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) “…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)

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)

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)

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)

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)

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)

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

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)

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)

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)

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)

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)

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)

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)

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)

Treatment Few side effects Rapid onset of action 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)

Treatment Alprazolam Clonazepam Lorazepam Diazepam 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

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