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
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
Patient may fear they are losing control over
themselves, “going crazy,” having a heart attack or
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
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
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
DSM- IV CRITERIA FOR PANIC
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
DSM- IV CRITERIA FOR PANIC
Increased heart rate, palpitations or chest pain
Chills or hut flushes, sweating, trembling,
dizziness or light- headedness
Feeling of choking, smothering or shortness of
Nausea or abdominal distress
Numbness or tingling
Fear of dying, “going crazy”, or losing control
Derealization or depersonalization
May be genetically transmitted
Genetic factors + environmental factors may be associated
Brain and chemical factors may count for its development
Bursts of activity in raphe nuclei (serotonin) and the
--> anxiety formation
Abnormalities in the brain’s benzodiazepine receptors
May be induced by caffeine, carbon dioxide or sodium
Pt. are less likely to panic when informed about the
symptoms they will experience
Nurse- patient relationship
Centered on the same issues and
interventions discussed for patients with
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.
Selective Serotonin Reuptake Inhibitors (SSRIs)- drug
May be used to block symptoms or to reduce panic
Monoamine oxidase inhibitor (MaOI)
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
When panic anxiety decreases from the
panic level to other levels, gross activities
are helpful to decrease tension and
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.