Panic Disorder

Panic attacks involve intense fear doubled with symptoms like heart pounding, breathing difficulties, trembling, and fear of dying or losing control. Panic attacks may be abrupt and peak within 10 minutes and last only minutes or they may last for hours. Symptoms are often perceived as medical and include: pounding heart, chest pains, trembling, choking, abdominal pain of distress (nausea), sweating, dizziness, confusion, dread, and a desire to flee. Attacks may have no noticeable precipitant (unexpected panic attacks) or may be triggered by situations such as crowds, stress, or anticipation of an attack (Situational bound panic attacks). Situational predisposed attacks occur when one has an attack when exposed to a trigger but attacks are not necessarily bound to this trigger. Panic attacks may be chronic or may appear and disappear. With panic disorder, at least one attack is followed by one month of persistent feelings that the person will have another attack. It should be noted that "panic attack" is not a disorder; rather, it is a symptom. Panic Disorder, according to the DSM-IV, is either present with or without Agoraphobia. Further, Agoraphobia may be present without a history of panic attacks. 

There appears to be a genetic component to Panic Disorder, with 15% of first-degree relatives and 30% of monozygotic twins suffering from the disorder. Common co-morbid conditions include Major Depression, Social and Specific Phobias, and alcoholism. The disorder occurs twice as often in females than in males. Panic occurs most often with Agoraphobia.

The theoretical approaches used in this disorder are behavioral, cognitive-behavioral, psycho education, psychodynamic. 

Reduction of the patient's fears and helping them to understand his/her physical complaints generally will help reduce the patient's fears. Moving the personal explanation from medical concerns is tantamount to successful treatment. Sometimes taking a look at what triggers the attack can be especially helpful too. However, since panic attacks often come without apparent triggers, this is often difficult. The somatic component is so powerful that it may be difficult to convince the patient that they are not close to death when they have an attack. 

The goal of panic disorder is to reduce the symptoms that the patient is experiencing. Another goal is to teach the patient better coping abilities in response to the anxiety. Types of intervention used are relaxation therapy, recognizing the bodily sensations they are experiencing and provide effective breathing before the attack is in full force. For an insightful patient, you will want to identify triggers and look at what are the meanings of the attacks. 

Cognitive-behavioral therapy and psychopharmocotherapy are shown to be most effective and have been widely accepted due to significant empirical research. Systematic desensitization and exposure either in vivo or imagine are shown to be quite effective in modifying panic response. Medication, including SSRIs, tricycles and Benzodiazepines are also quite effective. Medication should be used in conjunction with cognitive behavioral treatment. Often, medication is used for six months with cognitive-behavioral treatments, then the patient is slowly weaned off the medication. However, relapse is high and may require "half dose" maintenance. (Linton, 2008)