Panic Disorder

Panic Disorder is a common psychiatric condition and is characterized by attacks of sudden, unexpected anxiety accompanied by fearful thoughts ending up in physical symptoms. A panic attack occurs unexpectedly and is unrelated to situations which almost cause anxiety. To be labeled as panic disorder, it should be recurring with a frequency of not less than 4 discrete ones in 4 weeks.

Clinically it begins abruptly without warning and lasts for a few minutes. There are physical (dysponea or shortness of breath) Palpitation, chest pain, sweating, choking Hot and Cold flushes, cognitive (Fear of dying or going crazy) and behavioral changes. To make correct diagnosis, at least 4 of these symptoms should develop suddenly with increasing intensity.

Often a patient of panic disorder exhibits two more features i.e. anticipatory anxiety where the patient is always fearful of getting another one in those situations which brought the first attack.

Panic Disorder

Secondly: Many a patient develops Agoraphobia – a fear of getting it at places of risk. Thus the patient develops avoid-ant or phobic behavior.

Etiology of panic disorder involves a number of psychological and biological factors. In some a genetic vulnerability may be operative.

Treatment is by cognitive behavioral therapy (CBT) Tricyclic anti depressants and monoamine oxidase inhibitors are effective in the treatment and prevention of spontaneous instances. Anti depressants take 4 to 6 weeks before being effective and have little value in controlling anticipatory anxiety.

Benzodiazipines like Alprazolam and effective in dose of 0.5 mg twice a day and its effect works within one to two days. Moreover it not only controls it but also has anti depressant activity. For those with agoraphobia, psychotherapy should be employed.

DIAGNOSTIC CRITERIA

1 One or more is unexpected and not triggered by any situation.

2. Either four within a 4 week period or more followed by a period of at least a month of persistent fear of having another attack.

3. At least four of the following symptoms developed during at least one attack of Panic Disorder (Dizziness, dyspnea, palpitations, trembling, choking, sweating, nausea, depersonalization, numbness or tingling sensation, chest pain. Fear of dying or going crazy).

4. During at least some of the attacks, at least one of the symptoms described above developed suddenly and increased in intensity within 10 minutes of the beginning of the symptoms.

Post-traumatic stress disorder (PTSP)

It may be acute or chronic and generally follows traumatic events such as serious accidents natural catastrophes, assault etc. It is characterized by irritability a feeling of detachment and difficulty in concentrating and sleeping. In the acute form symptoms begin within 6 months of the trauma while in the chronic form they start after 6 months or persist more than that.

Patients suffering from PTSD avoid situations which may trigger flash backs. They have in addition anxiety, depression and suffer from drug abuse or alcoholism.

Treatment of Panic Disorder consists of counseling, reduction of target symptoms and anxiety management. Drugs include benzodiazipines (alprazolam 0.5 mg twice a day) and paroxetine (25 mg given once a day).

The video below explains the Panic disorder:

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