Panic Disorder
PANIC DISORDER A panic is defined as an episode of intense fear of sudden onset that usually peaks within a minute. The fear, often bordering on terror is generally accompanied by unpleasant physical sensations, difficulty in reasoning and a feeling of impending doom and catastrophe which most of us usually describe as "something terrible is about to happen, or is happening to me." You often feel as though you're in great danger. Some panics are unexpected, it appears as if they come out of the blue. Others are regularly provoked by exposure to identifiable stresses, and therefore can be anticipated. Whether spontaneous, or predictable, panic attacks are upsetting to those of us who have them, and even more fearful to family members and friends. On the average, panic attacks, or episodes of panic last between 10 and 20 minutes, extremely distressing, and leave the person feeling physically drained and apprehensive. Without medication, and with the stressor still lingering, panic attacks can flow repeatedly leaving the person feeling even more drained. It should be emphasized that most people experience panic to some degree in their lives at least once or twice. ( 15 per 1000 people) This is not necessarily a sign of psychological disorder.
The American Psychiatric Association defines the features of panic disorder as follows:
SYMPTOMS OF PANIC DISORDER Shortness of breath Dizziness or faintness Increased heart rate or pounding heart Trembling or shaking Feeling of choking Sweating Stomach distress, or nausea Feeling that one's surroundings are not quite real Feelings of numbness or tingling sensations Hot flashes or chills Chest pain or discomfort A fear of dying Fear of losing control, or of going crazy
In cases of panic disorder, the episodes may occur as often as daily, or several times per week. Reassurance is usually sufficient to provide temporary relief if the individual has only experienced one or two panic attacks. However, when the third or subsequent attacks, the person begins to fear that more episodes will take place, and at inappropriate or inconvenient times. He/she becomes anxious and apprehensive and no longer feels safe.
Panic episodes in other anxiety disorders Panics are almost as common in social phobias, obsessive-compulsive disorder, generalized anxiety disorder, and specific phobias as they are in panic disorder. Panics are also common in depression. However, in panic disorder the episodes tend to be more severe, more frequent, and more unpredictable, than they are in other forms of anxiety disorders or in depression. What precipitates a panic disorder? Most panic disorders appear to be brought on by a stressful event or period. It is rare for most people to explain their sudden experience of intense fear without treatment. However, during assessment and treatment, the stressful trigger of the panic tends to emerge. Major changes in life can bring on panics, and the most common triggers are: marital/personal conflict, illness or death of a spouse or close friend, births or miscarriages, and financial threats or loss, stress at work, health problems, and negative reactions to drugs. RISK FACTORS Family conflict Lack of parental support Separation anxiety during childhood Chronic physical or psychiatric illness in the family Alcohol or substance abuse in the family History of respiratory illness
CONSEQUENCES OF PANIC The consequences of experiencing panic can be disabling and can persist for years. We literally avoid any and all places that we THINK may cause panic. A person who fears suffocation will avoid tunnels, elevators, closed in places, underground tunnels, high places, bridges, airplanes, driving cars, buses, trains, large crowds, parties, stores, theatres, etc. The type of avoidance, can become so severe that it literally controls the persons entire life.
TREATMENT Persistent panic disorder has an effect on most aspects of a person's life- Marital relationships, mobility, social contacts, employment, and economic status. Moreover, it can be extremely disabling. Psychological treatment is effective in a majority of cases, but long-term effects are yet to be studied. A combination of psychological treatment (talk-therapy) and pharmacological treatment (medication) is usually implemented. The good news is that panic disorder is treatable. No one has to live their lives walled off from society.
MEDICATION Caution: As with any other condition, you must consult your physician. This is merely an information only! Whether or not a medication works depends upon trial and error. There are three classes of drugs that are used to treat panic disorder. Patience will be your reward. In the past, the anti- depressant drugs, the tricyclic group, (imipramine, desipramine, tofranil) These drugs were used widely because they treated not only depression, but panic disorder. Drugs, that are classified as MAO inhibitors are used.( nardil, norpramine) The list of precautions is lengthy, and extra care must be taken when taking this class of drugs. These foods are avoided when taking MAO inhibitors: Beer, cheese and foods containing cheese (pizza, macaroni and cheese), dry sausage, liver, meat extracts, yogurt, yeast, red wine A third class of drugs that is known to reduce panic frequency are the benzodiazepines. The Most commonly prescribed drug in this class is alprazolam (Xanax). This drug, however, has a high dependency rate and should be used with caution under the advice of a physician. Withdrawal can be difficult, therefore, it should NOT be discontinued abruptly. The newest drug that is commonly used today is PAXIL.
PSYCHOLOGICAL TREATMENT Cognitive Therapy is beneficial. The individual learns that you cannot die from a panic attack and how to go through the episode of panic.
RELAPSE PREVENTION Education is important. The client learns as much about their condition as the physician. By the end of treatment, the individual has been re-entered into society to prevent relapse.
PANIC DISORDER WITH AGORAPHOBIA MY STORY
ASSESSMENT AND EVALUATION
SUGGESTED READING
ADDRESSES OF USEFUL ORGANIZATIONS United Kingdom
United States The Anxiety Disorders Association of America 6000 Executive Blvd Suite 2000 Rockville, Maryland 20852-3801
Canada
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