panic disorder (signs and symptoms)

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signs and symptoms of panic disorder, psychology, clinical psychology

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PANIC DISORDER By: Gurleen Nanra

Case Study:

Case Study Smita is a 20 yr college going girl. On several occasions recently, she has experienced sudden , absolute panic. During these episodes, her heart pounds, she trembles, her mouth gets dry and it feels as if the walls are caving in. the feelings only last a few minutes but, when they occur, the only thing that seems to relieve her fear is walking around her apartment and reminding herself that she is in control. She won’t ride in cars anymore unless she is driving so she is sure that she can stop when necessary. She will only go to class if she can find an empty seat in the back row so that she can leave quietly if she has another attack. She avoids any situation in which she might feel embarrassed and out of control by her own terror. Smita is suffering from panic attacks.

Introduction and Definition:

Introduction and Definition The word “Panic” is derived from the word ‘pan’ which is the name of the Greek God of “woods and fields”, and who was blamed for the inexplicable apprehension that are felt by the travelers in lonely places. The word “Panic” derived from it does describes sudden senseless terror. Panic disorder is one of the types of anxiety disorder- those disorders that have unrealistic, irrational fears or anxieties of disabling intensities. Panic disorder is defined by the occurrence “unexpected” and “spontaneous” panic attacks that often seems to “come out of the blue.”

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In Panic disorder, a person suffers a sudden attack of a host of symptoms- Palpitations, Nausea, Chest pain, Feelings of choking, Dizziness, Sweating, Experiencing de-personalization, de-realization, Fear of losing control, dying etc. “Panic attacks” are a period of intense fear in which 4 of 13 defined symptoms develop abruptly, reaching peak within 10mins; the attacks usually subside in 20-30mins. Panic attacks as “un-cued or unexpected”- occurs in situations in which they might be least expected, like, during “relaxation” or “sleep”. Panic attacks as “situationally –predisposed”, eg, someone scared of public speaking may have a panic attack when placed in front of an audience

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During the episode of panic attack, patients have the urge to flee or escape and has a sense of impending doom as though they are dying from heart-attack or suffocation. Often these attacks subside as mysteriously as they occur. A person who has experienced one or more panic attacks often develops a fear of having one again. The individual may try to stay away from anything that reminds him/her of the last attack to avoid having another one.

PANIC ATTACKS:

PANIC ATTACKS The term panic attack denotes an abrupt surge of intense anxiety rising to peak, which is cued by either the presence of, or thoughts about particular stimuli, or that occurs without obvious cues and is spontaneous and unpredictable. People who have panic attacks when the evoking stimuli is not present typically do not have phobias. Stressful life events can trigger a panic attack, Panic attacks range in length from a few seconds to many hours and even days.

CLINICAL FEATURES :

CLINICAL FEATURES Shortness of breath or the feeling of being smothered. Dizziness, unsteadiness or faintness. Trembling, shaking or sweating. Heart palpitations or racing heart rate. Choking, nausea or stomach pain. Numbness or tingling, flushing or chills. Chest pain or discomfort. A sense of “strangeness” of being detached from oneself or one’s surroundings. Fear of going crazy, loosing control or dying.

PANIC ATTACK or HEART ATTACK??:

PANIC ATTACK or HEART ATTACK?? Panic attack Chest pain are sharp and only appear in the heart region. The pain is increasing due to hard breathing. chest pain ceases after the peak of attack in about 10 minutes. Tingly feeling throughout the body. Person will feel nauseous but will hardly vomit. Hyperventilation occurs before every attack.

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Heart attack Chest pain may not necessarily happen and if it does it is more of a squashing pain. Pain in middle of chest, can extend to left arm area, neck area and back of body. Pain is not increased by breathing. The chest pain is continuous and usually lasts a lot longer than 10 minutes. Tingly feeling if present at all is confined to left arm. Vomiting is quite common. There is no hyperventilation during a heart attack perhaps just a shortness of breath.

DSM-4-TR Criteria for Panic Disorder with Agoraphobia:

DSM-4-TR Criteria for Panic Disorder with Agoraphobia A . Both (1) and (2) Recurrent, unexpected panic attacks. At least one of the attacks followed by 1 month or more of (a) Concern about having another one. (b) Worry about consequences of an attack (“heart attack”) B. Presence of agoraphobia.

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C. Panic attack not due to physiological effects of a substance or medical condition. D. Panic attacks not better explained by another mental disorder such as social or specific phobia.

Panic disorder without agoraphobia:

Panic disorder without agoraphobia Panic disorder is characterized by severe and frightening episodes of apprehension and feeling of impending doom. These episodes are often described as horrible and can last from a few minutes to several hours. Individual with panic disorder report intense panic attack alternating with periods of low anxiety, during which they may be apprehensive about having another panic attack. The attacks are specially feared because they often occurred unpredictably and without warning.

DSM-4-TR criteria for Panic Disorder without Agoraphobia:

DSM-4-TR criteria for Panic Disorder without Agoraphobia A. Both (1) and (2) Recurrent, unexpected panic attacks. At least one of the attacks followed by 1 month or more of (a) Concern about having another one. (b) Worry about consequences of an attack (“heart attack”) B. Absence of agoraphobia

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C. Panic attack not due to physiological effects of a substance or medical condition. D. Panic attacks not better explained by another mental disorder such as social or specific phobia

Prognosis:

Prognosis Panic disorder usually has its onset in late adolescence or early adulthood, although onset during childhood, early adolescence, and midlife does occur. Panic disorder, in general, is a chronic disorder, although its course is variable, both among patients and within a single patient. After the first one or two panic attacks, patients may be relatively unconcerned about their condition; with repeated attacks, however, the symptoms may become a major concern.

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Panic attacks can occur several times in a day or less than once a month. Excessive intake of caffeine or nicotine can exacerbate the symptoms. Depression can complicate the symptom picture in anywhere from 40 to 80 percent of all patients, as estimated by various studies.

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Family interactions and performance in school and at work commonly suffer. Patients with good premorbid functioning and symptoms of brief duration tend to have good pronoses.

References:

References Carson, R., Butcher, J., Mineka, S., & Hooley, J.(2007). Abnormal Psychology (13 th ed.), Delhi, India: Pearson Education Davison, C.G., & Neale, M.J.(2006).Abnormal Psychology (10 th ed.). Washington, DC: Pearson Education Kaplan & Sadock. (2007). Synopsis of Psychiatry (19 th ed.). Philadelphia: Lippincott Williams & Williams http://www.panikattacksdisorder.org http://psychcentral.com/library/id253.html

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