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Panic disorder

Definition:

Panic disorder is a type of anxiety disorder in which you have repeated attacks of intense fear that something bad will happen.



Alternative Names:

Panic attacks



Causes:

The cause is unknown. Genes may play a role. Other family members may have the disorder. But panic disorder often occurs when there is no family history.

Panic disorder is twice as common in women as it is in men. Symptoms often begin before age 25, but may occur in the mid-30s. Children can also have panic disorder, but it is often not diagnosed until they are older.



Symptoms:

A panic attack begins suddenly, and most often peaks within 10 to 20 minutes. Some symptoms continue for an hour or more. A panic attack may be mistaken for a heart attack.

A person with panic disorder often lives in fear of another attack, and may be afraid to be alone or far from medical help.

People with panic disorder have at least four of the following symptoms during an attack:

Panic attacks may change behavior and function at home, school, or work. People with the disorder often worry about the effects of their panic attacks.

People with panic disorder may abuse alcohol or other drugs. They may feel sad or depressed.

Panic attacks cannot be predicted. At least in the early stages of the disorder, there is no trigger that starts the attack. Recalling a past attack may trigger panic attacks.



Exams and Tests:

Many people with panic disorder first seek treatment in the emergency room. This is because the panic attack often feels like a heart attack.

The health care provider will perform a physical exam and a mental health assessment.

Blood tests will be done. Other medical disorders must be ruled out before panic disorder can be diagnosed. Disorders related to substance use will be considered because symptoms can resemble panic attacks.



Treatment:

The goal of treatment is to help you function well during everyday life. Using both medicines and talk therapy works best.

Types of medicines used to treat panic disorder:

  • Antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for panic disorder.
  • Sedatives are medicines that relax you. These may be used for a short time. There is a risk of becoming dependent on these medicines.
  • Antiseizure medicines are sometimes used in severe cases.

Your symptoms should slowly get better over a few weeks. Do not stop taking your medicine or change the amount you are taking (dosage) without talking with your health care provider.

Talk therapy (cognitive-behavioral therapy, or CBT) helps you understand your behaviors and how to change them. During therapy you will learn how to:

  • Understand and control distorted views of life stressors, such as other people's behavior or life events.
  • Recognize and replace thoughts that cause panic and decrease the sense of helplessness.
  • Manage stress and relax when symptoms occur.
  • Imagine the things that cause the anxiety, starting with the least fearful. Practice in real-life situations to help you overcome your fears.

The following may also help reduce the number or severity of panic attacks:

  • Not drinking alcohol
  • Eating at regular times
  • Getting plenty of exercise
  • Getting enough sleep
  • Reducing or avoiding caffeine, certain cold medicines, and stimulants


Outlook (Prognosis):

Panic disorders may be long-lasting and hard to treat. Some people with this disorder may not be cured. But most persons get better when treated correctly.

People with panic disorder are more likely to:

  • Abuse alcohol or illegal drugs
  • Be unemployed or less productive at work
  • Have difficult personal relationships, including marriage problems
  • Become isolated by limiting where they go or who they are around


When to Contact a Medical Professional:

Call for an appointment with your health care provider if panic attacks are interfering with your work, relationships, or self-esteem.

Call 911 or see your doctor right away if you develop suicidal thoughts.



Prevention:

If you get panic attacks, avoid the following:

  • Alcohol
  • Stimulants such as caffeine and cocaine

These substances may trigger or worsen the symptoms.



References:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69:621-32. PMID: 18363421 www.ncbi.nlm.nih.gov/pubmed/18363421 .

Pollack MH, Kinrys G, Delong H, Vasconcelos e Sá D, Simon NM. The pharmacotherapy of anxiety disorders. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 41.

Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders: Panic, social anxiety, and generalized anxiety. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 32.




Review Date: 3/10/2014
Reviewed By: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Morristown Medical Center

100 Madison Avenue
Morristown, NJ 07960
973-971-5000

Overlook Medical Center

99 Beauvoir Avenue
Summit, NJ 07901
908-522-2000

Newton Medical Center

175 High Street
Newton, NJ 07860
973-383-2121

Chilton Medical Center

97 West Parkway
Pompton Plains, NJ 07444
973-831-5000

Hackettstown Medical Center

651 Willow Grove Street
Hackettstown, NJ 07840
908-852-5100

Goryeb Children's Hospital

100 Madison Avenue
Morristown, NJ 07960
973-971-5000

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