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Panic disorder

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Panic disorder (episodic paroxysmal anxiety)
ICD-10 F41.0
ICD-9 300.01, 300.21
OMIM [1]
DiseasesDB 30913
MedlinePlus [2]
eMedicine /
MeSH {{{MeshNumber}}}


A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than thirty minutes. Symptoms include anxiety, trembling, shortness of breath, heart palpitations, sweating, nausea, dizziness, hyperventilation, paresthesias (tingling sensations), and sensations of choking or smothering. The disorder is strikingly different from other types of anxiety disorders in that panic attacks are very sudden, appear to be unprovoked, and are often disabling. An episode is often categorized as a vicious cycle where the mental symptoms increase the physical symptoms, and vice-versa.

Most who have one attack will have others. People who have repeated attacks, or feel severe anxiety about having another attack, are said to have panic disorder.

Introduction

Most sufferers of panic attacks report a fear of dying, "going crazy", or losing control of emotions or behavior. The experiences generally provoke a strong urge to escape or flee the place where the attack begins ("fight or flight" reaction) and, when associated with chest pain or shortness of breath, a feeling of impending doom and/or tunnel vision, frequently resulting in seeking aid from a hospital emergency room or other type of urgent assistance.

The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks are often experienced by sufferers of anxiety disorders, agoraphobia, and other psychological conditions involving anxiety, though panic attacks are not always indicative of a mental disorder. Up to 10 percent of otherwise healthy people experience an isolated panic attack per year, and 1 in 60 people in the U.S. will suffer from panic disorder at some point in their lifetime.

People with phobias will often experience panic attacks as a direct result of exposure to their trigger. These panic attacks are usually short-lived and rapidly relieved once the trigger is escaped. In conditions of chronic anxiety one panic attack can often roll into another, leading to nervous exhaustion over a period of days.

Symptoms

The symptoms of a panic attack appear suddenly, without any apparent cause. They may include:

  • Racing or pounding heartbeat or palpitations
  • Sweating
  • Chest pains/PVCs
  • Dizziness, lightheadedness, nausea
  • Difficulty breathing (dyspnea)
  • Tingling or numbness in the hands, face, feet or mouth
  • A sudden feeling that everything around the person represents a threat to their wellbeing. This can cause a person to either behave extremely defensively (perhaps even assuming the fetal position), or to become enraged and lash out violently to these perceived threats.
  • The loss of the ability to react logically to oncoming stimuli, and the loss of cognitive ability in general. One suffering from a panic attack will often only be able to feel the attack and not be able to assess why they are feeling the attack or what they can do to stop the sensation.
  • Flushes to the face and chest or chills
  • Dream-like sensations or perceptual distortions (derealization)
  • Dissociation, the perception that one is not connected to the body or even disconnected from space and time (depersonalization)
  • Terror, a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
  • Vomiting
  • Tunnel vision
  • Fear of losing control and doing something embarrassing or of going crazy
  • Fear of dying
  • Feeling of impending doom
  • Trembling or "shivering"
  • Crying
  • Heightened senses
  • Loud internal dialogue
  • Exhaustion
  • Vertigo

A panic attack typically lasts from 2 to 8 minutes. More severe panic attacks may form a series of episodes waxing and waning every few minutes, only to be ended by physical exhaustion and sleep.

The various symptoms of a panic attack can be understood as follows. First comes the sudden onset of fear with little or no provoking stimulus. This then leads to a release of adrenaline (epinephrine) which cause the so-called fight-or-flight response where the person's body prepares for major physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to carbon dioxide levels lowering in the lungs and then the blood. This leads to shifts in blood pH which can in turn lead to many other symptoms, such as tingling or numbness, dizziness, and lightheadedness. (It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths. This also acts to decrease carbon dioxide levels in the blood.)

Anyone who hyperventilates for a while can demonstrate these symptoms. For the person with a panic attack who does not know this, these symptoms are often seen as further evidence of how serious the condition is. An ensuing vicious cycle of adrenaline release fuels worsening physical symptoms and psychological distress.

While the symptoms and the seriousness of panic disorder are very real, the feelings of panic or dying that accompany many attacks are exaggerated. One important note many physicians tell panic disorder sufferers is that while your body is affected by your attacks, you are not in any risk of fatality (except by auxiliary reactions such as crashing a car, running into traffic, committing suicide, etc). So if a sufferer can anticipate an attack and find a safe place to release, there is little immediate risk.

Main article: Panic disorder : History of the disorder.
Main article: Panic disorder :Theoretical approaches.
Main article: Panic disorder :Epidemiology.
Main article: Panic disorder :Risk factors.
Main article: Panic disorder :Etiology.
Main article: Panic disorder :Diagnosis & evaluation.
Main article: Panic disorder :Comorbidity.
Main article: Panic disorder :Treatment.
Main article: Panic disorder :Prognosis.
Main article: Panic disorder :Service user page.
Main article: Panic disorder :Carer page.

See also

References

Books

  • National Institute for Health and Clinical Excellence (2007). Management of Panic Disorder and Generalised Anxiety in Adults. Surrey : Alderson Brothers.
  • Office for National Statistics (2000). Psychiatric Morbidity among Adults, 2000. London : National Statistics

Papers

  • Birchall H, Brandon S, Taub N. Panic in a general practice population: prevalence, psychiatric comorbidity and associated disability. Soc Psychiatry Psychiatri Epidemiol 2000;35:235–41.
  • Clark, D. M (1986). Cognitive Approach to Panic. Behavioural Research Therapy, Vol. 24, No. 4, pp 461-470
  • Gould RA. A meta-analysis of treatment outcome for panic disorder. Clin Psychol Rev 1995;15:819–44.
  • Klein (1981) cited in Clark, D. M (1986). Cognitive Approach to Panic. Behavioural Research Therapy, Vol. 24, No. 4, pp 461-470
  • Klerman GL, Weissman MM, Ovellette R, Like J. Panic attacks in the community: social morbidity and health care utilization. JAMA 1991;265: 742–6.
  • Salkovskis, P. M (2007). Cognitive Behavioural treatment for Panic. Journal of Anxiety Disorders, Vol. 6, Issue 5, pp 193-197
  • Taylor, S, Asmundson, G. J & Wald, J (2007). Psychopathology of Panic Disorder. Journal of Anxiety Disorders, Vol. 5, Issue 5, pp 188-192

External links


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Panic disorder: Academic support materials

''' Panic disorder: Anonymous fictional case studies for training'''

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