Fears panic disorder

PHOBIC DISORDERS profound fear of, and avoidance of, a dreaded object or situation. Agoraphobia. Fear of places or situations from which escape is difficult—can occur with or without a history of panic disorder Social phobia. Fear of social or performance situations Specific phobia. Fear of a specific object or situation... 

The goals of therapy of panic disorder include a complete resolution of panic attacks, marked reduction in anticipatory anxiety and phobic fears,... 

Essentially this is a four-component definition. First, the person has to have panic attacks. Second, these attacks should not be caused by a substance or general medical condition, or be accounted for by another mental disorder. Third, at least two of these panic attacks have to be unexpected. Fourth, they should lead to a clinical syndrome that includes concern about additional attacks, worry about the consequences of panic, or significant behavioral change as a result of fear of panicking. This syndrome is the heart of panic disorder, and taxometric analyses would focus on it. However, an investigator should deal with the other components first. 

Panic disorder is characterized by the occurrence of panic attacks that occur spontaneously and lead to persistent worry about subsequent attacks and/or behavioral changes intended to minimize the likelihood of further attacks. Sporadic panic attacks are not limited, however, to those with syndromal panic disorder as they do occur occasionally in normal individuals and in those with other syndromal psychiatric disorders. The hallmark of panic disorder is that the panic attacks occur without warning in an unpredictable variety of settings, whereas panic attacks associated with other disorders typically occur in response to a predictable stimulus. For example, a person with acrophobia might experience a panic attack when on a glass elevator. A patient with obsessive-compulsive disorder (OCD) with contamination fears may have a panic attack when confronted with the sight of refuse, and a combat veteran with post-traumatic stress disorder (PTSD) may experience a panic attack when a helicopter flies overhead or an automobile backfires. 

As you might expect, the diagnostic criteria for panic disorder requires the presence of recurrent panic attacks, but panic attacks alone are not sufficient for the diagnosis of panic disorder. Those with other anxiety disorders, for example, can experience panic attacks when confronted by the situation or object that they fear. 

Obsessive-Compulsive Disorder (OCD). Like those with social phobia, patients with OCD can also experience a panic attack when confronted by the object of their fear. Again, the distinction from panic disorder lies in discriminating such stimulus-induced panic attacks from spontaneous panic attacks. 

Panic Disorder. Over half of OCD patients will at some time during the course of their illness experience a panic attack. This does not necessarily mean that they have comorbid panic disorder. The distinction is that those with panic disorder sometimes experience spontaneous attacks whereas patients with OCD experience panic attacks only when confronted by a specific feared trigger that is associated with the content of the obsessions. 

Few studies have examined noradrenergic function in patients with phobic disorders. In patients with specific phobias, increases in subjective anxiety and increased heart rate, blood pressure, plasma NE, and epinephrine have been associated with exposure to the phobic stimulus (Nesse et al. 1985). This finding may be of interest from the standpoint of the model of conditioned fear, reviewed above, in which a potentiated release of NE occurs in response to a reexposure to the original stressful stimulus. Patients with social phobia have been found to have greater increases in plasma NE in comparison to healthy controls and patients with panic disorder (Stein et al. 1992). In contrast to panic disorder patients, the density of lymphocyte a-adrenoceptors is normal in social phobic patients (Stein et al. 1993). The growth hormone response to intravenous clonidine (a marker of central a2-receptor function) is blunted in social phobia patients (Tancer et al. 1990). 

StrOhle A, Pasini A, Romeo E, Hermann B, Spalletta G, di Michele F, Holsboer F, Rupprecht R (2000) Fluoxetine decreases concentrations of 3a,5a-tetrahydrodeoxycorticosterone (3a,5a-THDOC) in major depression. J Psychiatr Res 34 183-186 StrOhle A, Kellner M, Holsboer F, Wiedemann K (2001) Anxiolytic activity of atrial natriuretic peptide in patients with panic disorder. Am J Psychiatry 158 1514-1516 StrOhle A, Romeo E, di Michele F, Pasini A, Yassouridis A, Holsboer F, Rupprecht R (2002) GABAA receptor modulatory neuroactive steroid composition in panic disorder and during paroxetine treatment. Am J Psychiatry 159 145-147 StrOhle A, Romeo E, di Michele F, Pasini A, Hermann B, Gajewsky G, Holsboer F, Rupprecht F (2003) Induced panic attacks shift GABAA receptor modulatory neuroactive steroid composition. Arch Gen Psychiatry 60 161-168 Szapiro G, Vianna MRM, McGaugh JL, Medina JH, Izquierdo I (2003) The role of NMDA glutamate receptors, PKA, MAPK, and CAMKII in the hippocampus in extinction of conditioned fear. Hippocampus 13 53-58... 

Panic disorder is characterized by the repeated and often unpredictable occurrence of panic attacks. According to the Diagnostic and Statistical Manual of Mental Disorders, panic attacks have an abrupt onset, reach their peak in 10 minutes, and are accompanied by at least 4 of 13 listed symptoms, which include shortness of breath, increased heart rate, chest pain, dizziness, choking sensations, numbness or tingling, hot/cold flashes, sweating, trembling, and nausea. Victims of these episodes feel an intense fear that can be better characterized as terror, often of losing control of their body and/or... 

Studies of patients with panic disorder suggest that those who suffer from panic report having quality of life as poor as that of patients with major depression. Panic attacks and/or fear of panic attacks can interfere with the development of social relationships, personal happiness, and employment. 

GAD differs from other types of anxiety disorders because, although the anxiety is present most of the time, GAD patients do not fear specific events such as social situations or having a panic attack (as in social anxiety or panic disorder). GAD is distinguished from normal worry or anxiety because of its long-term duration. GAD is frequently the underlying cause of many symptoms, including irritability, insomnia, headache, and muscle tension. This can often make it very hard to diagnose. A person with GAD will often go to his or her family physician and complain of nerves. ... 

G. The fear or avoidance is not due to the direct physiological effects of a substance [e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder [e.g., panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder). 

Anxiety sensitivity is a prominent characteristic of patients with panic disorder. It is defined as a stable dimension of personality that consists of fears of physical sensations based on the belief that these symptoms have harmful consequences (Reiss et al. 1986). Anxiety sensitivity is not dependent on a history of panic attacks, but rather, it is hypothesized to be an important cognitive risk factor in the development of panic attacks and panic disorder. This hypothesis is supported by some (Donnell and McNally 1990 Mailer and Reiss 1992) but not all (S. H. Stewart et al. 1992) studies with nonclinical subjects. 

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