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

ETIOLOGY AND PATHOPHYSIOLOGY

A combination of vulnerability factors compounding with life stressors which exacerbate the symptoms. These factors including genetics, childhood hardships, and personality characteristics which include increased sensitivity to anxiety.

RISK FACTORS

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

GENERAL PREVENTION

• Healthy lifestyle, including healthy diet, regular exercise, and stress reduction techniques (such as mindfulness) are useful.
• The USPTF recommends screening children and teens for anxiety and made a draft recommendation to screen adults aged ≤64 years.

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.