Recurrent episodes of attacks of severe anxiety.
Pathophysiology
The amygdala is a paired structure located in the temporal lobes and is important for processing of emotions such as anxiety, sadness, and fear.
Some studies have suggested abnormalities with the amygdala are a contributing factor to the development of panic disorder. Other neurological structures have also been implicated.
Other contributing factors to the development of panic disorder include neurotransmitter imbalances, genetics, and a stressful environment.
Risk Factors
- Family history
- Female sex
- Stressful life events: Bereavement, redundancy
- Trauma: Sexual assault/road traffic accident
Clinical Features
- Palpitations and tachycardia
- Sweating
- Breathlessness
- Nausea
- Paraesthesia
- Depersonalisation/derealisation: Feeling detached from oneself and feeling as though the world is not real respectively
- Chest pain
- Headache
- Dizziness/light-headedness
- Trembling
- Choking sensations
- Fear of dying/losing control
- Agoraphobia: Patients can develop symptoms of agoraphobia with time. Agoraphobia is a fear/anxiety from being in situations where escape would be difficult such as being in crowds or whilst on public transport. The fear is rooted in anxiety over becoming incapacitated/having an embarrassing physical symptom/having a panic attack in a place where they cannot escape from.
Differential Diagnosis
- Angina
- Myocardial infarction
- Asthma attack
- Alcohol or drug withdrawal
Management
- Mild-moderate: NICE recommend individual facilitated or non-facilitated self-help
- Moderate-severe: CBT. If the patient has long-standing panic disorder or hasn’t found benefit from a psychological intervention, an antidepressant can be offered.
- NICE advise against the use of benzodiazepines as the long-term outcome is generally less good.
References
https://www.ncbi.nlm.nih.gov/books/NBK430973/
https://www.nice.org.uk/guidance/cg113/chapter/Recommendations#principles-of-care-for-people-with-panic-disorder
