Panic Attacks & A

[David]

Panic disorder is defined as recurring panic attacks or episodes of
intense fear accompanied by an array of physical symptoms that strike
often and without warning, even during sleep. Mercifully, panic
attacks tend to be brief, usually lasting a few minutes, although in
rare instances, they can persist for an hour or more. For reasons as
yet unclear, panic disorder is twice as common in women as in men and
afflicts 3 million to 6 million Americans. The disorder usually begins
in young adulthood but can strike at any age.

Symptoms

According to American Psychiatric Association's official diagnostic
manual, DSM-IV, a panic attack includes four or more of the following
symptoms:

* Pounding heart or palpitations
* Sweating
* Trembling or shaking
* Sensations of shortness of breath or smothering
* Feeling of choking
* Chest pain or discomfort
* Nausea or abdominal distress
* Feeling dizzy, lightheaded or faint
* Feelings out of touch with reality
* Fear of losing control or going crazy
* Fear of dying
* Numbness or tingling sensations
* Chills or hot flushes

An isolated panic attack is probably nothing to worry about. But
recurring episodes can cause considerable disability and should be
investigated by a psychiatrist or another physician skilled at
identifying and helping people with anxiety disorders. Without
treatment, people with panic disorder may develop a fear of
supermarkets, public transportation, parties, restaurants or other
places or situations in which they have experienced previous panic
attacks.

In about one-third of cases, these irrational fears progress to
agoraphobia, or the fear of being in a place or situation from which
escape might be difficult or embarrassing. Some agoraphobics are
afraid to leave home or other familiar surroundings. In many cases,
early diagnosis and treatment can alleviate panic symptoms before
agoraphobia has a chance to develop.

Treatments

According to research, at least 70 percent of people with panic
disorder can be helped by cognitive-behavioral psychotherapy,
medications or a combination of both. Among those who respond to
treatment, significant improvement is usually seen within six to eight
weeks.

Cognitive-behavioral psychotherapy operates under the theory that
panic attacks are basically a learned response to something the
patient is afraid of. Therapy sessions focus on helping the patient
"unlearn" those physical reactions. The therapist may suggest certain
relaxation techniques, such as slow, controlled breathing, to refocus
attention when panic begins to rise. The therapist might also offer a
reality check by pointing out, for example, that a slightly elevated
heart rate cannot cause a heart attack. Aside from the therapeutic
exercises, talking things out during therapy sessions can be extremely
beneficial to patients as they combat panic disorder.

Like cognitive-behavioral psychotherapy, medications such as
benzodiazepines, monoamine oxidase inhibitors, selective serotonin
reuptake inhibitors and tricyclic antidepressants have been shown to
reduce the frequency and severity of panic attacks.

Children, teens and adults being treated with antidepressants,
particularly people being treated for depression, should be watched
closely for worsening of depression and for increased suicidal
thinking or behavior. Close watching may be especially important early
in treatment or when the dose is changed - either increased or
decreased. Bring up your concerns immediately with your doctor.

Paxil may increase the risk for birth defects, particularly heart
defects, when women take it during the first three months of
pregnancy, according to a 2005 advisory from the Food and Drug
Administration (FDA). The FDA is waiting for the results of recent
studies to better understand the higher risk. Discuss with your doctor
about the health risks of Paxil if you plan to become pregnant or are
in the first three months of pregnancy. You may want to consider
taking a different antidepressant. Do not stop taking the drug without
first talking to your doctor.

It's important to see a doctor if you are having panic attacks or
think you might have panic disorder. Panic disorder is a real illness
that can be treated with medicine and therapy. On the list below,
check any of the symptoms you have. Take this checklist to your
doctor; it might help you explain how you feel.

Panic Disorder Checklist

* I have sudden bursts of fear for no reason.
* I feel awful when they happen.

Check any other symptoms you have during these sudden bursts of fear.

* I have chest pains or a racing heart.
* I have a hard time breathing.
* I have a choking feeling.
* I feel dizzy.
* I sweat a lot.
* I have stomach problems or feel like I need to throw up.
* I shake, tremble, or tingle.
* I feel out of control.
* I feel unreal.
* I am afraid I am dying or going crazy.

