DISORDER: Panic Attack

When panic attacks happen again and again they become a medical disorder.

Most people at some point or the other have experienced it. The apprehension, racing pulse, dry mouth, shaky hands… it’s a phenomenon that surely exists but is not often explored and dealt with — panic attack!

Although the term is used loosely by people to describe any anxiety that they might be experiencing, panic attacks are also part of a syndrome known as panic disorder. So when do simple ‘panic attacks’ become a medical disorder? When they happen again and again and affect the quality of life.

Symptoms of Panic Attack

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Surprisingly, some very common symptoms, similar to the ones mentioned above, are used to diagnose panic disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, developing four of the 13 symptoms below, in less than 10 minutes and quite abruptly, together with worrying over these attacks and their consequences persistently (for over a month) is suggestive of panic disorder.

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sense of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization or depersonalization (feeling detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flashes

These symptoms usually last for 20-30 minutes, and can be associated with non-specific signs such as hypertension, tachycardia (increased heart rate), tachypnea (hyperventilation) and tremors.

Panic attacks do not have to be related to a trigger. There are ones that can be linked to a situation (cued attacks) and ones that can occur quite unexpectedly. The latter are, however, uncommon. Factors such as caffeine, alcohol or nicotine can also bring about attacks or present with symptoms similar to those of a panic attack. To differentiate, the insight and power of judgment of the person can be checked. These are intact in a person going through a panic attack but are affected in substance abuse.

Of course, a diagnosis of panic disorder cannot be made if these symptoms are found to result from substance abuse, other medical conditions or another psychiatric disorder. However it has also been shown that panic disorder itself can result in, or co-exist with other disorders, such as major depression, irritable bowel syndrome, migraine etc. If not dealt with properly, this condition hampers quality of life. The individual avoids ‘precipitating’ conditions and restricts his/her role in activities and projects which leads to loss in productivity and frustration.

No racial or genetic factors have as yet been implicated in this condition. Also, no known lab studies or imaging studies have provided with data that could point to exactly what goes wrong. All theories suggest hypersensitive brain receptors that react abnormally to normal stimuli. Different regions of the brain such as the amygdala, hypothalamus and brainstem are thought to house ‘fear areas’ that suffer from aberrant electrical/ metabolic activity resulting in attacks.

Treatment is bimodal. Acute attacks can be suppressed with benzodiazepines. In essence most drugs that decrease brain activity such as tricyclic antidepressants, SSRIs, Xanax and fluoxetine (Prozac) are helpful in this condition, and which one to administer depends on the patient profile. Apart from pharmacotherapy, behavioral psychotherapy can be used alone or as an adjunct to medicines. These include gradually exposing the patient to increasing levels of anxiety inducing situations so that he/she becomes desensitized. Relaxation techniques, such as breathing exercises to control hyperventilation are also part of the therapy.