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Characterized by recurrent episodes of intense apprehension, terror, and impending doom, panic disorder represents anxiety in its most severe form. Initially unpredictable, panic attacks may become associated with specific situations or tasks. The disorder commonly exists concurrently with agoraphobia. Equal numbers of men and women are affected 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, typically 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: He may resort to alcohol or anxiolytics in an attempt to relieve his extreme anxiety.
Like other anxiety disorders, panic disorder may stem from a combination of physical 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.
Panic disorder affects about 2% of the population. Symptoms usually develop before age 25.
The patient with panic disorder typically complains of repeated episodes of unexpected apprehension, fear or, rarely, 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 even daily. Because the attacks occur spontaneously, without exposure to a known anxiety-producing situation, the patient generally 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.
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.
Panic disorder may respond to behavioral therapy, supportive psychotherapy, or drug therapy, alone 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.
Drug therapy includes antianxiety 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.
❑ Stay with the patient until the attack subsides. If left alone, he may become even more anxious.
❑ Maintain a calm, serene approach. Statements such 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. Avoid giving him insincere expressions of reassurance.
❑ 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 a rapport. Unless he trusts you, he may be too stimulated or frightened to find touch reassuring.
❑ Administer medication as prescribed.
❑ 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, 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.
Read excerpts from these other book chapters related to Panic attack:
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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