Panic attack

Dyspnea Dyspnea is shortness of breath or difficulty in breathing. The victim is usually quite aware of the unusual breathing pattern. Shortness of breath can be an indicator of many physical ailments including simple exertion, a panic attack, a blow to the chest, asthma, cardiac disease, as well as exposure to toxic chemicals. If a person is suffering from shortness of breath, evaluate them for additional symptoms and possible exposures. Keep the victim in a sitting position. Remove the victim to fresh air, if possible, and seek medical attention. 

In two studies in which benzodia2epines were gradually tapered, concurrent cognitive-behavioral therapy (CBT) did not increase the proportion of patients who were able to successfully discontinue their use of these agents (Oude Voshaar et al. 2003 Vorma et al. 2003). On the other hand, other studies of patients with panic disorder found that CBT facilitated the discontinuation of benzodiazepine use (Otto et al. 1993). Similarly, CBT may be superior to supportive medical management in preventing the reoccurrence of panic attacks in panic disorder patients in whom alprazolam has been tapered (Bruce etal. 1999). 

Nutt DJ, Glue P, Lawson C, et al Flumazenil provocation of panic attacks evidence for altered benzodiazepine receptor sensitivity in panic disorder. Arch Gen Psychiatry 47 917-923, 1990... 

Table 19.3 Substances that induce panic attacks in humans...

In humans, CCKb receptor ligands can induce a panic attack, especially in panic patients, whereas antagonists (e.g. CL988) have the opposite effect. Nevertheless, the results from clinical trials of this compound are not promising, mainly due to low bioavailability and unacceptable side-effects. 

CBD has no activity at the CBl or CB2 receptor. It is well known that CBD influences the activity of THC if co-administered [140]. Another effect of CBD is the inhibition of cytochrome oxidase [141], which inversely to its antagonistic activity strongly potentiates THC effects above a certain threshhold. CBD is also active as a mild antipsychotic [142] and was proposed as a treatment for anxiety and panic attacks. The mechanism is not fully understood, but it might be caused by an interference with the endocannabi-... 

Use carefully in patients with known alcohol dependence or panic attacks... 

The acute phase of panic disorder treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and social anxiety avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation. 

The main objectives of treatment are to reduce the severity and frequency of panic attacks, reduce anticipatory anxiety and agoraphobic behavior, and minimize symptoms of depression or other comorbid disorders.48 The long-term goal is to achieve and sustain remission. 

Treatment options include medication, psychotherapy (e.g., CBT preferred), or a combination of both. In some cases, pharmacotherapy will follow psychotherapy treatments when full response is not realized. Patients with panic symptoms without agoraphobia may respond to pharmacotherapy alone. Agoraphobic symptoms generally take longer to respond than panic symptoms. The acute phase of PD treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and phobic avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation. 6 49 Patients who relapse following discontinuation of medication should have therapy resumed.49... 

Evaluate patients for symptom improvement frequently (e.g., weekly) during the first 4 weeks of therapy. The goal is to alleviate panic attacks and reduce anticipatory anxiety and phobic avoidance with resumption of normal activities. Alter the therapy of patients who do not achieve a significant reduction in panic symptoms after 6 to 8 weeks of an adequate dose of antidepressant or 3 weeks of a benzodiazepine. Regularly evaluate patients for adverse effects, and educate them about appropriate expectations of drug therapy. 

How to record symptoms (e.g., fears, panic attacks, avoidance behaviors) and report back to their clinician. 

CCK-B. Protease inhibitors that slow the degradation and inactivation of endogenous CCK promote satiety via CCK-A receptor. By contrast, the CCK-B receptor is important in mediating anxiety and panic attacks, and CCK antagonists are in clinical use to treat these symptoms. 

Symptoms usually begin as a series of unexpected panic attacks. These are followed by at least 1 month of persistent concern about having another panic attack. 

Symptoms of a panic attack are shown in Table 68-2. During an attack, there must be at least four physical symptoms in addition to psychological symptoms. Symptoms reach a peak within 10 minutes and usually last no more than 20 or 30 minutes. 

Many patients eventually develop agoraphobia, which is avoidance of specific situations (e.g., crowded places, bridges) where they fear a panic attack might occur. Patients may become homebound. 

The essential feature of SAD is an intense, irrational, and persistent fear of being negatively evaluated in a social or performance situation. Exposure to the feared situation usually provokes a panic attack. Symptoms of SAD are shown in Table 68-3. The fear and avoidance of the situation must interfere with daily routine or social/occupational functioning. It is a chronic disorder with a mean age of onset in the teens. 

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

Imipramine blocks panic attacks within 4 weeks, but maximal improvement, including reduced anticipatory anxiety and antiphobic response, requires 8 to 12 weeks. 

Ail SSRIs eliminate panic attacks in 60% to 80% of patients. The antipanic effect requires 4 weeks, and some patients do not respond until 8 to 12 weeks. 

It is not unusual for nosologic systems to adopt a mixed approach that contains both monothetic and polythetic elements. This type of system, which is used in the DSM, may require that certain diagnostic criteria are present. Other criteria for the disorder may be definitive but not necessary so that any combination of these latter criteria may be sufficient for the diagnosis. For example, panic attacks and some form of panic-related worry are both definitive and necessary criteria for panic disorder. However, any combination of 4 of the 13 symptoms constituting a panic attack is sufficient for this particular element in the diagnosis. 

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