Panic disorder (PD) or episodic paroxysmal anxiety is a neurotic disorder characterized by the main manifestation of severe anxiety attacks (panic attacks), which are not limited to a specific situation or circumstances and are therefore unpredictable.
Key symptoms:
- Sudden onset of palpitations, chest pain, and shortness of breath;
- Dizziness;
- Sensation of unreality (derealization and depersonalization);
- Secondary fear of death, insanity, loss of self-control.
Usually, panic attacks last for minutes, although sometimes longer. Their frequency and the course of the disorder are quite variable.
About 30% of people worldwide have experienced a panic attack at least once in their lives. However, the diagnosis of “Panic Disorder” will be established if several severe vegetative anxiety attacks occur within a period of about 1 month.
Statistics and General Issues
Panic disorder is one of the most common mental disorders; on average, 2.7% of the global population suffer from it. According to research data, women are twice as likely to suffer from PD than men. PD is associated with an increased risk of agoraphobia and clinical depression.
According to classification, PD belongs to the group of anxiety disorders. Patients with anxiety disorders constitute 30% of those seeking general practitioner medical care. The associated loss of productivity, the risk of alcoholism, drug addiction, and the deepening of somatic pathology create a serious problem not only for healthcare but also for society as a whole.
A comprehensive approach to the diagnosis of PR
A thorough medical history and physical examination by a general practitioner or psychiatrist is necessary for all patients in order to rule out medical causes of symptoms.
Conditions and diseases that can mimic or cause panic attacks:
- hyper- and hypothyroidism;
- certain types of epilepsy
- asthma
- cardiac arrhythmias;
- pheochromocytoma;
- excessive consumption of caffeine or other stimulants;
- refusal to drink alcohol;
- treatment with high doses of corticosteroids.
Measurement of thyrotropin levels and electrocardiography are often prescribed to identify medical causes, but these tests usually give negative results in the absence of other symptoms indicating medical causes.
Screening for depression is also necessary, given its increased prevalence among patients with PR and the associated risk of suicidal behavior.
Help with Panic Disorder consists of several stages:
Psychoeducation
After establishing the clinical diagnosis, it is crucial to discuss with the patient their fears regarding somatic illness and expectations from medical examination and treatment. Around 80% of patients with Panic Disorder experience medical symptoms, and most fear a serious condition like a heart attack. Clinical experience suggests that it is beneficial to inform patients about Panic Disorder as the cause of their symptoms and the mechanisms through which psychological processes can trigger physical symptoms. This point is often included in psychotherapeutic interaction.
Pharmacological Treatment
The first-line medications include antidepressants from the selective serotonin reuptake inhibitor (SSRI) class and anxiolytics. It is essential for the physician and the patient to have compliance because the selection of the right medication and dosage requires regular monitoring, especially in the initial stages of treatment. Therefore, patient cooperation and trust in their physician are crucial.
Psychotherapy
Simultaneously with prescribing pharmacological support, essential psychotherapeutic assistance is required. Regardless of the psychotherapy method employed by the specialist, they need to have undergone psychiatric propaedeutics training (or have specialized psychiatric education), receive supervision, and undergo personal therapy. In the process of psychotherapy, the therapist, in an atmosphere of trust and respect, helps the client master grounding and relaxation skills, learn to be aware of emotions, recognize feelings, relate to oneself with care, distribute and restore their internal resources, and find ways to meet their truly important needs.
The author of the article: Malyovana Olga, a psychiatrist and psychotherapist.