Panic Attacks

Definition

A panic attack is a condition where a person has a strong feeling of fear which is spontaneous and intense. It usually lasts less than an hour with several physical symptoms. These episodes can be repetitive, usually twice a week, when the person is said to have a panic disorder. Although a tendency to panic may be considered normal in certain situations, with a panic disorder the attacks are triggered for no apparent reason.

Symptoms

The person is said to be suffering from a panic disorder if there have been at least four panic attacks in a four week period or one attack followed by at least one month of sustained fear of having a subsequent attack.

At least a few of the following symptoms must be present during a panic attack :

  • Shortness of breath.
  • Dizziness or feeling of unsteadiness.
  • Palpitations.
  • Trembling.
  • Sweating.
  • Choking sensation.
  • Nausea or abdominal distress.
  • Fear of dying.
  • Fear of going insane or doing something uncontrolled.
  • Flushes or chills.
  • Chest pain or discomfort.
  • Depersonalization or derealization.
  • Paresthesias.

Causes

There is evidence for a genetic basis for panic disorder. A person with close relatives with this a panic disorder are at greater risk. According to some, panic disorders is the consequence of parental deprivation in the early childhood. Some believe it be a learned response based on life experiences.

People undergoing intense psychological stress or after experiencing severe psychological trauma may then develop panic disorders. It may also be associated with other psychiatric illnesses like schizophrenia, depressive disorders or phobia.

Physical causes of anxiety symptoms include cardiovascular disorders, anemia, immunological disorders such as systemic lupus erythematous, metabolic disorders such as hypoglycemia, hypocalcemia and respiratory disorders such as asthma. Central nervous system stimulants such as amphetamine and cocaine can cause panic attacks. Panic attacks can be seen alcohol withdrawal or sometimes even after a brain injury.

Treatment

A detailed history and physical examination is needed prior to starting treatment to exclude presence of a concurrent physical illness. The main line of treatment is medication although long term counseling is also essential in management. The patient is hospitalized if anxiety is severe.

Benzodiazepines are the emergency drugs of choice to alleviate symptoms of acute anxiety but are not used chronically due to fear of addiction. They are given orally. IV benzodiazepines are given only if there are life-threatening situation due to coexisting physical illness. A coexisting depressive disorder or schizophrenia should be treated with tricyclic antidepressants or neuroleptic medications.

Selective serotonin reuptake inhibitors (SSRIs) and Serotonin and norepinephrine reuptake inhibitors (SNRIs) are used which are antidepressant drugs. Tricyclic antidepressants and monoamine oxidase inhibitors can be used. Alprazolam or propanolol can be used if there is no improvement. The dosage of the drugs is gradually increased starting from a lower dose going up to the maximum dose. After the symptoms disappear, a lower dose should be continued for about a year as maintenance therapy.

Patients with panic disorder usually exhibit anticipatory anxiety which usually responds better to behavior therapy techniques such as desensitization involving increased exposure to the real or imaginary phobic situation and relaxation exercise. A panic disorder can grossly disturb the stability of the family and family therapy will help give emotional support to other members of the family. Follow up maintenance therapy may be necessary in the form of drugs and psychotherapy.

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