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 is 24 years. Prevalence significantly decreases after age 60 years; predominant sex: female > male (2:1)

Prevalence
Lifetime prevalence: 4.7%

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.

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

General Prevention

• Healthy lifestyle, including healthy diet, regular exercise, and stress-reduction techniques (such as mindfulness), are useful.
• The USPSTF now recommends screening children and teens for anxiety in ages 8 to 18. In September 2022, the USPTF 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.