Description

• A classic panic attack is characterized by rapid onset of a brief period of sympathetic nervous system hyperarousal accompanied by intense fear.
• In panic disorder, multiple panic attacks occur (including at least two without a recognizable trigger). Patients experience at least 1 month of worried anticipation of additional attacks and/or maladaptive (e.g., avoidance) behaviors.

Epidemiology

Incidence

• Median age of onset 24 years. Prevalence significantly decreases after 60 years.
• Predominant sex: female > male (2:1)

Prevalence

• Lifetime prevalence: 4.7%
• Of patients presenting with chest pain in the emergency room, 25% have panic disorder.
• Chest pain is more likely due to panic if atypical, younger age, female, and known problems with anxiety.

Etiology and Pathophysiology

Patients resist the initial surge of adrenaline which exacerbates the symptoms—in essence, they get anxious about being anxious.

Genetics
There is a higher incidence of panic disorder among family members, and there are a few genes associated with it; however, there is no specific known gene pattern that can fully explain the syndrome.

Risk Factors

• Life stressors of any kind can precipitate attacks.
• History of sexual or physical abuse
• Substance abuse, smoking, bipolar disorder, major depression, obsessive-compulsive disorder (OCD), and simple phobia

General Prevention

Healthy lifestyle, with stress reduction techniques and mindfulness are useful.

Commonly Associated Conditions

• Other psychiatric diagnoses: PTSD, social phobia, simple phobia, major depression, bipolar disorder, substance abuse, OCD, separation anxiety disorder
• More common in patients with asthma, migraine headaches, hypertension, mitral valve prolapse, reflux esophagitis, interstitial cystitis, irritable bowel syndrome, fibromyalgia, nicotine dependence
• Panic disorder increases the risk of suicide attempts and ideation.