Panic Disorder

Panic disorder
Panic disorder is a type of anxiety disorder characterized by
recurrent and unexpected panic attacks. These attacks
are sudden episodes of intense fear or discomfort that
reach a peak within minutes. Panic attacks can include
symptoms such as palpitations, sweating, trembling,
shortness of breath, chest pain, nausea, dizziness, and a
.fear of losing control or dying
Table of contents
01 02 03
Causes
Biological
Psychological
DSM - V Criteria Clinical features
Genetic factors 4 main criteria

04 05
Course and Treatment
prognosis Pharmacotherapy
Cognitive and Behaviour
Therapies
 Cause : Biological
Panic disorder is biologically influenced, involving
dysregulated neurotransmitter systems like
noradrenaline and serotonin, as evidenced by
exaggerated responses to certain drugs. GABA
system involvement is noted. Neuroimaging
reveals abnormalities in emotion-related brain
areas. Genetic factors play a role, but specific
genes remain unidentified despite higher
.concordance in twins and familial risk
Cause :
Psychological
Psychosocial stressors, especially childhood trauma
like abuse, often trigger panic attacks and
disorder despite its biological roots.
Psychoanalytic theories suggest panic arises
from unresolved conflicts, with symptoms
reflecting failed psychological defences. Thus,
while biological factors are significant,
psychosocial stressors crucially contribute to
.panic disorder onset
Cause :
Genetic factors
Family members of panic disorder patients have
significantly increased risk, with first-degree relatives
having a four- to eightfold higher likelihood. Twin
studies show higher concordance rates in monozygotic
compared to dizygotic twins. However, no evidence
links panic disorder to specific chromosomes or modes
.of inheritance
DSM - V Criteria
A. Recurrent unexpected panic attacks.
A panic attack is an abrupt surge of intense fear or intense
discomfort that reaches a peak within minutes and during
which time four (or more) of the following symptoms
occur:
Note: The abrupt surge can occur from a calm state or an
anxious state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or
depersonalization (being detached from one-self).
12. Fear of losing control or "going crazy."
13. Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck
soreness, headache, uncontrollable screaming or
crying) may be seen. Such symptoms should not count
as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month
(or more) of one or both of the following:
1. Persistent concern or worry about additional panic
attacks or their consequences (e.g., losing
control, having a heart attack, "going
crazy").
2. A significant maladaptive change in behaviour
related to the attacks (e.g., behaviours
designed to avoid having panic attacks, such as
avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition (e.g.,
hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another
mental disorder (e.g., the panic attacks do not occur
only in response to feared social situations, as in social
anxiety disorder; in response to circumscribed phobic
objects or situations, as in specific phobia; in response
to obsessions, as in obsessive-compulsive disorder; in
response to separation from attachment figures, as in
separation anxiety disorder).
Clinical features
• Panic attacks can be spontaneous, but sometimes follow
excitement, exertion, sex, or mild emotional trauma.
• Doctors look for triggers like caffeine, alcohol, lack of
sleep, or bright lights.
• Panic attacks often start with a 10-minute buildup of
intense fear and feeling like you're going to die.
• People can't explain their fear, feel confused, and have
trouble focusing.
• Physical symptoms include rapid heartbeat, chest pain,
shortness of breath, and sweating.
• People may try to escape the situation to get help.
• Attacks typically last 20-30 minutes, rarely exceeding
an hour.
• During an attack, people may dwell on thoughts, have
speech difficulties, and forget things.
• Depression or feeling detached from reality can occur
during an attack.
• Symptoms can disappear quickly or slowly.
• Between attacks, people may fear having another one
(anticipatory anxiety).
• Telling the difference between anticipatory anxiety and
generalized anxiety can be tricky, but with panic
disorder, the fear has a specific focus (another attack).
 Course and prognosis
• Panic disorder can start in late teens/young adulthood, but
can also happen in childhood, early teens, or midlife.
• Stressful events might trigger panic disorder, but there's no
single cause.
• It's a long-term condition, but how it affects people varies
greatly.
• Up to 40% of patients are symptom-free in the long term,
while 50% have mild symptoms and 10-20% have ongoing
severe symptoms.
• People may not worry after the first few attacks, but
repeated attacks can cause significant anxiety.
• They might try to hide their panic attacks, worrying
family and friends.
• Attacks can happen multiple times a day or less than
once a month.
• Caffeine, nicotine, depression, substance abuse, and
OCD can worsen panic disorder.
• School, work, and family life can be negatively
affected.
• People with good mental health before the disorder and
shorter episodes tend to have a better outcome.
Treatment
Pharmacotherapy
Pharmacotherapy options include SSRIs like paroxetine
and sertraline as first-line. Benzodiazepines like
alprazolam provide rapid relief but have
dependence risks. Other options are tricyclic
antidepressants, MAOIs and venlafaxine
Cognitive and
Behaviour Therapies
- Cognitive and behaviour therapies are effective
treatments for panic disorder, with mixed
findings on their superiority over
pharmacotherapy alone.
- Combining cognitive or behaviour therapy with
pharmacotherapy appears to be more effective
than either approach alone.
- Long-term follow-up studies suggest that these
therapies can lead to lasting remission of
symptoms.

Cognitive therapy focuses on correcting false

beliefs and providing information about panic
attacks.
- False belief instruction addresses the tendency to
misinterpret bodily sensations, while
information about panic attacks reassures
patients that attacks are time-limited and not
life-threatening.
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