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PANIC ATTACK

Overview

A panic attack is a sudden feeling of terror or discomfort that presents with physical symptoms such as increased heart rate, shortness of breath, palpitations, etc. Panic attacks occur in response to triggering situations that are otherwise harmless. Panic attacks may or may not be preceded by anxiety. Short-term panic attacks can occur at any time and can be managed by certain relaxation techniques. Persistent panic attacks are a sign of a panic disorder. If you experience recurrent panic attacks or are in a constant state of panic, it is better to seek professional help to resolve the underlying cause. 

Causes

Panic attacks can occur due to a variety of different factors. Research has indicated that panic attacks can have a hereditary factor and are likely to occur in those with a previous family history of panic attacks or panic disorders. Short-term panic attacks can occur due to a current or past traumatic event such as losing a loved one, physical violence, sexual abuse, financial stress, etc. History of such events can trigger a panic attack even in later stages of life despite the situation not occurring in real-time. 

Panic attacks also occur due to multiple psychological disorders such as generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), etc. These disorders can cause long-term or recurrent panic attacks that may disrupt the quality of your life. Phobias can also trigger panic attacks. For example, if you have claustrophobia, being in a closed or crowded space can trigger a panic attack. Certain systemic diseases can also make a person more prone to develop panic attacks such as hyperthyroidism, hypoglycemia, labyrinthitis, etc. Some medications, alcohol, smoking, or drug abuse can also contribute. 

Risk Factors And Epidemiology

Panic attacks are more likely to occur in those with a family history of panic attacks or panic disorders. History of traumatic events can also lead to a panic attack if exposed to a similar situation as your past. Stressors of day-to-day life such as preparation before an exam, public speaking, financial burdens, troubles with relationships, etc., are also significant risk factors for panic attacks. If you already have persistent anxiety or another psychological disorder such as PTSD, OCD, etc., you may experience recurrent panic attacks. Being exposed to a trigger or stimulant factor such as those in the case of phobias can also be a major risk factor. Certain systemic diseases, medications, smoking, alcohol intake, caffeine, or drug abuse are other risk factors. 

Panic attacks can occur at any age, but it has been observed that teenagers and young adults are more commonly affected by them. Panic attacks are more prevalent among women than men.

Signs And Symptoms

Panic attacks can occur with major physical signs and symptoms, including increased heart rate, shortness or lack of breath, hyperventilation, palpitations, excessive sweating, nausea, vomiting, dizziness, flashing vision, generalized weakness, chills, or tremors, tightness of chest, etc. These symptoms may vary in different persons. Panic attacks are also accompanied by an intense feeling of fear or discomfort as a response to a triggering factor. Some people also experience as if they are going to die from a severe panic attack.

Diagnosis

Panic attacks are mostly diagnosed on a clinical basis. It is done by a psychologist or psychiatrist specializing in mental health disorders. Your doctor will begin with acquiring a detailed history which will involve onset, duration, and severity of your symptoms, medical history, history of phobias, history of smoking, alcohol or drug abuse, history of a traumatic event or major stressors, information about social, financial and economic status, etc. A panic attack can be confirmed if a person experiences four or more of the symptoms mentioned above, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. A clinical exam may also accompany this if you present with other systemic signs and symptoms. Lab tests are not done unless they are required to diagnose an underlying systemic disease.

Differential Diagnosis

Signs and symptoms of a panic attack may resemble other psychological or medical conditions such as heart attack, chronic obstructive respiratory syndrome, asthma, drug intoxication, drug withdrawal, pheochromocytoma, etc. 

Treatment

Treatment of panic attacks depends on their severity and recurrence. The acute, short-term panic attacks that occur once or twice as a response to a triggering factor or situation can be managed by breathing exercises and grounding yourself. Severe or recurrent panic attacks are controlled by either psychotherapy, medications, or a combination of both. Cognitive-behavioral therapy is considered a first-line treatment for panic attacks or related disorders. This therapy aims to rewire your brain activity and provide specific guidelines to deal with your past or present situations. Some lifestyle modifications such as exercising, meditations, yoga, sufficient diet, limited intake of caffeine, alcohol, etc., are also suggested. 

Medication

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, etc., are prescribed in patients with recurrent panic attacks or those with panic disorders. Sedatives such as benzodiazepines may be prescribed in a limited number of cases to relieve severe physical symptoms. These medications should not be used without a prescription by a psychiatrist, and abrupt withdrawal should be avoided.

Prognosis

Panic attacks cannot be predicted and may occur at any time despite the lack of any previous history. Breathing exercises, relaxation techniques, lifestyle modifications, psychotherapy, and medications can help in improving your mental health and limit the occurrence of panic attacks to a certain degree. 

Prevention

There are no established methods to prevent the occurrence of panic attacks. However, it can be avoided to some extent by seeking help at an early stage if you went through a traumatic event, talking with your family or friends, exercising regularly, avoiding smoking, alcohol intake or excessive use of caffeine, establishing a productive routine, and making out time for yourself to relax and destress yourself.