Lecture Notes: Understanding Panic Attacks and Panic Disorder

Introduction to Panic Attacks

• A panic attack involves a sudden period of intense fear or discomfort.
• Accompanied by feelings of imminent threat or danger.
• Physiological symptoms include:
  • Heart palpitations
  • Dizziness
  • Shortness of breath
• Symptoms peak within 10-20 minutes, lasting potentially for hours.
• Can feel like a heart attack or life-threatening illness.
• Occur unpredictably, even in familiar places.

Diagnostic Criteria for Panic Attacks (DSM-V)

• Must have an abrupt onset of four out of thirteen symptoms:
  • Pounding heart or fast heart rate
  • Chest pain or discomfort
  • Sweating
  • Trembling
  • Shortness of breath
  • Nausea
  • Dizziness
  • Chills
  • Numbness
  • Feelings of choking
  • Detachment from oneself
  • Fear of losing control
  • Fear of dying
• Symptoms can be difficult to separate, often occurring together.
• Involves both physical symptoms and specific thoughts/ideas.

Panic Attacks in Context

• Can occur with other mental disorders such as:
  • Depressive disorders
  • Posttraumatic stress disorder (PTSD)
  • Substance abuse disorders
• Also occur in panic disorder, characterized by recurrent and unexpected attacks.

Diagnostic Criteria for Panic Disorder (DSM-V)

• Recurrent, unexpected panic attacks.
• Persistent worry or behavioral changes due to attacks.
• Not due to substance effects or better explained by other anxiety disorders.

Impact of Panic Disorder

• Patients may develop avoidance behaviors, avoiding places where attacks occurred.
• Avoidance can reduce anxiety temporarily but complicates daily life.
• Anticipatory anxiety: fear of having a panic attack, leading to reclusiveness.
• Potential development of agoraphobia.

Epidemiology

• Panic disorder is twice as common in women as in men.
• A genetic component is suggested but not fully understood.

Treatment Approaches

Psychotherapy

• Cognitive Behavioral Therapy (CBT) is effective:
  1. Learning about panic disorder and symptoms.
  2. Monitoring attacks with a diary.
  3. Breathing and relaxation techniques.
  4. Changing beliefs about attack severity.
  5. Exposure to fear-provoking situations.

Medications

• Antidepressants (SSRIs) with sedative effects.
• Anti-anxiety medications (benzodiazepines):
  • Can lead to side effects like tolerance, dependence, and withdrawal.
• Severe cases may use anti-seizure medications.

Conclusion

• Combination of CBT and medication can effectively treat many patients with panic disorder.