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.
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