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Panic disorder

Panic disorder. By Rachel Jensen. What is Panic Disorder?. “…repeated occurrence of discrete panic attacks” (DSM-IV, 1994) Random and sudden attacks of fear that last for several minutes (Panic Disorder & Agoraphobia, 2012)

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Panic disorder

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  1. Panic disorder By Rachel Jensen

  2. What is Panic Disorder? • “…repeated occurrence of discrete panic attacks” (DSM-IV, 1994) • Random and sudden attacks of fear that last for several minutes (Panic Disorder & Agoraphobia, 2012) • “…patients develop apprehension towards the possibility of having another attack.”(DSM-IV, 1994) • Sudden attacks of fear are called panic attacks (Panic Disorder & Agoraphobia, 2012) • Can occur at anytime, anywhere • Seem “out of the blue” (Panic Disorder & Agoraphobia, 2013)

  3. Signs and Symptoms of Panic Disorder • Sudden and repeated attacks of fear • A feeling of being out of control during a panic attack • An intense worry about when the next attack will happen • Fear or avoidance of places where panic attacks have occurred in the past • Physical symptoms during an attack are • Pounding or racing heart • Sweating • Breathing problems • Weakness or dizziness • Feeling hot or a cold chill • Tingly or numb hands • Chest or stomach pains (Panic Disorder & Agoraphobia, 2012)

  4. Facts About Panic Disorder • Common Disorder • Part of Axis 1 • About 1.7% of Americans suffer from Panic Disorder (Panic Disorder, 2012) • Woman twice as likely to have than men (Panic Disorder, 2012) • Usually develops between the ages of 20s-30s (Panic Disorder, 2013) • Can occur in children, but not diagnosed till 20s-30s (Panic Disorder, 2013) • Not everyone who has panic attacks has panic disorder (Panic Disorder, 2013)

  5. What is a Panic Attack? • “A discrete period of intense fear or discomfort” that “builds to a peak rapidly (usually 10 minutes or less)” (DSM-IV, 1994) • Those who are having a panic attack feel the urge to escape doom or danger (DSM-IV, 1994)

  6. Panic Attacks • Usually comes on suddenly • Symptoms usually only last for about 5-15 minutes • People usually feel “shaken” and “drained” after • Can feel this way for hours • Some patients think they are having a heart attack or are dying and go to the hospital • Patients rarely have no anxiety and only some discomfort during a panic attack • After many attacks people begin to fear situations • Fear the situation not because the situation will cause the attack but because they will have an attack in that situation and not be able to get help (DSM-IV, 1994)

  7. Panic Attacks • Three types of Panic Attacks • Unexpected Panic Attacks • attack occurs “out of the blue” • Situational Panic Attacks • Attack is caused by a trigger • Situationally Predisposed Panic Attacks • Similar to situational panic attacks, but do not necessarily occur immediately after the exposure or trigger (DSM-IV, 1994)

  8. Symptoms of Panic Attacks • Anxiety • Tremor • Palpitations • Chest discomfort • Diaphoresis • Acralparethesias (DSM-IV, 1994) • Hot and cold flashes • Dyspea • Dizziness or faintness • Nausea or abdominal distress Patients rarely have all symptoms during any one attack

  9. Diagnostic Criteria for Panic Attacks • Palpitations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Sensations of shortness of breath or smothering • Feeling of choking • Chest pain or discomfort • Parethesias (numbness or tingling sensations) • Chills or hot flashes • Nausea or abdominal distress • Feeling dizzy, unsteady, lightheaded, or faint • Derealization (feelings of unreality) or depersonalization (being detached from oneself) • Fear of losing control or going crazy • Fear of dying (DSM-IV, 1994)

  10. Causes of Panic Disorder • No known cause • Sometimes runs in families • “researchers have found that several parts of the brain are involved in fear and anxiety” • Researchers are learning more about fear and anxiety in the brain to learn more about treatments • Researchers are looking into how stress and environment factors may play a role (Panic Disorder, 2012)

  11. Essential Features • Presence of recurrent, unexpected panic attacks followed by at least 1 month of persistent concern of having another panic attack, worry about the possible implications or consequences of panic attacks, or significant behavioral change because of panic attacks • Panic attacks not due to the direct physiological effects of a substance or a general medication • Not accounted for by another mental disorder • At least 2 unexpected panic attacks (DSM-IV, 1994)

  12. Associated Feature • Constant or intermittent feelings of anxiety that are not focused on any specific situation or event • Anticipate a catastrophic outcome from a mild physical symptom or medication side effect • Must less tolerant of medication side effects and need reassurance to continue to take medication • Apprehensive towards outcome of routine activities and experiences • Loss or disruption of important interpersonal relationships • Demoralization • Frequently absent from work or school for doctor or emergency room visits (DSM-IV, 1994)

  13. Differentiated Diagnosis • Not diagnosed if panic attacks are a direct physiological consequences of a general medical condition • hyperthyroidism • Hyperparathyroidism • Seizure disorders • Cardiac conditions • Not diagnosed if panic attacks are direct result of physiological consequences of a substance • Drug abuse or medication (DSM-IV, 1994)

  14. Diagnostic Criteria • Chest pain or discomfort • Dizziness or faintness • Fear of dying • Fear of losing control or impending doom • Feeling of choking • Feelings of detachment • Sweating, chills, or hot flashes • Trembling or shaking • Feelings of unreality • Nausea or upset stomach • Numbness or tingling in the hands, feet, or face • Palpitations, fast heart rate, or pounding heart • Sensation of shortness of breath or smothering (Panic Disorder, 2013)

  15. Agoraphobia • “Most common complication of panic disorder” (DSM-IV, 1994) • 1/3 to1/2 of all patients are seen with agoraphobia within the first year (DSM-IV, 1994) • Anxiety becomes so severe in many different situations, that people begin to restrict their travel (DSM-IV, 1994) • Avoid public places where they feel immediate escape is difficult (Panic Disorder & Agoraphobia, 2013) • Stop going to places where they anticipate another panic attack happening because of previous experiences (Panic Disorder & Agoraphobia, 2013)

  16. Treatment • Medicine and Cognitive – Behavioral treatment (DSM-IV,1994) • Many people become free of panic attack because of taking the medication (DSM-IV, 1994) • Cognitive – Behavioral treatment therapy • Teaches person different ways of thinking, behaving, and reacting to situations where they feel anxious and fearful (Panic Disorder, 2012)

  17. Treatment Anti-depressants Benzodiazepines • SSRIs • Better tolerated • Start with low dose then is increased • Every patient has a different response • Once a dose has been reached, the response may take up to 3 months to be seen • Few side effects • Rapid onset of action • Reduce the anticipatory anxiety that people experience (DSM-IV, 1994)

  18. Treatment Antidepressant Benzodiazepines • MAOIs and Tricyclics • SSRIs • Paroxetine • Fluoxetine • Citalopram • Sertraline • Common names are Prozac, Zoloft, Paxil, Lexapro • Alprazolam • Clonazepam • Lorazepam • Diazepam • Common names are Klonopin and Xanax

  19. Case Study • I have Panic Disorder with Agoraphobia • Been diagnosed with it for about 4 months now • Go see a psychiatrist for it • Has greatly affected my life • To treat it, took Zoloft for a while and not take Lexapro

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