Panic disorder, one of the anxiety disorders, is characterized by repeated and unexpected attacks of intense fear and anxiety. Panic attacks are usually not related to a particular situation (although attacks in patients with social and specific phobias are usually expected or "cued" to a recognized or specific stimulus) and typically "peak" within ten minutes of their onset. Agoraphobia refers to a fear of being in places where escape might be difficult, or where help might be unavailable in case of a panic attack.

Causes, incidence, and risk factors

The exact cause of panic disorder is unknown, but it is associated with multiple physiological factors. Panic disorder can occur with or without agoraphobia , but agoraphobia develops in more than one-third of cases. The development of agoraphobia may involve learned behavior, since it reflects a fear of experiencing panic attacks in unprotected settings. Sometimes the association of panic attacks occurs with areas where they have happened. Studies have reported lifetime prevalence rates of 1.5 to 5% for panic disorder. Panic disorder can occur in children, but the average age of onset is 25 years old. Panic disorder affects middle-aged and older adults as well. Studies have shown that women are 2 to 3 times more likely to be affected.

Signs and tests

A physical examination and a psychological evaluation are performed to arrive at a diagnosis. People with undiagnosed panic disorder may truly feel as if they are dying, so they often go to emergency rooms or other urgent care centers because they feel as if they are having a heart attack. Given the physical nature of symptoms and the possibilities for misdiagnosis, it is critical that any underlying medical disorders are ruled out. Cardiovascular , endocrine , respiratory , neurologic, and substance abuse disorders may be suspected and can coexist with panic disorders. Diagnostic tests will done depending on the symptoms.

Treatment

The goal of treatment is to help the person function effectively. The success of treatment usually depends in part on the severity of the agoraphobia. Antidepressant medications are effective treatments for many people with panic disorder -- selective serotonin reuptake inhibitors (SSRIs), such as Paxil, have become the primary medication. Antianxiety medications may also be prescribed. Behavioral therapies that may be used in conjunction with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive behavioral therapy to restructure distorted and potentially harmful interpretations of the experience of severe anxiety. Other psychological counseling and therapy techniques may be helpful to help individuals gain an understanding of the illness and the specific factors that serve as protectors or "triggers" for them.

Expectations (prognosis)

Although many people with this disorder may not be cured with treatment, all can expect improvement with drug or behavioral therapy. However, without early and effective intervention, the disorder may be long-standing and difficult to treat.

Complications

Calling your health care provider

Call for an appointment with your health care provider if you are experiencing episodes that could suggest panic attacks.

Prevention

If you are prone to panic attacks, early intervention is essential, particularly to prevent the development of agoraphobia which could significantly interfere with your ability to function at work and social situations outside the home.