1. Panic disorder
By Rachel Jensen

2. What is Panic Disorder?
“…repeated occurrence of discrete panic attacks” (DSM-IV, 1994)
Random and sudden attacks of fear that last for several minutes (Panic Disorder & Agoraphobia, 2012)
“…patients develop apprehension towards the possibility of having another attack.” (DSM-IV, 1994)
Sudden attacks of fear are called panic attacks (Panic Disorder & Agoraphobia, 2012)
Can occur at anytime, anywhere
Seem “out of the blue” (Panic Disorder & Agoraphobia, 2013)

3. Signs and Symptoms of Panic Disorder
Sudden and repeated attacks of fear
A feeling of being out of control during a panic attack
An intense worry about when the next attack will happen
Fear or avoidance of places where panic attacks have occurred in the past
Physical symptoms during an attack are
Pounding or racing heart
Sweating
Breathing problems
Weakness or dizziness
Feeling hot or a cold chill
Tingly or numb hands
Chest or stomach pains (Panic Disorder & Agoraphobia, 2012)

4. Facts About Panic Disorder
Common Disorder
Part of Axis 1
About 1.7% of Americans suffer from Panic Disorder (Panic Disorder, 2012)
Woman twice as likely to have than men (Panic Disorder, 2012)
Usually develops between the ages of 20s-30s (Panic Disorder, 2013)
Can occur in children, but not diagnosed till 20s-30s (Panic Disorder, 2013)
Not everyone who has panic attacks has panic disorder (Panic Disorder, 2013)

5. What is a Panic Attack?
“A discrete period of intense fear or discomfort” that “builds to a peak rapidly (usually 10 minutes or less)” (DSM-IV, 1994)
Those who are having a panic attack feel the urge to escape doom or danger (DSM-IV, 1994)

6. Panic Attacks Usually comes on suddenly
Symptoms usually only last for about 5-15 minutes
People usually feel “shaken” and “drained” after
Can feel this way for hours
Some patients think they are having a heart attack or are dying and go to the hospital
Patients rarely have no anxiety and only some discomfort during a panic attack
After many attacks people begin to fear situations
Fear the situation not because the situation will cause the attack but because they will have an attack in that situation and not be able to get help
(DSM-IV, 1994)

7. Panic Attacks Three types of Panic Attacks Unexpected Panic Attacks
attack occurs “out of the blue”
Situational Panic Attacks
Attack is caused by a trigger
Situationally Predisposed Panic Attacks
Similar to situational panic attacks, but do not necessarily occur immediately after the exposure or trigger
(DSM-IV, 1994)

8. Symptoms of Panic Attacks
Anxiety
Tremor
Palpitations
Chest discomfort
Diaphoresis
Acral parethesias
(DSM-IV, 1994)
Hot and cold flashes
Dyspea
Dizziness or faintness
Nausea or abdominal distress
Patients rarely have all symptoms during any one attack

9. Diagnostic Criteria for Panic Attacks
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Parethesias (numbness or tingling sensations)
Chills or hot flashes
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or going crazy
Fear of dying
(DSM-IV, 1994)

10. Causes of Panic Disorder
No known cause
Sometimes runs in families
“researchers have found that several parts of the brain are involved in fear and anxiety”
Researchers are learning more about fear and anxiety in the brain to learn more about treatments
Researchers are looking into how stress and environment factors may play a role
(Panic Disorder, 2012)

11. Essential Features
Presence of recurrent, unexpected panic attacks followed by at least 1 month of persistent concern of having another panic attack, worry about the possible implications or consequences of panic attacks, or significant behavioral change because of panic attacks
Panic attacks not due to the direct physiological effects of a substance or a general medication
Not accounted for by another mental disorder
At least 2 unexpected panic attacks
(DSM-IV, 1994)

12. Associated Feature
Constant or intermittent feelings of anxiety that are not focused on any specific situation or event
Anticipate a catastrophic outcome from a mild physical symptom or medication side effect
Must less tolerant of medication side effects and need reassurance to continue to take medication
Apprehensive towards outcome of routine activities and experiences
Loss or disruption of important interpersonal relationships
Demoralization
Frequently absent from work or school for doctor or emergency room visits
(DSM-IV, 1994)

13. Differentiated Diagnosis
Not diagnosed if panic attacks are a direct physiological consequences of a general medical condition
hyperthyroidism
Hyperparathyroidism
Seizure disorders
Cardiac conditions
Not diagnosed if panic attacks are direct result of physiological consequences of a substance
Drug abuse or medication
(DSM-IV, 1994)

14. Diagnostic Criteria Chest pain or discomfort Dizziness or faintness
Fear of dying
Fear of losing control or impending doom
Feeling of choking
Feelings of detachment
Sweating, chills, or hot flashes
Trembling or shaking
Feelings of unreality
Nausea or upset stomach
Numbness or tingling in the hands, feet, or face
Palpitations, fast heart rate, or pounding heart
Sensation of shortness of breath or smothering
(Panic Disorder, 2013)

15. Agoraphobia
“Most common complication of panic disorder” (DSM-IV, 1994)
1/3 to1/2 of all patients are seen with agoraphobia within the first year (DSM-IV, 1994)
Anxiety becomes so severe in many different situations, that people begin to restrict their travel (DSM-IV, 1994)
Avoid public places where they feel immediate escape is difficult (Panic Disorder & Agoraphobia, 2013)
Stop going to places where they anticipate another panic attack happening because of previous experiences (Panic Disorder & Agoraphobia, 2013)

16. Treatment Medicine and Cognitive – Behavioral treatment (DSM- IV,1994)
Many people become free of panic attack because of taking the medication (DSM-IV, 1994)
Cognitive – Behavioral treatment therapy
Teaches person different ways of thinking, behaving, and reacting to situations where they feel anxious and fearful (Panic Disorder, 2012)

17. Treatment Few side effects Rapid onset of action
Anti-depressants
Benzodiazepines
SSRIs
Better tolerated
Start with low dose then is increased
Every patient has a different response
Once a dose has been reached, the response may take up to 3 months to be seen
Few side effects
Rapid onset of action
Reduce the anticipatory anxiety that people experience
(DSM-IV, 1994)

18. Treatment Alprazolam Clonazepam Lorazepam Diazepam
Antidepressant
Benzodiazepines
MAOIs and Tricyclics
SSRIs
Paroxetine
Fluoxetine
Citalopram
Sertraline
Common names are Prozac, Zoloft, Paxil, Lexapro
Alprazolam
Clonazepam
Lorazepam
Diazepam
Common names are Klonopin and Xanax

19. Case Study I have Panic Disorder with Agoraphobia
Been diagnosed with it for about 4 months now
Go see a psychiatrist for it
Has greatly affected my life
To treat it, took Zoloft for a while and not take Lexapro