Panic Disorder: A Comprehensive Overview

Introduction to Panic Disorder

Panic disorder, also referred to as a heightened sensitivity disorder or anxiety disorder in Hindi, is a mental health condition characterized by sudden episodes of intense fear or panic without any apparent reason. These episodes, known as panic attacks, often lead to significant physical and emotional symptoms. During such attacks, individuals may feel as though they are facing a life-threatening situation, even when no real danger exists.

Definition of Panic Disorder

Panic disorder involves sudden and intense episodes of fear and discomfort that may last for a few minutes. Symptoms experienced during a panic attack can include:

• Rapid heartbeat
• Shortness of breath
• Sweating
• Dizziness

The fear of recurring panic attacks often disrupts daily life.

Epidemiology of Panic Disorder

The prevalence of panic disorder is increasing in India, similar to global trends.

1. Prevalence: Research suggests that 1-2% of the Indian population experiences panic disorder, though many cases remain undiagnosed.
2. Gender Differences: Women are at a higher risk than men, especially during puberty or menopause.
3. Age of Onset: Symptoms typically appear during adolescence or early adulthood, peaking between 20 to 40 years.

Etiology (Causes) of Panic Disorder

Panic disorder can result from multiple factors:

1. Genetic Factors: A family history of panic disorder increases the risk. Certain genes may heighten susceptibility.
2. Biological Imbalance: An imbalance in neurotransmitters like serotonin and dopamine may contribute, linked to brain areas that regulate fear.
3. Psychological and Traumatic Events: Stressful life events, such as job loss, relationship issues, or the death of a loved one, may trigger panic disorder.
4. Sensitivity and Reactivity: Individuals highly sensitive to their physical sensations may react strongly, increasing vulnerability to the disorder.

Types of Panic Attacks (As per DSM-5)

1. Unexpected Panic Attacks: Occur without any identifiable trigger.
2. Expected Panic Attacks: Triggered by specific situations, such as flying or public speaking.

DSM-5 Diagnostic Criteria for Panic Disorder

Key criteria include:

1. Panic Attacks: At least four of the following symptoms during an episode:

1. 1. Palpitations
   2. Breathlessness
   3. Dizziness
   4. Chest pain
   5. Trembling or chills
   6. Fear of losing control or dying
2. Post-Attack Concerns: Worry about future attacks or behaviour changes to avoid triggers.
3. Duration: Symptoms and fear persist for at least one month.
4. Exclusion of Other Conditions: The disorder must not result from other mental illnesses, physical health issues, or substance use.

ICD-10 Diagnostic Criteria

Panic disorder is classified under code F41.0 in ICD-10 and falls under anxiety disorders. Key features include sudden, intense panic attacks lasting a few minutes to 30 minutes.

Investigations

• Psychological Assessments: Mental status examinations (MSE)
• Routine Tests: CBC, LFT, RFT, TFT, Chest X-ray, Urine RM, ECG
• Imaging: CT or MRI if necessary

Treatment Approaches

A. Psychotherapy

1. Cognitive Behavioral Therapy (CBT):
   • Focuses on understanding and altering negative thoughts and behaviors.
2. Exposure Therapy:
   • Gradually exposes individuals to their fears to reduce anxiety.

B. Medications

1. Antidepressants:
   • SSRI: Fluoxetine, Paroxetine, Sertraline
   • SNRI: Duloxetine, Venlafaxine
   • Benzodiazepines: Alprazolam, Clonazepam (short-term use due to addiction risk)
   • Beta-Blockers: Propranolol for managing physical symptoms like palpitations.

C. Supportive Therapies

• Breathing Techniques: Deep breathing and box breathing techniques.
• Relaxation Techniques: Progressive muscle relaxation and mindfulness meditation.
• Positive Thinking and Affirmations: Reinforce calmness and self-assurance.

Lifestyle Modifications

• Regular Exercise: Boosts endorphins, reducing anxiety.
• Healthy Diet: Reduces caffeine and sugar intake to minimize triggers.
• Sleep Hygiene: Ensures sufficient rest to maintain emotional balance.

Group and Family Support

• Group Therapy: Creates a sense of community among those with similar experiences.
• Family Involvement: Empathy and support from loved ones can aid recovery.

Regular Medical Follow-ups

Routine check-ups ensure treatment effectiveness and rule out underlying physical causes.

By combining psychotherapy, medications, lifestyle changes, and social support, panic disorder can be effectively managed, improving the individual’s quality of life.

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