Panic disorder

Introduction

Anxiety is an alerting signal, which enables a person to become prepared to deal with a threat. Every person experiences anxiety during stressful situations in life. Normal anxiety is a diffuse, unpleasant vague sense of apprehension, which subsides easily. But anxiety becomes pathological, when it interferes with day to day activities of an individual, or necessitates treatment. Panic disorder is a common anxiety disorder. Life time prevalence is 1.5 to 5%.

Aetiology and Pathogenesis of Panic disorder

The major neurotransmitter systems implicated are those for norepinephrine, serotonin and GABA. The limbic system, the prefrontal cortex as well as the noradrenergic neurons of locus ceruleus and the serotonergic neurons of the median raphe nucleus are responsible for the generation of panic attacks. The autonomic nervous system of patients with panic disorder has been reported to exhibit increased sympathetic tone and to respond excessively to emotional stimuli.
Psychoanalytic theories conceptualize panic attacks as arising from an unsuccessful defense against anxiety provoking impulses. Psychodynamic exploration of patients with panic disorder frequently reveals a clear psychological trigger for the panic attacks. The pathogenesis of panic attacks is related to neurophysiologic factors triggered by the emotional problems.

Clinical Features and Diagnosis of Panic Disorder

Panic attack is a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach the peak within 10 minutes.
• Palpitation
• Sweating
• Trembling
• Sensation of shortness of breath
• Feeling of choking
• Chest pain or chest discomfort
• Nausea or abdominal distress
• Feeling dizzy or unsteady
• Derealisation or depersonalization.
• Fear of losing control
• Fear of dying
• Chills or hot flushes
Panic disorder is diagnosed when a person develops recurrent unexpected panic attacks and has persistent concern about having additional attacks.

Course and Prognosis of Panic disorder

Panic disorder has its onset during late adolescence. If not managed at the earliest it can have a chronic relapsing course. Patient with good premorbid functioning and a brief duration of symptoms tend to have good prognosis.

Psychological Treatment of Panic Disorder

Several studies have shown that cognitive behavior therapy is effective in producing long lasting remission of symptoms in panic disorder. Relaxation therapy, insight oriented psychotherapy and family therapy are also effectively used in the management of panic disorder. Early diagnosis and management will also help in preventing further panic attacks. Through life skills training, we can improve the emotional well being of the individuals.

Conclusion

Untreated panic disorder will have far reaching detrimental effects. Hence panic disorder should be diagnosed and managed scientifically at the earliest. Psychological therapies have an important role in the management of panic disorder.