Panic Disorders


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Panic Disorders

  1. 1. PANIC DISORDER       Patient experiences recurrent panic attacks and are worried about having more attacks. Accompanied by intense fear and discomfort and lasts from minutes to approx. an hour Panic attacks- severe, frightening, incapacitating Symptoms of anxiety may last for hours Usually develops suddenly, often with no obvious precipitating factor, and reaches a peak in approximately 10 minutes Panic attacks may vary in intensity and occurrence: ranging from experiencing multiple episodes for several months at a time to daily attacks for a brief period, with months separating the next episode
  2. 2.    Patient may fear they are losing control over themselves, “going crazy,” having a heart attack or dying Can occur in sleep (resulting to exhaustion) Panic attacks may be:  Unexpected, “out of the blue”, or occur spontaneously    Sudden onset of unanticipated intense anxiety generated arousal of the SNS such as tachycardia, diaphoresis, parestehesias, and a sense of “doom” Are situationally bound Patient may become preoccupied with their health because of the physical symptoms they experience
  3. 3.  Can result in agoraphobia      May fear having a panic attack in place where embarrassment could occur, where help might not be available, or where escape is impossible Patient restricts activity outside home or require another person to be with them when outside home Affects 1/3 of people with panic disorders, twice as often in females than in males Feelings of depression can occur Rarely in peripubertal period; probably begins by adolescence or young adulthood; women are two to three times more likely to suffer as compared to males
  4. 4. DSM- IV CRITERIA FOR PANIC DISORDER Recurrent, unexpected panic attacks  Panic attacks are followed by a month or more of worry about having additional attacks, worry about the result of attacks, and behavioral changes related to attacks  Panic disorder can be accompanied by agoraphobia 
  5. 5. DSM- IV CRITERIA FOR PANIC ATTACK        Increased heart rate, palpitations or chest pain Chills or hut flushes, sweating, trembling, dizziness or light- headedness Feeling of choking, smothering or shortness of breath Nausea or abdominal distress Numbness or tingling Fear of dying, “going crazy”, or losing control Derealization or depersonalization
  6. 6. ETIOLOGY       May be genetically transmitted Genetic factors + environmental factors may be associated with vulnerability Brain and chemical factors may count for its development  Bursts of activity in raphe nuclei (serotonin) and the locus ceruleus --> anxiety formation  Abnormalities in the brain’s benzodiazepine receptors May be induced by caffeine, carbon dioxide or sodium lactate Pt. are less likely to panic when informed about the symptoms they will experience
  8. 8. Nurse- patient relationship Centered on the same issues and interventions discussed for patients with GAD  Help patient get through the panic attack safely with as little discomfort as possible.  Reduce anxiety to a more manageable level.  Educate about panic disorder to reassure that they are not losing their minds or dying during an attack.  Cognitive restructuring. 
  9. 9. Psychopharmacology   Selective Serotonin Reuptake Inhibitors (SSRIs)- drug of choice Antidepressant    May be used to block symptoms or to reduce panic attacks Benzodiazepine    Alprazolam (Xanax) Clonazepam (Klonopin) Monoamine oxidase inhibitor (MaOI)   Imipramine (Tofranil) Phenelzine (nardil) Pt. may resist drug therapy because it may mean a loss of control at a time when they are struggling to maintain control over themselves and their symptoms
  10. 10. Milieu management  When panic anxiety decreases from the panic level to other levels, gross activities are helpful to decrease tension and anxiety Walking  Jogging  Basketball  Volleyball  Stationary bicycle 
  12. 12.         Stay with the patient who is having a panic attack and acknowledge the patient’s discomfort. Maintain a calm style and demeanor. Speak in short, simple sentences, and give one direction at a time in a calm tone of voice. If the patient is hyperventilating, provide a brown paper bag and focus on breathing with the patient. Allow patients to pace or cry; this enables the release of tension and energy. Communicate to patients that you are in control and will not let anything happen to them. Move or direct patients to a quieter, less stimulating environment. DO NOT TOUCH THESE PATIENTS. Touching may increase feelings of panic. Ask patients to express their perceptions of fears about what is happening to them.