Panic disorder

Panic Disorder (also known as heart neurosis or neurosis cordis) is a mental condition that causes the sufferer to experience sporadic panic attacks.

Symptoms

Panic disorder sufferers usually have a series of intense episodes of extreme anxiety, known as panic attacks. A panic event may be triggered by an especially stressful situation, or it may occur for no particular reason. These events usually last for several minutes. Some individuals deal with these events on a regular basis—sometimes daily or weekly. Because of the constant fear of having another panic attack, individuals with panic disorder are often extremely uncomfortable in social situations. As a result, as many as 35% of all individuals with panic disorder also have agoraphobia.

Occurrence

Panic disorder is a serious health problem in the United States but can be treated. It is estimated that 1.7 percent of the adult American population has panic disorder. It typically strikes in young adulthood; roughly half of all people who have panic disorder develop the condition before age 24, though some sources say that the majority of young people affected for the first time are between the ages of 25 and 30. Women are twice as likely as men to develop panic disorder.

Panic disorder can continue for months or years, depending on how and when treatment is sought. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal them. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic disorder. It does not usually go away unless the person receives treatments designed specifically to help people with panic disorder.

For people who seek active treatment early in development, the majority of symptoms can disappear within a few weeks, with no permanent negative effects once treatment is completed.

Treatment

Panic disorder is real and potentially disabling, but it can be controlled. Because of the disturbing symptoms that accompany panic disorder, it may be mistaken for a life-threatening medical illness. This misconception often aggravates or triggers future attacks. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions, thus creating further anxiety.

Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy. Normally the mental health professionals that can assist you in treatment of panic disorder are psychiatrists, psychologists, professional counselors and social workers. To pursue a medical treatment for panic disorder, one should visit a medical doctor, typically a psychiatrist. Psychotherapy is typically provided by a clinical or counseling psychologist, a professional counselor or a licensed clinical social worker (LCSW). More information on Mental health professionals

Medications can be used to break the psychological connection between a specific phobia and panic attacks. Medications can include:

• antidepressants (SSRIs, MAOIs, etc.) taken every day
• anti-anxiety drugs (benzodiazepines) during or in anticipation of panic attacks.

Exposure to the phobia trigger multiple times without a resulting panic attack (due to medication) can often break the phobia-panic pattern, allowing people to function around their phobia without the help of medications. However, minor phobias that develop as a result of the panic attack can often be eliminated without medication through monitored cognitive-behavioral therapy or simply by exposure. The decision to participate in this therapy personally or through a registered practitioner should always be made in conjunction with a medical professional.

Usually, a combination of psychotherapy and medications produces good results. Some improvement may be noticed in a fairly short period of time -- about 6 to 8 weeks. Often, it may take longer to find the right pair of medications and mental health professional. Thus appropriate treatment by an experienced professional can prevent panic attacks or at least substantially reduce their severity and frequency--bringing significant relief to 70 to 90 percent of people with panic disorder. Relapses may occur, but they can often be effectively treated just like the initial episode.

In addition, people with panic disorder may need treatment for other emotional problems. Clinical depression has often been associated with panic disorder, as have alcoholism and drug addiction. About 30% of people with panic disorder use alcohol and 17% use drugs such as cocaine or marijuana to alleviate the anguish and distress caused by their condition. Research has also suggested that suicide attempts are more frequent in people with panic disorder, although this research remains controversial.

As with many disorders, having a support structure of family and friends who understand the condition can help increase the rate of recovery. During an attack, it is not uncommon for the sufferer to develop irrational, immediate fear, which can often be dispelled by a supporter who is familiar with the condition. For more serious or active treatment, there are support groups for anxiety sufferers which can help people understand and deal with the disorder.

Other forms of treatment include journalling, in which a patient records their day-to-day activities and emotions in a log to find and deal with their personal stresses. Breathing exercises, such as diaphragmatic breathing, can also be found helpful. In some cases, a therapist may use a procedure called interoceptive exposure, in which the symptoms of a panic attack are induced in order to promote coping skills and show the patient that no harm can come from a panic attack. Stress-relieving activities such as tai-chi, yoga, and physical exercise can also help ameliorate the causes of panic disorder. Many physicians will recommend stress-management, time-management, and emotion-balancing classes and seminars to help patients avoid anxiety in the future. Research has also shown that the herbal supplement 5-HTP can be used to treat panic disorders by its ability to boost serotonin levels. This works by providing the body with the raw material to make serotonin, as opposed to SSRIs which work by recycling serotonin. It is an excellent choice if the sufferer would like to pursue a more natural approach first.

Causes

Panic disorder has been found to run in families, and this may mean that inheritance plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it.

Other biological factors, stressful life events, environment, and thinking in a way that exaggerates relatively normal bodily reactions are also believed to play a role in the onset of panic disorder. Often the first attacks are triggered by physical illnesses, major stress, or certain medications. People who tend to take on excessive responsibilities may develop a tendency to suffer panic attacks. PTSD patients also show a much higher rate of panic disorder than the general population. The exact causes of panic disorder are unknown at this point.

Studies in animals and humans have focused on pinpointing the specific brain areas involved in anxiety disorders such as panic disorder. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. It has been found that the body's fear response is coordinated by a small but complicated structure deep inside the brain called the amygdala. Eating disorders have also been linked to have caused panic attacks in several people.

Hypoglycemia may also cause panic attacks. In this condition the receptors for insulin do not respond properly to insulin, interfering with the transport of glucose across the membranes of cells. The brain depends on a steady supply of glucose — its only source of energy. When there is a sudden fall in blood sugar levels the brain sends a hormonal signal to the adrenal glands to produce adrenaline. This hormone functions to raise blood sugar levels by converting glycogen into glucose, thus preventing brain starvation, but it is also a panic hormone that is responsible for attacks of fear. The non-drug treatment for this is the adoption of the hypoglycemic diet.

DSM-IV Criteria

DSM-IV Diagnostic Criteria for Panic Disorder With or Without Agoraphobia A. Both (1) and (2):

(1) recurrent unexpected Panic Attacks

(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

persistent concern about having additional attacks

worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")

a significant change in behavior related to the attacks

B. Presence or Absence of Agoraphobia

C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D. The Panic Attacks not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).