Panic attacks what they are, what to know, and what to do about them.

An anxiety attack or panic attack consists of the sudden appearance, usually in less than 10 minutes, of an uncontrollable feeling of intense discomfort or apprehension, fear or terror, frequently associated with an idea of ​​imminent catastrophe (feeling of death, of going crazy or losing control), along with an urgent need to flee the situation. The episode is accompanied by different clinical manifestations and usually disappears on its own, in minutes or, more rarely, in hours. Between 1 and 3 people in 100 will experience a panic attack in their lifetime. Anxiety disorder

or panic attack disorder consists of the sustained appearance time of recurring and unpredictable panic attacks. The frequency of panic attacks is variable, from one per week to several episodes in a short space of time followed by long periods without any type of symptom. The first attack usually occurs outside the home and often appears in late adolescence or early adulthood. Frequently the patient remembers the moment of the first crisis with precision, without necessarily having any clear precipitating situation. In many subjects, the appearance of the first attack is associated with fear and progressive anxiety that the attack will repeat itself, and they, therefore, avoid those places or situations that they think could trigger the episode again. In this sense, agoraphobia,

Panic disorder is common in the population and usually has a chronic course, although it fluctuates in intensity.

Causes of panic attacks

Its causes are unknown, although an important genetic component has been demonstrated. It seems that an exaggerated release of catecholamines (substances that promote nervousness, tremor, tachycardia, and agitation) is involved in response to certain stimuli.

What are the symptoms of a panic attack?

A panic attack consists of the appearance of a differentiated episode of fear or anguish that evolves in less than 10 minutes and in which 4 or more of the following symptoms appear suddenly:

1. Palpitations, pounding of the heart, or increased heart rate.
2. sweating.
3. Trembling or shaking.
4. Choking sensation or shortness of breath.
5. Choking sensation.
6. Tightness or discomfort in the chest.
7. Nausea or abdominal discomfort.
8. Unsteadiness, dizziness, or fainting.
9. Derealization (feeling of unreality) or depersonalization (feeling separate from oneself).
10. Fear of losing control or going crazy.
11. Afraid to die.
12. Paraesthesias (numbness or tingling sensation) in extremities or around the mouth.
13. Chills or hot flashes.

These symptoms usually disappear after approximately one hour of evolution.

Diagnostic criteria have been proposed for panic attacks based on the circumstances in which they appear and the mode of onset:

• Spontaneous or unexpected crises. They appear without being associated with any immediate trigger. They are the ones that will define the existence of an anxiety disorder (or panic disorder).
• Crises triggered by certain situations. They invariably appear immediately after exposure to or anticipation of an environmental stimulus or trigger. They are characteristic of phobic disorders. The onset of these crises is usually progressive depending on the approach and/or premonition of the phobic stimulus. They quickly subside or fail to appear when avoidance behaviors are successful.
• Crises predisposed by situations. They appear during exposure to an environmental trigger, although they are not always associated with the said situation, nor when they do appear immediately after coping. These crises would be characteristic of agoraphobia.

How is it diagnosed?

The diagnosis of panic disorder implies persisting for at least a month with fear about the possibility of a panic attack appearing or that changes in behavior occur as a consequence of it, according to the following criteria:

• 1 and 2 are fulfilled:

1. Unexpected recurring (repetitive) panic attacks (panic attacks).
2. At least one of the crises has been followed for 1 month (or more) by one (or more) of the following symptoms:

• Persistent concern about the possibility of having more seizures.

• Worry about the implications of the crisis or its consequences (eg losing control, having a heart attack, “going crazy”).

• Significant behavior change related to seizures.

• Panic attacks are not due to the direct physiological effects of a substance (drugs, pharmaceuticals) or a general medical condition (hyperthyroidism).
• Panic attacks cannot be better explained by the presence of another mental disorder, such as social phobia (appears when exposed to feared social situations), specific phobia (appears when exposed to specific phobic situations), obsessive-compulsive disorder (for example exposure to dirt when the obsession is about pollution), post-traumatic stress disorder (in response to stimuli associated with highly stressful situations), or separation anxiety disorder (being away from home or loved ones ).

Panic attacks or anxiety disorders can occur with or without agoraphobia. The agoraphobia criteria refer to:

1. The appearance of acquired and irrational anxiety when being in places or situations from which it may be difficult (or embarrassing) to escape or in which help may not be available in the event of a panic attack or situation of unexpected distress. Agoraphobic fears are often associated with a set of characteristic situations, including being outside the home alone, mixing with people or standing in line, going over a bridge, or traveling by bus, train, or car. A diagnosis of specific phobia should be considered if the avoidance behavior is limited to one or a few specific situations, or social phobia if it is only related to events of a social nature.
2. These situations are avoided (for example, the number of trips is limited) at the cost of significant discomfort or anxiety for fear that a panic attack or symptoms similar to anxiety may appear, or the presence of an acquaintance is essential to endure them.
3. This anxiety or avoidance behavior cannot be better explained by the presence of another mental disorder such as social phobia (avoidance limited to social situations due to fear of blushing), specific phobia (avoidance limited to isolated situations such as elevators), obsessive-compulsive disorder ( for example, avoidance of everything that can make a mess in an individual with obsessive ideas of contamination), post-traumatic stress disorder (avoidance of stimuli related to a highly stressful or traumatic situation) or separation anxiety disorder (avoidance of leaving the home or the family).

Any diagnosis of anxiety must have previously ruled out some diseases that can cause extreme nervousness in some situations.

Is it hereditary?

Panic disorder is more common in close relatives. Between 30 to 50% of the twin brothers of a patient with panic disorder also have the disease.

What is the prognosis?

Treatment usually controls the episodes. Most treated patients become symptom-free and many of them can withdraw treatment without recurrence of the disease. Unfortunately, many people with panic attacks do not go to the doctor and may suffer
significant changes in their quality of life.

Panic attack treatment

The goal of treatment is to reduce the number of panic attacks and their intensity.

The fundamental treatment of these patients is antidepressants, especially selective serotonin reuptake inhibitors (fluoxetine, paroxetine, citalopram, etc.). They are usually started at lower doses than those used to treat depression and are continued for up to 2 years after the attacks have subsided. Benzodiazepines (anxiolytics) are often used when the disease is initially diagnosed and sporadically thereafter.

Psychotherapeutic interventions can help the patient control symptoms during attacks. They are strategies used by professionals to explain and help deal with the problem.

Watch the following video will show you more about panic attack