What is Panic disorder

Panic disorder is a psychological disease. It is a type of anxiety disorder.

Anxiety disorders are classified according to whether the anxiety is persistent (general anxiety) or episodic, with the episodic conditions classified according to whether the episodes are regularly triggered by the same cue (phobia) or not (panic disorder). The more severe form of panic disorder features agoraphobia – the fear of open spaces, fear of being outside of the house alone or fear of being in crowds.

Statistics on Panic disorder

The prevalence of panic disorder is approximately 1.5-4% of the general population. It occurs most frequently in the late 20-30 age bracket. With the presence of agoraphobia, panic attacks are twice as common in women than in men. In the absence of agoraphobia, males and females are affected equally.

Risk Factors for Panic disorder

The most important risk factor for the development of any anxiety disorder is a family history of an anxiety disorder. It has been estimated that 20% of first-degree relatives of patients with agoraphobia suffer from the same condition.

Progression of Panic disorder

Panic attacks tend to occur two or three times per week. They may occur without warning or may be associated with certain situation.

Panic attacks are thought to progress through a number of stages, starting from simple panic attacks and progressing to the state of agoraphobia (socially withdrawn often housebound). The condition begins with subclinical anxiety attacks which soon progress to full panic attacks. The patient then begins to associate certain situations with the development of panic attacks, and will become hypochondriacal about these situations. They then develop anticipatory anxiety about the situation, becoming anxious on considering becoming invovled with that situation. Following this, patients will actively avoid certain situations for fear of experiencing a panic attack. The final product of this progression in the development of agoraphobia, which represents an incessant fear of venturing outside for fear of developing an anxiety panic attack. Patients with agoraphobia may become completely housebound and hence socially withdrawn, leading to depression, alcoholism and illicit drug use.

How is Panic disorder Diagnosed?

Extensive investigation of panic attacks is usually unnecessary, unless there is strong suspicion of a medical cause. Investigation tends to increase patient anxiety levels as they ruminate over the potential results of investigation.

Investigation should be limited to the following:

1. ECG – Detection of cardiac arrhythmias as a cause of palpitations.
2. Bloods – Thyroid function tests, catecholamine assays and blood sugar level.
3. A provocation test involving voluntary overbreathing for 2-3 minutes, provokes similar symptoms; rebreathing from a large paper bag relieves them.

Prognosis of Panic disorder

The prognosis of panic disorder is excellent, provided that appropriate therapy is applied. If the panic disorder is allowed to progress to a state of agoraphobia, the condition becomes more difficult to treat.

How is Panic disorder Treated?

As with most psychiatric illness, panic disorder is best treated with both psychotherapy and anti-anxiety medications. There are a number of types of psychotherapy suitable for the treatment of panic disorder. These include relaxation therapy, behaviour therapy and cognitive behavioural therapy.

Medications are used to assist psychotherapy as a primary form of treatment. Medications such as sedatives and antidepressants are used in this setting to reduce the frequency and severity of panic attacks. The most commonly used sedatives are the benzodiazepines such as diazepam, however their use beyond 4-6 weeks is discouraged with the emergence of dependence beyond this duration. The most commonly used antidepressant for this condition are the SSRI’s such as flluoxetine and sertraline.
Antidepressant medications will usually require three months of therapy to achieve adequate effect, but have the advantage that they do not induce patient dependency.

Another class of drugs commonly used for panic disorder are the beta-blockers. These drugs block the body’s response to anxiety, preventing the occurrence of palpitations, sweating and tremor in the event of a panic attack. They can also be taken in anticipation of a stressful situations to reduce the effect of anxiety on the body.

Panic disorder References

[1] eMedicine.
[2] Kumar P, Clark M. Clinical Medicine. Fourth Ed. WB Saunders, 2002.
[3] Sadock BJ., Sadock VA. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry 3rd edition. Lippincott Williams and Wilkins 1996.