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Panic Disorders: 10 Minutes Of Hell / Psychotherapy
Panic disorder is characterized by the spontaneous and unexpected occurrence of panic attacks, the frequency of which can vary from several attacks a day to only a few attacks a year. Panic attacks can indicate the presence of panic disorder, depression, or other forms of anxiety-based illnesses.
Lifetime prevalence estimates range from 1.5-5% for panic disorder and 3-5.6% for panic attacks. One-month prevalence estimates for women are 0.7% versus 0.3% for men.
Panic disorder has a bimodal distribution, with highest incidence in late adolescence and a second peak in the mid 30s.
Panic attacks are a period of intense fear in which 4 of 13 defined symptoms develop abruptly and peak rapidly less than 10 minutes from symptom onset.
Some of these symptoms will most likely be present in a panic attack. The attacks can be so disabling that the person is unable to express to others what is happening to them.
For someone who may be experiencing their first panic attack, a call to the doctor’s office is warranted. The idea is to make sure that the cause of the person’s distress is not a heart attack, asthma problem, endocrine emergency, or other dangerous medical condition.
If a person has been diagnosed with panic attacks in the past and is familiar with the signs and symptoms, the following techniques may help the person stop the attack.
• Relax your shoulders and become conscious of any tension that you may be feeling in your muscles.
• Then progressively tense and relax all the large muscle groups. Tighten your left leg with a deep breath in, for example, hold it, and then release the leg muscles and the breath. Move on to the other leg. Move up the body, one muscle group at a time.
• Slow down your breathing. This may best be done blowing out every breath through pursed lips as if blowing out a candle. This may allow you to further control your symptoms.
• Tell yourself that you are not "going crazy."
Consultation with a psychiatrist is helpful to initiate longer-term therapy and to provide follow-up planning. Longer-term therapy currently consists of SSRIs (selective serotonin reuptake inhibitors), often with additional psychotherapeutic techniques.
Clinical trials have shown SSRIs reduce the frequency of panic attack up to 75-85%. SSRIs must be taken 3-6 weeks before they are effective in reducing panic attacks and are taken once daily.
People suffering from panic disorder often participate in cognitive-behavioral therapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings. Therapy also aims to identify possibly triggers for panic attacks.
With appropriate treatment, nearly 90% of people with panic disorder can find relief. Unfortunately, many people with panic disorder do not seek treatment. Without treatment, panic disorder can have serious consequences and can severely impair quality of life. Complications of untreated panic disorder include:
• Avoidance. A person may discontinue any activities that seem to trigger a panic attack. This can make a normal work and home life nearly impossible.
• Anticipatory anxiety. This refers to anxiety that is triggered merely by thinking about the possibility of having an anxiety attack.
• Agoraphobia. This is the fear of being in places or situation in which an attack may occur, or from which escape would be difficult or highly embarrassing. This fear can drive people to avoid public places and crowds, and may even progress to the point that the person will not leave his or her home. About one-third of people with panic disorder develop agoraphobia.
The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) delineates the following potential symptom manifestations of a panic attack:
• Palpitations, accelerated heart rate
• Trembling or shaking
• Sense of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization or depersonalization (feeling detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flashes
Kulesh Julia MD, psychiatrist