Wednesday, May 8, 2013


What is panic disorder? 

A severe attack of anxiety which reaches peak instantly and settles down within 15-30 minutes is called panic attack. It invariably is accompanied by a feeling of impending doom. Panic attack can occur in all physical as well as mental conditions but to be classified as panic disorder it should be independent of those conditions.
Panic disorder is present in approximately 3% of population. It is 3 times more common in women than in men.

Causes of panic attacks

Certain neurochemicals like serotonin are implicated in this disorder
Panic inducing substances are known to occur in these people
Brain imaging may show certain minute abnormalities.
Risk factors for panic disorder is family history
Mitral valve prolapse might mimic panic attack
For panic attack to be classified as panic disorder the frequency of panic attack should be once/ week for 4 weeks.
Types of panic disorder
     1.      Panic disorder without agoraphobia
     2.      Panic disorder with agoraphobia
Agoraphobia is defined as fear of occurrence of panic disorder in places from where immediate escape is not possible like open fields, cinema halls etc. If accompanied by some person the patient feels safe.
Symptoms of panic attack include-
     1.      Dryness of mouth
     2.      Palpitations
     3.      Sweating
     4.      Coldness of skin
     5.      Tremors
     6.      Chest discomfort
     7.      Headache
     8.      Feeling of impending doom

Treatment of panic disorder

Differentiating panic attack caused by other medical and psychiatric conditions from true panic disorder.
Pharmacological treatment includes
SSRI’S particularly Paroxetine is the mainstay of treatment of panic disorder.
TCA’S can also be used
Benzodiazepines are for the initial symptomatic control of panic attack till the SSRI’S or other drugs act. Long term use of these for panic disorder should be avoided as they cause dependence
MAOI’S are to be used with caution.
Non pharmacological treatment includes cognitive behavioraltherapy.
Wishing you a long and healthy life
Dr Hitesh Sharma
MBBS, MD (Psychiatry)
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