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 (genetics, childhood hardships, and personality characteristics), with life stressors

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 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.