Panic disorder is characterized by spontaneous, repeated panic attacks, anticipatory anxiety about future attacks, and behavioral changes to avoid associated situations. The disorder may be linked to neurochemical imbalances and genetic factors, with effective treatments including antidepressants and cognitive-behavioral therapy. Despite effective treatment options, about 10-20% of individuals may continue to experience significant symptoms, and the risk of suicide is higher in those with panic disorder.

2. Panic disorder
Covered by: Arwa H. Al-Onayzan.

3. • Panic attack:
• Is a brief period of extreme distress, anxiety, or fear that begins
suddenly and is accompanied by physical and/or emotional
symptoms.
• Panic disorder:
• Is involves spontaneous panic attacks that occur repeatedly, worry
about future attacks, and changes in behavior to avoid situations
that are associated with an attack.

4. • Neurochemical dysfunction behind panic disorder: May involve
autonomic imbalance, decreased gamma-aminobutyric acid (GABA),
increased adenosine receptor function, increased cortisol, diminished
benzodiazepine receptor function, and disturbances in serotonin.
• Genetic factor:
• Studies of the association between psychiatric illness in first-degree
relatives revealed a heredity of approximately 43% for panic disorder.
• The exact nature of the panic disorder genetic basis is unclear.
• However, some studies shows that Locus 13q22-32 and locus 9q31
are linked.

5. Cognitive symptoms Somatic symptoms
• Fear of dying.
• Fear of going crazy or of losing the control.
• Feeling of unreality, strangeness or
detachment from the self (depersonalization).
• Chest pain or discomfort.
• Dizziness or fainting.
• Feeling of choking.
• Flushes or chills.
• Nausea or abdominal distress.
• Numbness or tingling sensation.
• Palpitation or accelerated heart rate.
• Sensations of shortness of breath.
• Sweating.
• Trembling or shaking.
• A panic attack involves the sudden onset of at least 4 of the 13 symptoms in the table.
• Symptoms usually peak within 10 minute.
• Panic attacks may occur in any anxiety distress.
• Most people within panic disorder anticipate and worry about another attack (anticipatory
anxiety)and avoid the places or situations where they have previously panicked.

6. • A doctor's evaluation, based on specific criteria
• Because serious physical disorders often cause some of the same physical and
emotional symptoms as panic attacks, doctors first make sure people do not have
a physical disorder.
• Panic disorder is diagnosed when people have repeated unprovoked and
unexpected panic attacks plus at least one of the following for at least 1 month:
• Persistent worry that they will have more panic attacks or worry about the
consequences of the attack (for example, that they will lose control or go crazy)
• Changes in behavior due to the panic attacks (for example, avoiding situations
that may cause an attack)
• Once doctors are confident that a person's symptoms are caused by a panic
disorder, they try to avoid doing extensive tests when future panic attacks occur
unless the person's symptoms or physical examination results suggest a new
problem.

7. • Drugs that are used to treat panic disorder include:
1. Antidepressants (SSRIs or SNRIs are the preferred drugs because
they are as effective as the other drugs but usually have fewer side
effects)
2. Antianxiety drugs such as benzodiazepines (Benzodiazepines work
faster than antidepressants but can cause drug dependence).
• Initially, will start of benzodiazepine and antidepressant. When the
antidepressant starts working, the dose of benzodiazepine is
decreased.
• Exposure therapy and cognitive behavioral therapy are types of
psychotherapy, often helps diminish the fear.

8. • Panic disorder is a chronic disorder with a variable course.
• Appropriate pharmacologic therapy and cognitive-behavioral therapy,
are effective in more than 85% of cases.
• About 10-20% of patients continue to have significant symptoms.
• Overall, the long-term prognosis is usually good.
• The suicide rate in individuals with panic disorder is also many times
higher than the general population.

9. • These recommendations may help:
• Get treatment for panic attacks as soon as possible to help stop them
from getting worse or becoming more frequent.
• Stick with treatment plan to help prevent relapses or worsening of
panic attack symptoms.
• Get regular physical activity, which may play a role in protecting
against anxiety.

10. • Merk manual (nineteenth edition, page 1496-1497).
• Medscape:
• http://emedicine.medscape.com/article/287913-overview#a4.