Panic Disorder

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Panic Disorder

• Dr. Vishwamohan
• Thakur, MD

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What is Panic Disorder?

• Panic Disorder is a serious anxiety disorder.
• Individuals who suffer from Panic Disorder
  experience "panic attacks." This attack is
  extremely intense and people who have such
  experiences describe them as "horrible and
  unforgettable." Commonly a person suffering from
  this disorder remembers the time, day and events
  occurring at the time of this powerful and
  overwhelming set of symptoms.

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When does someone experience a Panic Attack?

• Panic attacks happen unexpectedly.Individuals
  who experience a panic attack usually say that
  they were not experiencing anything stressful, or
  doing anything unusual, when the attack "just
  happened out of the blue." It may occur in sleep.
  It is common that people who have panic attacks
  report significant stresses in their lives but
  the attack itself is generally perceived as
  unexpected.

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What is a Panic Attack ?

• A panic attack is a sudden episode of intense
  fear with symptoms that may include the
  following
• chest pain
• increased heart rate
• a feeling that the heart is beating harder
  (called a palpitation)
• shortness of breath or smothering feeling or a
  sensation of choking
• sweating
• dizziness
• tingling in the hands or feet
• chills or hot flashes
• nausea or stomach pain
• a feeling that things seem unreal
• fear that you are going to die or that you "are
  going crazy"
• A person needs to have 4 or more of these
  symptoms, one of these symptoms does not mean
  that he/she is having a panic attack. Some of the
  above symptoms can also be indications of serious
  medical conditions that would require a
  physician's medical evaluation.

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What the patient believes

• People with panic believe very strongly that the
  "attack" they experienced means that something is
  physically wrong with them.
• The central point is that people with panic fear
  that they have a physical, medical disease.

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What happens when someone experiences a Panic
Attack?

• Panic attacks last 20-30 minutes
• No lasting effects
• In healthy individuals, the medical evaluation is
  usually normal, except for a mildly elevated
  heart rate and a mildly elevated breathing rate
  during the attack
• What happens next?

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What happens next...?

• Individuals who suffer from panic attacks can
  frequently begin to
• Worry about having another attack (Panic attacks
  fears about having more attacks Panic
  Disorder)
• Or may progress to
• Avoid situations where they experienced an attack
  in the past (out of fear of having another
  attack)
• Avoid going anywhere alone
• Avoid leaving home (Panic Disorder avoiding
  situations that may cause panic Panic Disorder
  with Agoraphobia)

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Who experiences Panic Disorder?

• Usually
• Healthy people in their 20's or 30's (but any age
  may be affected)
• Females more than males
• Lifetime prevalence of panic attacks in the
  general population is 3 to 4
• Lifetime prevalence of Panic Disorder in the
  general population is 1 and 1/2

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How does Panic Disorder affect the family?

• Panic Disorder is also very difficult on the
  individual's family.
• Are family members more likely to have Panic
  Disorder? The answer is Yes.
• Statistics show that there is a 4 to 8 times
  greater risk of Panic Disorder in family members
  of individuals with Panic Disorder.

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Untreated Panic Attacks

• ?distress ? breathlessness
• ? GP visits
• ? ambulance calling
• ? hospitalisation
• ? medications and medical interventions
• ? distress in middle of night
• Therefore ? costs to the person and to the health
  services

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How to Identify Panic Disorder

• The Diagnostic Criteria to Diagnose Panic
  Disorder are laid down.
• They can be obtained from me as separate handout.

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What should be done when someone has a panic
attack?

• For first time panic attacks or for a change in
  usual symptoms
• Medical evaluation The symptoms of a panic attack
  are very similar to the symptoms of several
  serious medical illnesses including Heart
  attack (myocardial infarction), stroke
  (cerebrovascular accident), and bloot clot in the
  lung (pulmonary embolism). These illnesses are
  life-threatening medical emergencies and
  individuals suffering from these illnesses need
  to receive medical treatment immediately.
• In a healthy individual, if a complete medical
  evaluation is normal, a diagnosis of panic attack
  is considered.
• If a complete medical evaluation is normal, an
  individual with panic attacks is not at any
  greater risk of developing a medical illness than
  an individual without panic attacks.

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What is the medical evaluation?

• The usual medical evaluation includes
• physical examination
• blood tests
• ECG (electrocardiogram of the heart) sensors are
  placed on the chest to record the electrical
  current in the heart.
• Further medical testing may be required
  including
• further tests of heart function
• MRI (test for abnormalities in brain structure)
• EEG (test for seizures)
• What medical problems can sometimes cause a
  panic attack?

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What medical problems can sometimes cause a panic
attack?

• There are many medical problems that may
  sometimes cause symptoms of a panic attack or
  have symptoms that are similar to a panic attack,
  including
• myocardial infarction (heart attack)
• congestive heart failure
• high blood pressure
• pulmonary embolism (bloot clot in the lung)
• cerebrovascular accident (stroke)
• epilepsy
• Parkinson's Disease
• multiple sclerosis
• thyroid disease
• diabetes

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Can medications sometimes cause a panic attack?

• Yes. There are some medications that may cause
  symptoms of a panic attack or have symptoms that
  are similar to a panic attack in some people,
  including
• cold and allergy medications, cough medicine
• appetite suppressants
• "herbal remedies" containing ephedrine
• motion sickness and nausea medications
• asthma inhalers
• Nicotine, coffee, tea
• Alcohol withdrawal, Opium-withdrawal,
  sedative-withdrawal

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Panic Disorder Causes

• What Causes Panic Disorder?
• We dont really know many factors.
• But Strong evidence that norepinephrine is
  involved.
• Norepinephrine neurotransmitter especially
  active in Locus ceruleus part of the brain.

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Models of Abnormality

• Biological model
• How the brains anatomy physiology affect
  emotions, cognitions behavior

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Models of Abnormality

• Biological model Anatomy (structures)

Neo-Cortex
Corpus callosum
Amygdala
Locus ceruleus
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Amygdala
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Models of Abnormality

• Biological model Physiology (processes)

Nerve impulse
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Panic Disorder

• Anti-depressant drugs that regulate
  norepinephrine successful in treating panic
• When Locus ceruleus stimulated in monkeys ? panic
  like behavior
• Locus ceruleus rich in norepinephrine carrying
  neurons
• Hypothesis Norepinephrine dysregulation may well
  be implicated in Panic Disorder

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What is the treatment for Panic Disorder?

• There are several common treatments for Panic
  Disorder including
• Anti-anxiety medication
• Anti-depressant medication
• Psychotherapy
• Relaxation training

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Any Questions?