Panic Disorders

What is panic disorder?

Panic Attacks:

Panic attacks are defined as a state of discomfort or sever fear , which peaks in 10 min, in which four or more of the following symptoms developed abruptly:

  1. Psychiatric symptoms:
    1. Fear or losing control or going crazy
    2. Fear of dying
    3. Derealization or depersonalization
  2. Neurological complaints:
    1. Shaking
    2. Trembling
    3. Numbness or tingling sensation
    4. Feeling dizzy, unsteady, lightheaded or fainting
  3. Autonomic system symptoms:
    1. Excessive sweating
    2. Chills or hot flushes
  4. Heart symptoms:
    1. Chest pain or feeling pressure on chest or tightness
    2. Shortness of breath
    3. Rapid heart rate
  5. GI symptoms:
    1. Feeling of choking
    2. Nausea or
    3. Abdominal distress

 

Panic disorders with agoraphobia:

This condition causes individual to get anxious about being in closed spaces or in situation which escape might be difficult. Such panics might occur while being outside home alone, being in crowded places such as buses, lines, trains, social gatherings, or on bridge. It is important to distinguish specific phobia and social phobia from agoraphobia. In specific phobia avoidance is limited to one or only a few specific situations such as trains, air plains, etc. In social phobia the avoidance is limited to active participation social events such as giving a public speech or attending group meetings. Also, it has to be noted underlying medical or health conditions or using drugs and substances should not account for the agoraphobia.

What are some common causes of panic attacks?

  • Hyperthyroid
  • Anxiety disorders
  • Specific phobia
  • PTSD
  • Cocaine use
  • Amphetamine use
  • Low blood sugar
  • Heart attacks

Diagnostic work ups

There is no specific laboratory work up for diagnosis of panic disorders, however a variety of investigations might needed to be performed to rule out other medication conditions that produce similar symptoms.

The most common lab work ups requested are:

  • CBC
  • Serum glucose
  • TSH, T4
  • Serum Calcium
  • Toxicology study
  • Urine drug screen
  • ECG

Management

Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating panic disorder. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and fearful.

Medication. Doctors also may prescribe medication to help treat panic disorder. The most commonly prescribed medications for panic disorder are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

Antidepressants are used to treat depression, but they also are helpful for panic disorder. They may take several weeks to start working. Some of these medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Another type of medication called beta-blockers can help control some of the physical symptoms of panic disorder such as excessive sweating, a pounding heart, or dizziness. Although beta blockers are not commonly prescribed, they may be helpful in certain situations that bring on a panic attack.

Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

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