Panic Disorder

Characterized by recurrent episodes of intense apprehension, terror, and impending doom, panic disorder represents anxiety in its most severe form. Initially unpredictable, these panic attacks may come to be associated with specific situations or tasks. The disorder often exists concurrently with agoraphobia. Equal numbers of men and women are affected by panic disorder alone, whereas panic disorder with agoraphobia occurs about twice as often in women.

Panic disorder typically has an onset in late adolescence or early adulthood, often in response to a sudden loss. It also may be triggered by severe separation anxiety experienced during early childhood.

Without treatment, panic disorder can persist for years, with alternating exacerbations and remissions. The patient with panic disorder is at high risk for a psychoactive substance abuse disorder: He may resort to alcohol or anxiolytics in an attempt to relieve his fear.

Causes

Like other anxiety disorders, panic disorder may stem from a combination of physiologic and psychological factors. For example, some theorists emphasize the role of stressful events or unconscious conflicts that occur early in childhood.

Recent evidence indicates that alterations in brain biochemistry, especially in norepinephrine, serotonin, and gamma-aminobutyric acid activity, may also contribute to panic disorder.

Signs and symptoms

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

• Racing or pounding heartbeat
• Chest pains
• Dizziness , lightheadedness, nausea
• Difficulty breathing
• Tingling or numbness in the hands
• Flushes or chills
• Dreamlike sensations or perceptual distortions
• Terror - a sense that something unimaginably horrible is about to occur and one is powerless to prevent it
• Fear of losing control and doing something embarrassing
• Fear of dying

A panic attack typically lasts for several minutes and is one of the most distressing conditions that a person can experience. Most who have one attack will have others. When someone has repeated attacks, or feels severe anxiety about having another attack, he or she is said to have panic disorder.

Diagnosis

For characteristic findings in patients with this condition, see Diagnosing panic disorder.

Because many medical conditions can mimic panic disorder, additional tests may be ordered to rule out an organic basis for the symptoms. For example, tests for serum glucose levels rule out hypoglycemia, studies of urine catecholamines and vanillylmandelic acid rule out pheochromocytoma, and thyroid function tests rule out hyperthyroidism.

Urine and serum toxicology tests may reveal the presence of psychoactive substances that can precipitate panic attacks, including barbiturates, caffeine, and amphetamines.

Treatment

Specific treatment for panic disorder will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

Psychotherapy commonly uses cognitive techniques to enable the patient to view anxiety-provoking situations more realistically and to recognize panic symptoms as a misinterpretation of essentially harmless physical sensations.

Drug therapy includes anti-anxiety drugs, such as diazepam, alprazolam, and clonazepam, and beta blockers such as propranolol to provide symptomatic relief. Antidepressants, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors, are also effective.