to rule out other medical conditions that could cause panic-like symptoms. Standard laboratory studies that may be performed include a thyroid function tests, an electrocardiogram (ECG), and a test to detect electrolytes in the blood.
These tests should eliminate most of the more common medical conditions that can mimic panic disorder, such as hyperthyroidism and low blood sugar. The results of these tests will help your doctor decide what additional studies, if any, are needed.
Prevention and Screening
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- Medications to Avoid While on AntidepressantsCould your antidepressant interact with something else you're taking?