Panic disorder – panic attacks, causes, symptoms, diagnosis, treatment & pathology

I’m sure you’ve heard someone say or joke
about “having a panic attack,” but panic attacks are very real situations where someone
has a sudden period of intense fear or discomfort that something bad’s going to happen, and
that there’s some imminent threat or danger. These feelings are often so intense that they’re
accompanied by physiological symptoms like heart palpitations, dizziness, or shortness
of breath. These symptoms peak within the first 10-20 minutes, but some might last hours.
Sometimes patients having a panic attack might feel as though they’re having a heart attack
or some other life-threatening illness. Panic attacks can happen even in familiar places
where there are no real threats, and therefore they’re unpredictable, which can further
increase anxiety about when the next panic attack is going to happen. In order to be characterized as a panic attack,
the Diagnostic and statistical manual for mental disorders, the fifth edition, or DSM-V,
says patients need to have an abrupt onset of four of the following thirteen symptoms:
pounding heart or fast heart rate, chest pain or discomfort, , sweating, trembling, shortness
of breath, nausea, dizziness, chills, numbness, feelings of choking, feelings of being detached
from oneself, fear of losing control, and fears of dying. Admittedly, some of these symptoms might naturally
happen together, and so they can be very hard to tease apart. For example, it would be unusual
for a person that is sweating, feeling dizzy, and feeling chills, to also not be trembling.
It’s also important to note that some of these are physical symptoms whereas others
are specific thoughts/ideas. Panic attacks can happen in the context of several mental
disorders including depressive disorders, posttraumatic stress disorder, and substance
abuse disorders. It can also, however, happen in the context of a panic disorder, which
is basically defined by the panic attacks being recurrent, meaning 2 or more, and unexpected.
In addition, the DSM-V says that for somebody to be diagnosed with a panic disorder, they
also need to have persistent worry or change in behavior because of their panic attacks.
Also, the panic attacks can’t be due to the effects of some substance, like an illicit
drug or medication. Finally, the panic attacks aren’t better explained by some other anxiety
disorder, like agoraphobia or social anxiety disorder. Patients with a panic disorder can’t predict
where the panic attack will happen next, so it’s important to get treated before patients
develop something called avoidance, which is when they actively avoid the places where
one previously happened. They might stop doing activities that they think might trigger the
attacks, like going to the park, riding in elevators, or driving. Avoiding these situations
might temporarily reduce symptoms of anxiety about having a panic attack, but it makes
daily life really tough, right? And ultimately doesn’t stop the attacks from happening. Sometimes patients get anxiety just thinking
about the possibility of having a panic attack, and this is called anticipatory anxiety. Anticipatory
can be particularly debilitating because it might cause the patient to be reclusive and
choose to endure the attacks alone instead of risking an attack in public—this situation
can actually lead to the development of agoraphobia, a fear of going into crowded spaces. Panic disorder is twice as common among women
as men, and it appears to have a genetic component and run in families, although we don’t know
exactly what causes it. Treating someone with panic disorder usually involves psychotherapy,
medication, or both. Cognitive behavior therapy has been an effective type of psychotherapy
for patients with panic disorder, and this relies on five fundamental steps. First, they
just learn about panic disorder, and how to identify certain symptoms. Second, they monitor
their panic attacks using a diary. Third, they work on breathing and relaxation techniques.
Fourth, they start rethinking and changing their beliefs about the severity of a panic
attack from totally catastrophic to a realistic level. Fifth, they allow themselves to be
exposed to situations that provoke fear and anxiety. Now if medications are used, antidepressants
like SSRIs are the most commonly prescribed, which have sedative and relaxing effects.
Anti-anxiety medications might also be prescribed, like benzodiazepines, which also have a relaxing
effect, although the use of anti-anxiety medications can sometimes lead to unwanted side effects
like tolerance, dependence, and withdrawal. If very severe, anti-seizure medications may
sometimes be prescribed. Overall though, between cognitive behavior
therapy and medication, many patients can be effectively treated for panic disorder.

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