Your doctor may want to examine you and do some tests to make sure you
don't have some other illness. If you put a check in the box next to
some of these problems, you may have panic disorder.
This article was reviewed June 2007, by Phyllis D. Cross, MD, MPH ,
Medical Consultant , Optum

Definition

The word agoraphobia is derived from Greek words literally meaning
"fear of the marketplace." The term is used to describe an irrational
and often disabling fear of being out in public.

Description

Agoraphobia is just one type of phobia, or irrational fear. People
with phobias feel dread or panic when they face certain objects,
situations, or activities. People with agoraphobia frequently also
experience panic attacks, but panic attacks, or panic disorder, are
not a requirement for a diagnosis of agoraphobia. The defining feature
of agoraphobia is anxiety about being in places from which escape
might be embarrasing or difficult, or in which help might be
unavailable. The person suffering from agoraphobia usually avoids the
anxiety-provoking situation and may become totally housebound.

Causes and symptoms

Agoraphobia is the most common type of phobia, and it is estimated to
affect between 5-12% of Americans within their lifetime. Agoraphobia
is twice as common in women as in men and usually strikes between the
ages of 15-35.

The symptoms of the panic attacks which may accompany agoraphobia vary
from person to person, and may include trembling, sweating, heart
palpitations (a feeling of the heart pounding against the chest),
jitters, fatigue, tingling in the hands and feet, nausea, a rapid
pulse or breathing rate, and a sense of impending doom.

Agoraphobia and other phobias are thought to be the result of a number
of physical and environmental factors. For instance, they have been
associated with biochemical imbalances, especially related to certain
neurotransmitters (chemical nerve messengers) in the brain. People who
have a panic attack in a given situation (e.g., a shopping mall) may
begin to associate the panic with that situation and learn to avoid
it. According to some theories, irrational anxiety results from
unresolved emotional conflicts. All of these factors may play a role
to varying extents in different cases of agoraphobia.

Diagnosis

People who suffer from panic attacks should discuss the problem with a
physician. The doctor can diagnose the underlying panic or anxiety
disorder and make sure the symptoms aren't related to some other
underlying medical condition.

The doctor makes the diagnosis of agoraphobia based primarily on the
patient's description of his or her symptoms. The person with
agoraphobia experiences anxiety in situations where escape is
difficult or help is unavailable--or in certain situations, such as
being alone. While many people are somewhat apprehensive in these
situations, the hallmark of agoraphobia is that a person's active
avoidance of the feared situation impairs his or her ability to work,
socialize, or otherwise function.

Treatment

Treatment for agoraphobia usually consists of both medication and
psychotherapy. Usually, patients can benefit from certain
antidepressants, such as amitriptyline (Elavil), or selective
serotonin reuptake inhibitors, such as paroxetine (Paxil), fluoxetine
(Prozac), or sertraline (Zoloft). In addition, patients may manage
panic attacks in progress with certain tranquilizers called
benzodiazepines, such as alprazolam (Xanax) or clonazepam (Klonipin).

The mainstay of treatment for agoraphobia and other phobias is
cognitive behavioral therapy. A specific technique that is often
employed is called desensitization. The patient is gradually exposed
to the situation that usually triggers fear and avoidance, and, with
the help of breathing or relaxation techniques, learns to cope with
the situation. This helps break the mental connection between the
situation and the fear, anxiety, or panic. Patients may also benefit
from psychodynamically oriented psychotherapy, discussing underlying
emotional conflicts with a therapist or support group.

Prognosis

With proper medication and psychotherapy, 90% of patients will find
significant improvement in their symptoms.

Key Terms

Benzodiazepines
A group of tranquilizers often used to treat anxiety.

Desensitization
A treatment for phobias which involves exposing the phobic person to
the feared situation. It is often used in conjunction with relaxation
techniques.

Phobia
An intense and irrational fear of a specific object, activity, or
situation.

For Your Information
Resources
Periodicals

* Forsyth, Sondra. "I Panic When I'm Alone."Mademoiselle April 1998:
119-24.

Organizations

* American Psychiatric Association. 1400 K Street NW, Washington DC
20005. (888) 357-7924. http://www.psych.org.

* Anxiety Disorders Association of America. 11900 Park Lawn Drive,
Ste. 100, Rockville, MD 20852. (800) 545-7367. http://www.adaa.org.

* National Institute of Mental Health. Mental Health Public Inquiries,
5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438.
http://www.nimh.nih.gov.