PANIC DISORDER

Panic disorder is one among the list of anxiety disorders.  It is essential to differentiate between panic attack and panic disorder.

Panic Attack and Panic Disorder

  • PANIC ATTACK: period of abrupt onset of intense fear and discomfort along with the symptoms, mentioned below, usually peaking within 10 minutes of the onset. Attacks can last for one minutes to 1 hour

Symptoms of a PANIC attack:

P – palpitations, paresthesia, depersonalization,

A – abdominal distress,

N – nausea

I – intense fear of dying, intense fear of losing control  “going crazy”, light headedness

C – chest pain, chills, choking,

S – sweating, shortness of breath “air hunger”

  • PANIC DISORDER: Panic disorder is a chronic illness characterized by recurrent panic attacks which are not triggered or expected without a clear circumscribed stimulus and associated with ≥ 1 month of: (1) persistent concern of having additional attacks or (2) worrying about consequences of attacks or (3) significant maladaptive behavioral changes related to the attack

TREATMENT:

Treatment for panic disorder has several approaches. Usually, therapies and pills go hand-in-hand.

A.   REASSURANCE:

It involves educating the patient that their symptoms are neither from a serious medical condition nor from a psychotic disorder, but rather from a chemical imbalance in the fight-or-flight response.

B. COGNITIVEBEHAVIORAL THERAPY:

Cognitive behavior therapy includes applied relaxation, exposure in vivo, exposure through imagery, panic management, breathing retraining, and cognitive restructuring.

Cognitive-behavioral therapy (CBT) helps patients to understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as anxiety, and how they can lead to secondary behavioral consequences.

C. BEHAVIOURAL THERAPY:

It employs graded exposure to anxiety-provoking stimuli.

D. PHARMACOTHERAPY:

Benzodiazepine

Selective serotonin reuptake inhibitor

Tricyclic antidepressants

Relapse is common therefore a person needs to be kept on medication for 6-12 months

 

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

Rosenberg NK, Mellergård M, Rosenberg R, Beck P, Ottosson JO. Characteristics of panic disorder patients responding to placebo. Acta Psychiatr Scand Suppl. 1991. 365:33-8. [Medline].

Uptodate

medscape

PETER HAM, M.D., DAVID B. WATERS, PH.D., and M. NORMAN OLIVER, M.D.

University of Virginia School of Medicine, Charlottesville, Virginia

Ocford handbook of medicine

Usmle first aid 2016