Definition

Unpredictable attacks of anxiety that are accompanied by physiological manifestations (see also generalized anxiety disorder).

Alternative Names
Panic attacks

Causes, incidence, and risk factors
The exact cause of panic disorder is unknown. There is a clear influence of heredity. There may be a temporal lobe dysfunction, or the disorder may develop as a persistent pattern of maladaptive behavior acquired by learning. Stimulants, such as caffeine and cocaine, or alcohol may induce or worsen the symptoms.

People with this disorder often undergo medical evaluations for symptoms related to heart attack or other medical conditions before the diagnosis of panic disorder is made. Attacks may last from minutes to hours. An affected person often lives in fear of another attack and may be reluctant to be alone or far from medical assistance.

There is a familial tendency, with age of onset before 25 years old. It occurs more often in women than men. Approximately 2% of the population is affected. Panic disorder can occur in children, but is often not recognized.

Symptoms

At least 4 or more of the following symptoms within ten minutes; or 1 or more attacks followed by at least 1 month of persistent fear of having another attack:

 
• Shortness of breath  
• Dizziness or faintness  
• Palpitations  
• Trembling  
• Sweating  
• Choking  
• Nausea  
• Numbness or tingling  
• Chest pain or discomfort  
• Fear of dying  
• Fear of being out of control  
• Sleep disturbances  
• Skin, clammy  
• Skin blushing or flushing  
• Heartburn  
• Facial paralysis  
• Agitation

Signs and tests
A physical examination and a psychological evaluation are performed. Underlying medical disorders are ruled out. Cardiovascular, endocrine, respiratory, neurologic, and substance abuse disorders may be suspected and can coexist with panic disorders. Diagnostic tests will vary with symptoms.

Treatment
Anti-anxiety medications and anti-depressants have been successfully used to treat panic disorders. These medications act on the central nervous system to reduce the feelings of anxiety and associated symptoms. A common class of anti-anxiety medications are the benzodiazepines. However, benzodiazepines are associated with dependence.

Behavioral therapies that may be used in conjunction with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive restructuring. Psychological counseling and therapy techniques may be helpful.

Regular exercise may help reduce the frequency of the attacks. Caffeine and other stimulants should be reduced or eliminated.

Expectations (prognosis)
The disorder may be long-standing and difficult to treat. Although many with this disorder may not be cured with treatment, many can expect improvement with drug or behavioral therapy.

Complications

 
• Dependency on anti-anxiety medications  
• Avoidance of situations or places that might bring on an attack

Calling your health care provider

Call for an appointment with your health care provider if panic is interfering with work, relationships, or self-esteem.

Prevention
Avoid stimulants such as caffeine and cocaine, and avoid alcohol use, if you are prone to panic attacks. Psychiatric intervention may be helpful.