Panic attacks are sudden periods of intense fear or discomfort that reach a peak within minutes. They can occur as part of panic disorder or as isolated events.
Causes
- Genetic Predisposition: A family history of panic attacks or panic disorder increases the risk.
- Psychological Factors: Stress, history of trauma, and certain personality traits.
- Neurobiological Factors: Dysregulation in brain circuits involved in fear and anxiety responses.
- Medical Conditions: Thyroid disorders, cardiac arrhythmias, asthma, and substance use can mimic or trigger panic attacks.
- Medications and Substances: Certain medications, caffeine, alcohol, and drugs can precipitate panic attacks.
Diagnosis
- History:
- Symptoms: Rapid onset of palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills, or heat sensations, fear of losing control or “going crazy,” fear of dying, numbness, or tingling sensations.
- Duration: Typically last minutes but can vary; inquire about the onset, duration, and frequency.
- Context: Occurrence in specific situations or spontaneously.
- Psychiatric History: Previous panic attacks, other anxiety disorders, depressive disorders, substance use.
- Physical Examination:
- To rule out other medical causes, a thorough
- cardiovascular,
- respiratory,
- neurological, and
- endocrine
- examination is recommended.
- To rule out other medical causes, a thorough
- Investigations:
- Laboratory Tests: Thyroid function tests, electrolytes, glucose, and full blood count to exclude medical mimics.
- ECG: Particularly in older patients or those with a cardiac risk profile.
- Pulmonary Function Tests: If respiratory disorders are suspected.
Differential Diagnosis
- Cardiac Disorders: Such as angina, arrhythmias.
- Endocrine Disorders: Thyroid disorders, pheochromocytoma.
- Respiratory Disorders: Asthma, pulmonary embolism.
- Neurological Disorders: Partial seizures
- Psychiatric Disorders: Other anxiety disorders, depressive disorders, somatization.
Management
- Acute Management:
- Reassurance and Support: Providing a safe environment, reassurance that the symptoms are not life-threatening.
- Breathing Techniques: Controlled breathing exercises to manage hyperventilation.
- Long-term Management:
- Psychotherapy: Cognitive-behavioral therapy (CBT) is effective in treating panic disorder.
- Pharmacotherapy:
- Selective serotonin reuptake inhibitors (SSRIs) are first-line medications.
- Benzodiazepines may be used for rapid relief but have a risk of dependence.
- Prazosin
- Lifestyle Modifications:
- Reducing caffeine, alcohol, and smoking.
- Stress management and relaxation techniques.
- Education and Counseling:
- Educate about the nature of panic attacks, the course of the disorder, and the importance of adhering to treatment.
- Regular Follow-up:
- Monitoring response to treatment, adjusting medications, and managing side effects.
- Referral:
- Referral to a psychiatrist or psychologist for specialized therapy, particularly for refractory cases.
It is crucial to distinguish panic attacks from other serious conditions with similar presentations. A comprehensive approach including psychotherapy, pharmacotherapy, and lifestyle changes is vital in managing panic disorder effectively.