Panic Attack and Panic Disorder



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Panic Attack and Panic Disorder

Panic attacks are defined as sudden increase in anxiety and fear, while panic disorder describes recurrent panic attacks. It is important to remember that a panic attack does not necessarily constitute a panic disorder and appropriate treatment of a panic attack may limit the development of panic disorder. 



Symptoms:

A panic attack is described as an overwhelming anxiety and fear. It peaks quickly – between one and ten minutes. It‘s not consistent with specific situations, comes „out of the blue“. Your heart pounds and you can‘t breathe. You may feel like you‘er dying or going crazy.

A full-blown panic attack includes a combination of the following signs and symptoms:


  1. Shortness of breath or hyperventilation.

  2. Skipping, racing or pounding heart.

  3. Chest pain or discomfort

  4. Trembling or shaking.

  5. Choking feeling.

  6. Feeling unreal or detached from your surroundings.

  7. Sweating.

  8. Nausea or upset stomach.

  9. Feeling dizzy, light-headed, or faint feeling.

  10. Numbness or tingling sensations in parts of your body.

  11. Hot or cold flashes.

  12. Fear of dying, losing control, or going crazy.

You may be suffering from panic disorder if you:

  • Experience frequent, unexpected panic attacks that aren‘t tied to a specific situation

  • Worry a lot about having another panic attack

  • Are behaving differently because of the panic attacks, such as avoiding places where you‘ve previously panicked.

Causes:

There appears to be a connection with major life transitions such as starting or graduating from College, entering a new workplace, getting married, having a baby…etc…Severe stress, such as the death of a loved one, divorce, or job loss can also trigger a panic attack.

If you are suffering from symptoms of panic, it‘s important to see a doctor to rule out the following possibilities:


  • Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart‘s valves doesn‘t close correctly.

  • Medication withdrawal.

  • Stimulant use (amphetamines, cocaine, caffeine).

  • Hyperthyroidism (overactive thyroid gland).

  • Hypoglycemia (low blood sugar).

Treatments:

Calming technique (see link):

http://www.cci.health.wa.gov.au/docs/ACF3942.pdf

...or find a guided calming technique exercise on the internet, this one i.e.:

https://www.youtube.com/watch?v=4e3Csho8CBw



Progressive Muscle Relaxation (see link):

http://www.cci.health.wa.gov.au/docs/ACF3944.pdf

...or find a guided progressive muscle relaxation exercise on the internet, this one i.e.:

https://www.youtube.com/watch?v=2ZKNr-W9A1U



When to see a doctor or a psychologist?:

Panic Disorder and Agoraphobia:

When someone with Panic Disorder has a persistent fear of having another attack or worries about the consequences of the attack, it can have an affect on the behaviour. This someone can start to avoid any place where it might happen or where it might be difficult to get help or to escape from. This severe avoidance is called Agoraphobia.



Safety Behaviours:

In addition to avoidance many people use „safety behaviours“ or subtle avoidance to help cope with anxiety. These may include relying on medication, having the mobile phone on you all the time, always having an exit plan for potentially-anxious situations or making sure you have someone else with you. You may also use other more subtle methods, such as trying to distract yourself from your anxiety by seeking reassurance, listening to music etc. These types of behaviours can play a part in the vicious cycle (see picture):



Treatment:

The following are recommended treatment options that have an evidence base:

  1. Psychological therapy - according to international clinical guidelines - NICE guidelines - Cognitive Behavioural Therapy should be used,

  2. Medication - long term choice: SSRI / Benzodiazepines are associated with a less good outcome in the long term and should not be prescribed for the treatment of individuals with panic disorder…and…

  3. Self-help material. 

References:

Westbrook, C., Kennerley, H. & Kirk, J. (2007). An Introduction to Cognitive Behaviour Therapy. Skills and Applications. SAGE Publications, London.

http://www.helpguide.org/articles/anxiety/panic-attacks-and-panic-disorders.htm

NICE guidelines: http://www.nice.org.uk/guidance/cg113/chapter/1-recommendations



Katrín Sverrisdóttir 2015



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