• What is a panic attack?
• What is panic disorder?
• How is it diagnosed?
• Why do people suffer from panic attacks?
• Treatment methods
What is a panic attack?
Panic attacks are anxiety attacks characterized by intense fear, feeling dizzy, lightheaded, faint, short of breath, a feeling of choking, and also a fear of death and a feeling of going insane.
The attacks generally last 15-30 minutes. The frequency and severity of the attacks are important from a diagnostic point of view. The patient cannot tell in advance when an the attack will set in. Due to the associated physical symptoms and the advanced state of panic, the picture that presents itself is very noisy and therefore people often go directly to the accident and emergency department of a hospital. Sufferers of panic attacks often wonder how a psychological condition can lead to such marked physical symptoms.
Panic attacks generally start in youth. The actual cause is not known, but it is thought to often be related to important life events that have caused stress (like finishing school, marrying, having children, starting a new job, losing a loved one, overcoming a serious illness).
The physical symptoms during a panic attack are as follows:
• Shortness of breath, a feeling of suffocation
• Feeling hot and cold
• A feeling of numbness in the body
• Chest pain
• Fear of an impending death
Another characteristic that helps with the diagnosis is the fact that there is no connection between the severity of the anxiety and the event that has taken place. In some cases the condition occurs spontaneously, in others the first attack is triggered by a stressful incident or situation (for example the loss of a loved one, a physical illness etc). When the attacks become more frequent they lead to a serious loss of competence, and the patient frequently visits the hospital emergency department. Such attacks are often signs of the disorder called panic disorder, but can also be seen in depression, post-traumatic stress disorder or other psychiatric illnesses.
When a doctor is consulted, he has to first of all rule out other physical conditions that present the same symptoms (for example thyroid gland problems, heart conditions, epileptic attacks). Various blood tests, EKG, lung x-ray are important in establishing the actual cause of the symptoms. Another fact that needs to be known is that such attacks are not of a life-threatening nature.
Panic disorder and agoraphobia
If panic attacks occur frequently, the patient will in time develop a tendency to avoid everyday tasks and activities. The biggest fear in patients, that have experienced a panic attack, is the fear of having to live through it again. For this reason they try and keep away from the situation that has triggered the attack. This may result in the condition called agoraphobia (fear of open spaces). The patient will try and avoid environments from which he believes he cannot easily escape. For example, the patient may prefer to stay at home out of fear of having a panic attack, and after a while have difficulties leaving the house on his own. He may avoid crowded places (like a bus, mosque, town square). This will lead to a gradual deterioration of his quality of life. The time he spends on social activities and hobbies will diminish, the patient will consider himself ill and in need of the help of others. He will become unable to stay at home alone, leave the house alone, work or go to work. Not every panic disorder patient develops agoraphobia, but panic disorder patients have certain elements of avoidance in their behaviour, in varying degrees. Furthermore, agoraphobia, which in its developmental mechanism shows similarities with conditioned reflexes, almost always develops secondary to a panic attack.
How is it diagnosed?
Patients often attend emergency clinics before they are diagnosed with panic disorder, it would therefore be prudent to refer the patient to a psychiatrist instead of sending him home saying “there is nothing wrong with you”. Because as long as the reason for the patients’ physical complaints remains unexplained and their panic attacks continue, they will keep visiting one doctor after another, having many unnecessary tests and wasting time and effort. Furthermore, their complaints will continue.
The diagnosis of panic disorder should be made by a psychiatrist. The aim in the diagnostic process is to tell the condition apart from physical and other psychological conditions. A detailed physical examination, various blood tests, imaging and, if necessary, consultations with doctors from other branches will be required.
Why do people have panic attacks?
It is thought that there is a connection between panic attacks and the fight-or-flight response seen in animals. Similar to the response of an animal who is facing a serious threat, the person perceives a serious threat and responds both psychologically and physically. The person’s autonomous nervous system is activated, circulation and respiration increases, which the patient experiences as shortness of breath and palpitations. As a result of the heavy breathing the carbon dioxide level in the blood drops and this produces a feeling of dizziness, numbness in hands and lips, and a feeling of giddiness.
Stressful events in life can trigger out panic attacks. Some patients may have experienced a negative incident before the attack (for instance the loss of a loved one, family conflicts, change of work and environment). Others may have had a physical illness (heart disease, respiratory disease or endocrinological disease). All of these are situations that can be experienced by the patient as a life-threatening situation. It is thought that panic attacks which occur after such events, are the result of a learning process and are a conditioned response. However, in spite of all these the patient still has to have a genetic predisposition in order to develop the disorder.
Treatment of panic disorder
If left untreated, the disorder will continue for years and lead to a loss of the patient’s capabilities. In advanced stages of the disorder the patient can develop depression secondary as a secondary condition. In order to alleviate their anxiety and tension, patients may turn to alcohol or increase their alcohol consumption because of alcohol’s short-term relaxing effect. It is therefore important that the disorder is treated right from the start.
The aim of treatment with drugs is to avoid further panic attacks and to prevent the avoidance that sets in after the attacks. The primary approach in the treatment of panic disorder is the use of an appropriately chosen antidepressant. In some cases a short-term therapy with drugs from the benzodiazepine group can be added to the antidepressants. Drug treatment on its own or if necessary together with a cognitive-behavioural therapy has a success rate of up to 90%.
What we need to know about antidepressants:
• These drugs should only be used under the supervision of a doctor.
• It takes 2-4 weeks before the patient experiences the full effect of the medication. They have no immediate beneficial effect. In fact, in the early stages some complaints may be exacerbated by the medication.
• Your doctor should decide whether the drug is sufficient for the patient’s needs, whether or not to change it, or if additional medication is required in order to strengthen the effect.
• After a certain level of improvement is achieved, you should continue with the treatment for at least 6-9 months. The decision to stop the medication at the end of the treatment should be discussed with your doctor and you should act in accordance with his recommendation.
• Contrary to what is commonly believed, antidepressants do not act by tranquillizing the patient. Your ability to think and decide will not be affected during use of antidepressants.
• Antidepressants do not cause drug dependency.
• Side effects associated with antidepressants are usually mild and short-term. The usually occur during the first week. The patient may experience nausea, vomiting, headaches or a feeling of confusion. Longer term side effects may be a lack of sexual drive, difficulties in erection and ejaculation. Weight gain is only associated with a certain group of this medication and does not reach extreme levels. Do not refrain from sharing such side effects with your doctor, he will welcome it. If any unexpected side effects occur during treatment you must contact your doctor immediately.
The therapy proven to be effective in panic disorder is cognitive behavioural therapy. Psychotherapy in addition to drug therapy will help the patient to change his negative thoughts and behaviour pattern and aims at making the patient more active in combating the disorder. The therapy can last 6-12 sessions.
In cognitive-behavioural therapy the patient is firstly educated on the illness and its causes. In addition, the patient is encouraged to relax with the help of breathing and relaxation exercises and methods for coping with stress. Equipped with these coping mechanisms the patient feels stronger to cope with another panic attack, should one occur. A further method that is employed, is to encourage the patient to face in stages the situation which he has been trying to avoid.