Panic disorder
Definition
Panic disorder is a condition where people have regular occurences of panic attacks, with periods of relatively normal mental state in between. Often there is no causative stressor for the attacks.
Epidemiology
0.8% of the population will get Panic Disorder - but that includes very mild cases - I've had a panic attack once, ten years ago. Slightly more common in women.
Pathophysiology
Its a biological problem, related to serotonin/noradrenaline. No one knows, as usual, but something like that shoulg be enough to fob off patients.
Risk Factors
- Female
- Early Twenties Age
- Family History
- History of cardiac disease, asthma, seizures
- Psychiatric history
- Drug/alcohol abuse
- Caffeine abuse
Clinical Features
Panic disorder is a condition where people have regular occurences of panic attacks, with periods of relatively normal mental state in between, whereas Generalised Anxiety Disorder tends to be present throughout a person's day.
However, many people with PD will have a continuing level of anxiety during the day, as well as their panic attacks. This can make it difficult to distinguish from GAD. They key difference is that for people with PD, the focus of their anxiety is on whether they will have another attack, leading to behaviour where they avoid places or situations where they have had previous episodes.
According to ICD-10, Panic disorder should also not be given as the main diagnosis if the patient has a depressive disorder at the time the attacks start; in these circumstances the panic attacks are probably secondary to depression.
The following are symptoms of a panic attack:
- Sudden onset of palpitations
- Chest pain
- Choking sensations
- Dizziness
- Feelings of unreality (depersonalization or derealization)
- Fear of dying
Investigations
- Phaechromocytoma
- TFTs - thyroid disorder can cause the symptoms
- Vitamin B deficiency?
Management
Pharmocological
Non-meds
- CBT
- Relaxation techniques
Prognosis
With modern treatment, up to 90% remission is achieved. However, panic disorder is liable to return, treatment must often be continued in order to provide prophylactic prevention.