Panic disorder

Panic disorder: Excerpt from Handbook of Diseases

Panic disorder represents anxiety in its most severe form and is characterized by recurrent episodes of intense apprehension, terror, and impending doom. Initially unpredictable, these panic attacks may come to be associated with specific situations or tasks. The disorder commonly exists with agoraphobia. Men and women are affected equally by panic disorder alone, whereas panic disorder with agoraphobia occurs in about twice as many women.

Panic disorder typically has an onset in late adolescence or early adulthood, commonly in response to a sudden loss. It may also 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 and may resort to alcohol or anxiolytics in an attempt to relieve his fear.

Causes

As with other anxiety disorders, panic disorder may stem from a combination of physiologic and psychological factors. Evidence implicates hereditary and temporal lobe dysfunction, and some theorists emphasize the role of stressful events or unconscious conflicts that occur early in childhood. The disorder may also develop as a persistent pattern of maladaptive behavior acquired by learning.

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 panic disorder are intensely uncomfortable. The patient with panic disorder typically complains of repeated episodes of unexpected apprehension, fear, and intense discomfort. These panic attacks may last for minutes or hours and leave the patient shaken, fearful, and exhausted. They occur several times a week, sometimes daily. Because the attacks occur spontaneously, without exposure to a known anxiety-producing situation, the patient commonly worries between attacks about when the next episode will occur.

Physical examination of the patient during a panic attack may reveal signs of intense anxiety, such as hyperventilation, tachycardia, trembling, and profuse sweating. He may also complain of difficulty breathing, digestive disturbances, and chest pain.

Diagnosis

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

Many medical conditions can mimic panic disorder, and 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

Panic disorder may respond to behavioral therapy, supportive psychotherapy, or drug therapy, singly or in combination. Behavioral therapy works best when agoraphobia accompanies panic disorder because the identification of anxiety-inducing situations is easier.

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.

Anxiolytics and antidepressants have been used successfully to treat panic disorders.

Special considerations

❑ Stay with the patient until the attack subsides. If left alone, he may become even more anxious.

CLINICAL TIP: Maintain a calm, serene approach. Such statements as “I won’t let anything here hurt you” and “I’ll stay with you” can assure the patient that you’re in control of the immediate situation.

❑ The patient’s perceptual field may be narrowed, and excessive stimuli may cause him to feel overwhelmed. Dim bright lights or raise dim lights as necessary.

❑ If the patient loses control, move him to a smaller, quieter space.

❑ The patient may be so overwhelmed that he can’t follow lengthy or complicated instructions. Speak in short, simple sentences, and slowly give one direction at a time. Avoid giving lengthy explanations and asking too many questions.

❑ Allow the patient to pace around the room (provided he isn’t belligerent) to help expend energy. Show him how to take slow, deep breaths if he’s hyperventilating.

❑ Avoid touching the patient until you’ve established rapport. Unless he trusts you, he may be too stimulated or frightened to find touch reassuring.

❑ Administer medication as necessary.

❑ During and after a panic attack, encourage the patient to express his feelings. Discuss his fears, and help him identify situations or events that trigger the attacks.

❑ Teach the patient relaxation techniques, such as focusing on slow, deep breathing, and explain how he can use them to relieve stress or avoid a panic attack.

❑ Review with the patient any adverse effects of the drugs he’ll be taking. Caution him to notify the physician before discontinuing the medication because abrupt withdrawal could cause severe symptoms.

❑ Encourage the patient and his family to use community resources such as the Anxiety Disorders Association of America.

Pictures

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

 » Next page: Chest pain (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

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