Panic attacks and panic disorder

A panic attack is a sudden onset of a brief attack of severe discomfort or fear, accompanied by somatic or cognitive symptoms. Panic disorder consists of repeated panic attacks, usually accompanied by fear of their recurrence or behavior avoidance of situations that can provoke the development of an attack. Diagnosis is based on clinical data. Isolated panic attacks may not require treatment. In the treatment of panic disorder, drug therapy, psychotherapy (for example, exposure therapy, cognitive-behavioral therapy), or both.

Panic attacks are quite common, about 10% of the population fall ill during the year. Most people recover without treatment, only some develop panic disorder. Panic disorder is less common, 2-3% of the population fall within a 12-month period. Panic disorder usually begins in late adolescence, early adulthood; women fall 2-3 times more often than men.

Symptoms of panic attacks and panic disorders

A panic attack begins suddenly and includes at least 4 symptoms out of 13. Symptoms usually peak within 10 minutes, then gradually, over a period of several minutes, disappear, with virtually no signs that the doctor can observe. Despite the discomfort, sometimes very strong, panic attacks do not pose a danger to life.

Symptoms of Panic Attack

Cognitive

• Fear of death
• Fear of losing one's mind or losing control
• Feeling of unreality, unusualness, detachment from the environment

Somatic

• Pain or discomfort in the chest
• Dizziness, instability, weakness
• Sensation of suffocation
• Sensation of fever or chills
• Nausea or other unpleasant sensations in the stomach
• Stupor or tingling sensation
• Palpitation or rapid pulse
• Feeling short of breath or shortness of breath
• Increased sweating
• Tremor and trembling

Panic attacks can occur in other anxiety disorders, especially in situations associated with the main signs of the disease (for example, a person with fear of snakes can develop panic when seeing a snake). With true panic disorder, some panic attacks develop spontaneously.

Most patients with panic disorder have anxiety, fear of another attack (anticipating anxiety), they avoid places and situations in which panic was previously observed. Patients with panic disorder often feel that they suffer from a serious heart, lung or brain disease; they often visit a family doctor or seek help from emergency departments. Unfortunately, in these situations, the focus is on the somatic symptoms, and the correct diagnosis is often not established. Many patients with panic disorder also have symptoms of major depression.

The diagnosis of panic disorder is exhibited after the elimination of somatic diseases that may have similar symptoms when the criteria for the Diagnostic and Statistical Manual of Mental Disorders are met, 4th edition (DSM-IV).

Treatment of panic attacks and panic disorders

Some patients recover without any treatment, especially if they continue to resist situations in which panic attacks are observed. In other patients, especially those who remain untreated, the disease acquires a chronic intermittent course.

Patients need to clarify that usually treatment helps control the symptoms. If avoiding behavior is not formed, then perhaps there will be enough explanatory talk about anxiety, support in coming back and staying in places where panic attacks were observed. However, in situations of a long-term disorder, with frequent panic attacks and avoiding behavior, drug therapy is required in combination with more intensive psychotherapeutic interventions.

Many drugs can prevent or significantly reduce early warning ("anxiety ahead"), avoidance, amount and intensity of panic attacks. Different classes of antidepressants - SSRIs, serotonin and noradrenaline reuptake inhibitors (SSRIs), serotonin modulators, tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) are approximately equally effective. At the same time, SSRIs and SIZHS have certain advantages over other antidepressants due to a more favorable profile of side effects. Benzodiazepines act faster than antidepressants, but when used, it is likely the development of physical dependence and such side effects as drowsiness, ataxia, memory impairment. Antidepressants are often prescribed in combination with benzodiazepines at the beginning of treatment, followed by a gradual withdrawal of benzodiazepines after the antidepressant effect. Panic attacks often resume after stopping medication.

Different methods of psychotherapy are effective. Exposure therapy, in which the patient confronts with his fears, helps reduce the fear and complications caused by avoiding behavior. For example, a patient who is afraid of fainting is suggested to rotate on an armchair or hyperventilation to achieve a sensation of fainting, so the patient is shown that a sensation of fainting does not lead to fainting. Cognitive-behavioral therapy includes teaching the patient to recognize and control distorted thoughts and false beliefs and helps to change the patient's behavior to a more adaptive one. For example, patients who describe an increase in heart rate or a feeling of suffocation in certain places or situations and are afraid that they will develop a heart attack explain that their anxiety is unreasonable and should be reacted by slowed controlled breathing or other ways that cause relaxation.