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Back to Psychiatry Diseases

 

Panic attacks

A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than 30 minutes. Symptoms include trembling, shortness of breath and sensations of choking or smothering.

Introduction

Most people 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 and, when associated with chest pain or shortness of breath, frequently results 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 not always indicative of a mental disorder, and up to 10 percent of otherwise healthy people experience an isolated panic attack per year (Barlow, 1988; Klerman et al., 1991).

Panic attacks are often experienced by sufferers of anxiety disorders, agoraphobia and other psychological conditions involving anxiety.

A phobic will often experience a panic attack 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 one, leading to nervous exhaustion over a period of days.

What are the symptoms of a panic attack?

As described above, 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
  • Flushed Face and Chest

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.

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What is panic disorder?

Panic disorder is a serious health problem in the United States. At least 1.6 percent of adult Americans, or 3 million people, will have panic disorder at some time in their lives. The disorder is strikingly different from other types of anxiety in that panic attacks are so sudden, appear to be unprovoked, and are often disabling.

Once someone has had a panic attack--for example while driving, shopping in a crowded store, or riding in an elevator--he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where the individual with panic disorder may be unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus panic disorder can have as serious an impact on a person's daily life as other major illnesses--unless the individual receives effective treatment.

Is panic disorder serious?

Yes, panic disorder is real and potentially disabling, but it can be controlled with specific treatments. Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for heart disease or some other life-threatening medical illness. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions.

Others often try to reassure the person who is having a panic attack that he or she is not in great danger. Expressions such as "nothing serious," "all in your head," or "nothing to worry about" may give the incorrect impression that there is no real problem and that treatment is not possible or necessary.

What is the treatment for panic disorder?

Thanks to research, there are a variety of treatments available, including several effective medications, and also specific forms of psychotherapy. Often, a combination of psychotherapy and medications produces good results. Some improvement may be noticed in a fairly short period of time--about 6 to 8 weeks. Thus appropriate treatment of panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency--bringing significant relief to 70 to 90 percent of people with panic disorder.

In addition, people with panic disorder may need treatment for other emotional problems. Depression has often been associated with panic disorder, as have alcohol and drug abuse. Recent research also suggests that suicide attempts are more frequent in people with panic disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself.

Tragically, many people with panic disorder do not seek or receive treatment. To encourage recognition and treatment of panic disorder, the U.S. National Institute of Mental Health (NIMH) is sponsoring a major information campaign to acquaint the public and health care professionals with this disorder. NIMH is the agency of the U.S. government responsible for improving the mental health of the American people by supporting research on the brain and mental disorders and by increasing public understanding of these conditions and their treatment.

What happens if panic disorder is not treated?

Panic disorder tends to continue for months or years. It typically begins in young adulthood, but the symptoms may arise earlier or later in life. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal them. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic disorder. It does not usually go away unless the person receives treatments designed specifically to help people with panic disorder.

So, if you or someone you know has symptoms like those described in this article, it is important to see a health care professional for a correct diagnosis and proper treatment.

How Common Is Panic Disorder?

About 1.7% of the adult U.S. population ages 18 to 54 - approximately 2.4 million Americans - has panic disorder in a given year. Women are twice as likely as men to develop panic disorder. Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 24.

What Causes Panic Disorder?

Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.

Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which underlie anxiety disorders such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small structure deep inside the brain, called the amygdala.

The amygdala, although relatively small, is a very complicated structure, and recent research suggests that anxiety disorders may be associated with abnormal activitation in the amygdala. One aim of research is to use such basic scientific knowledge to develop new therapies.

What Treatments Are Available for Panic Disorder?

Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. NIMH is conducting a large-scale study to evaluate the effectiveness of combining these treatments. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70% to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.

Can People With Panic Disorder Also Have Other Illnesses?

Research shows that panic disorder can coexist with other disorders, most often depression and substance abuse. About 30% of people with panic disorder abuse alcohol and 17% abuse drugs, such as cocaine and marijuana, in unsuccessful attempts to alleviate the anguish and distress caused by their condition. Appropriate diagnosis and treatment of other disorders such as substance abuse or depression are important to successfully treat panic disorder.

Panic Attacks and Panic Disorder

A panic attack is a discrete period of intense fear or discomfort that is associated with numerous somatic and cognitive symptoms (DSM-IV). These symptoms include palpitations, sweating, trembling, shortness of breath, sensations of choking or smothering, chest pain, nausea or gastrointestinal distress, dizziness or lightheadedness, tingling sensations, and chills or blushing and ?hot flashes.? The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes. Most people 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 and, when associated with chest pain or shortness of breath, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance. Yet an attack rarely lasts longer than 30 minutes. Current diagnostic practice specifies that a panic attack must be characterized by at least four of the associated somatic and cognitive symptoms described above. The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks may be further characterized by the relationship between the onset of the attack and the presence or absence of situational factors. For example, a panic attack may be described as unexpected, situationally bound, or situationally predisposed (usually, but not invariably occurring in a particular situation). There are also attenuated or ?limited symptom? forms of panic attacks.

Panic attacks are not always indicative of a mental disorder, and up to 10 percent of otherwise healthy people experience an isolated panic attack per year (Barlow, 1988; Klerman et al., 1991). Panic attacks also are not limited to panic disorder. They commonly occur in the course of social phobia, generalized anxiety disorder, and major depressive disorder (DSM-IV).

Panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and develops persistent concern or worry about having further attacks or changes his or her behavior to avoid or minimize such attacks. Whereas the number and severity of the attacks varies widely, the concern and avoidance behavior are essential features. The diagnosis is inapplicable when the attacks are presumed to be caused by a drug or medication or a general medical disorder, such as hyperthyroidism.

Lifetime rates of panic disorder of 2 to 4 percent and 1-year rates of about 2 percent are documented consistently in epidemiological studies (Kessler et al., 1994; Weissman et al., 1997) (Table 4-1). Panic disorder is frequently complicated by major depressive disorder (50 to 65 percent lifetime comorbidity rates) and alcoholism and substance abuse disorders (20 to 30 percent comorbidity) (Keller & Hanks, 1994; Magee et al., 1996; Liebowitz, 1997). Panic disorder is also concomitantly diagnosed, or co-occurs, with other specific anxiety disorders, including social phobia (up to 30 percent), generalized anxiety disorder (up to 25 percent), specific phobia (up to 20 percent), and obsessive-compulsive disorder (up to 10 percent) (DSM-IV). As discussed subsequently, approximately one-half of people with panic disorder at some point develop such severe avoidance as to warrant a separate description, panic disorder with agoraphobia.

Panic disorder is about twice as common among women as men (American Psychiatric Association, 1998). Age of onset is most common between late adolescence and midadult life, with onset relatively uncommon past age 50. There is developmental continuity between the anxiety syndromes of youth, such as separation anxiety disorder. Typically, an early age of onset of panic disorder carries greater risks of comorbidity, chronicity, and impairment. Panic disorder is a familial condition and can be distinguished from depressive disorders by family studies (Rush et al., 1998).

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