Panic disorder patients were mostly examined in many clinics due to their complaints, had tests done and even started treatment. The patient may have been followed up in the emergency services with complaints such as having a heart attack, paralysis, etc. many times. The disease can be diagnosed with the patient's anamnesis and examination findings.

Panic disorder

Panic disorder patients were mostly examined in many clinics due to their complaints, had tests done and even started treatment. The patient may have been followed up in the emergency services with complaints such as having a heart attack, paralysis, etc. many times. The disease can be diagnosed with the patient’s anamnesis and examination findings.

Diagnostic criteria for panic attacks and panic disorder:  

A discrete period of intense fear or discomfort in which four (or more) of the following symptoms begin abruptly and reach a peak within 10 minutes:

  • Palpitations, sense of heartbeat or increased heart rate
  • Sweating,
  • Shaking
  • Feelings of shortness of breath or choking
  • Cut off,
  • Chest pain or feeling of tightness in the chest,
  • Nausea or abdominal pain,
  • Dizziness, lightheadedness, feeling like you’re about to fall or faint
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or going crazy
  • Fear of death,
  • Paresthesias (numbness or tingling sensations),
  • Chills or hot flashes.



Diagnostic criteria for agoraphobia:  

  • Anxiety about being in places or situations from which help may not be available or escape may be difficult (or distressing) unexpectedly or when encountering an event/event/place, or if a panic attack or panic-like symptoms occur upon encounter. Among the agoraphobic fears; These include being outside the home alone, being in a crowded environment or waiting in line, being on a bridge, and taking a trip by bus, train, or car.
  • These situations are avoided or they are endured with anxiety that panic attacks/panic-like symptoms will occur, or with intense distress, or the presence of a companion is needed.
  • These include anxiety or phobic avoidance, social phobia (e.g. avoiding social situations due to fear of embarrassment), specific phobia (e.g. limited avoidance of a single situation, such as an elevator), obsessive-compulsive disorder (e.g. avoiding dirt and filth due to an obsession with contagion). is not associated with another mental disorder such as post-traumatic stress disorder (eg, avoidance of stimuli accompanying a severe stressor) or separation anxiety disorder (eg, avoidance of leaving home or relatives).

Diagnostic criteria for panic disorder without agoraphobia:  

  • There are both of the following:
    • Recurrent unexpected panic attacks
    • At least one attack is followed by one (or more) of the following for 1 month (or longer):
      • Persistent anxiety that there will be other attacks,
      • Worrying about the consequences or consequences of the attack (e.g. losing control, having a heart attack, going crazy)
      • Showing a marked change in behavior associated with the attacks.
    • Absence of agoraphobia

Panic attacks are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hyperthyroidism).

Panic attacks, social phobia (e.g., upon encountering feared social situations), specific phobia (e.g., encountering a specific phobic situation), obsessive compulsive disorder (e.g., encountering dirt or filth by someone obsessed with contagion), post-traumatic stress It is not associated with another mental disorder such as disorder (eg, in response to stimuli accompanying a severe stressor) or separation anxiety disorder (eg, in response to being away from home or close relatives).



Diagnostic criteria for agoraphobia without a history of panic disorder:

  • The presence of agoraphobia associated with fear of panic-like symptoms (eg, dizziness or diarrhoea),
  • The diagnostic criteria do not meet the diagnostic criteria for panic disorder.
  • The disorder is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition.
  • If there is an accompanying general medical condition, the fear described in the first item is usually much greater than the accompanying fear.

Panic disorder can be associated with some diseases. However, a clear cause-effect relationship could not be determined.

Diseases with panic attacks:

  • Withdrawal syndrome (alcohol, benzodiazepine, barbiturate)
  • Intoxication (alcohol, benzodiazepine, amphetamine, caffeine, cocaine)
  • Hormonal diseases
    • Hyperthyroidism
    • Hypoglycemia
    • Pheochromocytoma
    • Hypoparathyroidism
    • Cushing’s disease
  • Heart diseases
    • Paroxysmal supraventricular tachycardia
    • Angina pectoris
    • Mitral valve prolapse
  • Chest diseases
    • Bronchial asthma
    • Pulmonary embolism
    • Chronic obstructive pulmonary disease
  • neurological diseases
    • Transient ischemic attack
    • Partial complex seizures
    • Migraine
  • Menopause
  • Anemia

Panic disorder treatment:  

Panic disorder is a disease that can be easily diagnosed and treated by our physicians compared to the past.

Treatment options:

Medication:

  • Selective serotonin reuptake inhibitors (sertraline, flovoxamine, citalopram etc.), tricyclic antidepressants, benzodiazepines, MAO inhibitors can be used in drug therapy. Although the choice of drug varies depending on the patient and the severity of the disease, selective serotonin reuptake inhibitors are generally chosen as the first choice. Considering the possible side effects of the drugs, the dose is started at a low dose and then the dose is increased. Treatment may take 8-12 months in total. In the presence of periods without panic attacks, treatment should be continued in line with the advice of the physician. In addition, increasing or decreasing the dose of drugs without the advice of a physician weakens the effectiveness of the treatment.

Psychological treatments:

  • Cognitive behavioral therapy is usually used. With this treatment, it is aimed to inform the patient about panic attacks, to explain that they are harmless, to go over their fears (going to places they avoid, etc.).

Recommendations to the patient:  

What you can do in the presence of panic attacks:
  • Stay where you are if possible.
  • Breathe slowly and deeply, practice breathing techniques,
  • Remember that the attack will pass by itself,
  • Remember that the attack will not harm you and those around you.
  • Remember the good, positive things, the events that made you happy,
What you can do to reduce panic attacks:
  • Do regular exercise
  • Balanced diet,
  • Avoid sugary foods
  • Stay away from caffeine
  • Drinking alcohol,
  • If you smoke, quit
  • Stay away from stress
  • Try complementary medicine practices (aromatherapy, massage, etc.).



Tags: