Introduction To Panic Disorder

Panic disorder is an anxiety disorder that is characterized by sudden attacks of fear and panic. A panic attack may be defined has a sudden, intense experience of fear coupled with an overwhelming feeling of danger and death.

Incidence
It occurs in 1-3 % of the population ; female to male ratio is 2 : 1. Familial aggregation is common. Onset is usually in the second or third decade of life.

Clinical Presentation
Initial presentation is almost always to a non psychiatric doctor , frequently in the ER as a possible heart attack or serious respiratory problem. The disorder is often intially unrecognized or misdiagnosed.

Attacks are sudden, unexpected paroxysms of terror and apprehension with multiple associated somatic symptoms.

Usually reach a peak within 10 minutes , then slowly resolve spontaneously.

Panic disorder is often associated with concomitant major depression.

Diagnostic Criteria for Panic disorder The diagnostic criteria for panic disorder requires four or more panic attacks within 4 weeks occurring in non threatening or non exertional settings and attacks must be accompanied by at least 4 of the following ;

• Dyspnea
• Palpitations
• Chest pain or Discomfort
• Feeling of being choked
• Dizziness/ vertigo/ unsteady feelings
• Sweating
• Faintness
• Trembling.
• Fear of dying
• Going crazy or doing something uncontrolled.

Medical Conditions that may mimic Panic attacks
Panic disorders must be differentiated from cardiovascular and respiratory disorders. Conditions that may mimic or worsen panic attacks include

• Hyperthyroidism
• Pheochromocytoma
• Hypoglycemia
• Drug ingestion ( amphetamines, cocaine, caffeine )
• Drug withdrawal with alcohol barbiturates opiates minor tranquilizers.

Management

Cognitive behavioral psychotherapy – identifying and aborting panic attacks through relaxation and breathing techniques either alone or in combination with medication is effective. The cornerstone of drug therapy is antidepressant medications.

The tricyclic antidepressants imipramine and clomipramine benefits 75-90 % of panic disorder patients. Low doses ( 10-25 mg/day 0 are given initially.

SSRIs are equally effective ; they should be started at one third to one half of their usual anti depressant dose.

Benzodiazepines may be used in short term while waiting for antidepressants to take effect.

Prognosis
When the disorder goes unrecognized and untreated , patients often experience significant morbidity, they become afraid of leaving home or may develop anticipatory anxiety and different phobias. Also may turn to self medication with alcohol or benzodiazepines