Panic Attacks: Symptoms and treatment

Panic attacks (also called anxiety crisis) are episodes of sudden and intense fear or anxiety normally present a rapid escalation. They are accompanied by somatic and cognitive symptoms, such as palpitations, sudden sweating, trembling, feeling of choking, chest pain, nausea, dizziness, fear of dying or going crazy, chills or hot flushes.
Those who have tried panic attacks describe them as a terrible experience, often sudden and unexpected, at least the first time. It 'obvious that the fear of another attack immediately becomes strong and dominant.

The single episode, then, flows easily in a real panic disorder, more for "fear of fear" than anything else. The person is quickly embroiled in a terrible vicious cycle that often brings with it the so-called "agoraphobia", or anxiety related to being in places or situations from which escape might be difficult or embarrassing to get away, or in which it may not be available help, in the case of a panic attack unexpected.

With the fear of panic attacks then it becomes almost impossible to leave the house alone, traveling by train, bus or drive a car, stand out in a crowd or in the queue, and so on.
The avoidance of all potentially anxiety-provoking situations becomes the predominant mode and the patient becomes the slave of his panic attacks, often forcing all family members to adapt accordingly, not to leave him alone and to accompany him everywhere, with the inevitable sense of frustration that comes from being "big man" but dependent on others, which can lead to a secondary depression.

The essential feature of Panic Disorder is the presence of recurrent panic attacks, unexpected, followed by at least 1 month of persistent concern about having another panic attack.
The person is concerned about the possible implications or consequences of the attacks of anxiety and changes its behavior as a result of the attacks, mainly by avoiding situations in which fear that they might occur.
The first panic attack is usually unexpected, that occurs "out of the blue," in which the subject is enormously frightening, and often occurs in the ER; then may become more predictable.
For the diagnosis required at least two unexpected panic attacks, but the majority of individuals have many more.

Individuals with panic disorder exhibit features interpretations or concerns about the implications or consequences of the panic attacks. The concern for the next attack or its implications are often associated with the development of avoidance behavior that can lead to a real Agoraphobia, in which case you are diagnosed with Panic Disorder with Agoraphobia.
Usually panic attacks are more frequent in stressful times. Some life events may in fact serve as precipitating factors, though not necessarily announce a panic attack. Among the events of life are the most commonly reported precipitating the marriage or cohabitation, separation, loss or illness of a significant person, the victim of some form of violence, financial problems and working.
The first attacks usually occur in agoraphobic situations (such as driving yourself or traveling on a bus in the city) and in some context, however, often stressful.
Stressful events, situations agoraphobic, the hot and humid climatic conditions, psychoactive drugs can in fact give rise to bodily sensations that can be interpreted in a catastrophic manner, increasing the risk of developing panic attacks.

Panic Attacks Symptoms

The panic attack has a sudden onset, peak rapidly (usually within 10 minutes or less) and takes about 20 minutes (but sometimes much less or more).
The symptoms of panic attacks are typical:
- Palpitations / tachycardia (irregular beats, heavy agitation in the chest, feeling the pulse in his throat)
- Fear of losing control or going crazy (eg, fear of doing something embarrassing in public or fear of running away when it hits the panic or lose your temper)
- Feelings of confusion, instability (dizziness and vertigo)
- Tremors purposes or to large shocks
- Sweating
- Feeling of choking
- Pain or discomfort in the chest
- Feelings of unreality (perception of the external world as strange and unreal feeling dizzy and detachment) and depersonalization (altered sense of self characterized by feeling of detachment or estrangement from their thought processes or body)
- Chills
- Hot flashes
- Paresthesias (numbness or tingling sensations)
- Nausea or abdominal discomfort
- Feeling of suffocation (narrow or lump in the throat)

Not all symptoms are needed because it is a panic attack. There are many connections, characterized in particular by only or some of these symptoms. The frequency and severity of the symptoms of panic attacks varies widely over time and circumstances. For example, some individuals have moderately frequent attacks (for eg., Once a week), which occur regularly for months. Others report a short series of attacks more frequent, perhaps with less intense symptoms of a panic attack (eg. Every day for a week), interspersed with weeks or months without seizures or with less frequent attacks (eg., Two every month ) for many years.
There are also so-called limited-symptom attacks are very common in individuals with panic disorder, which attacks occur when only a portion of the symptoms of panic, without exploding in a real attack. The majority of individuals with symptoms of panic attack with few symptoms, however, have had panic attacks complete with all the classic symptoms, at some time during the disturbance.
During a panic attack, catastrophic thoughts automatic and uncontrolled fill the mind of the person, who then has difficulty thinking clearly and fears that these symptoms are really dangerous. Some fear that the attacks indicate the presence of an undiagnosed illness, life-threatening (eg., Heart disease, epilepsy). Despite repeated medical examinations and reassurance may be frightened and convinced that they are physically vulnerable. Others fear that the symptoms of a panic attack indicate that they are "going crazy" or losing control, or who are emotionally weak and unstable.

Panic attacks treatment

In the treatment of panic disorder with or without agoraphobia, and generalized anxiety disorder in general, the form of psychotherapy that scientific research has shown to be most effective in the shortest time possible, is that "cognitive-behavioral". It is a short-term psychotherapy, usually at weekly intervals, in which the patient plays an active role in the solution of your problem and, together with the therapist, focuses on learning modes of thought and behavior more functional to the care of attacks panic, in order to break the vicious circles of the disorder.
For panic and agoraphobia, a treatment based on cognitive behavioral therapy is highly recommended and first choice. Basically trust is contraindicated drugs or other forms of psychotherapy without taking that form of treatment that the entire scientific community has proven to be the most effective for the treatment of panic attacks.

Pharmacologic treatment of panic attacks and agoraphobia, as often unwise (at least as the sole treatment), is fundamentally based on two classes of drugs: benzodiazepines and antidepressants are often used in combination.
In mild forms the prescription of benzodiazepines alone may be sufficient as a cure for panic attacks temporary, but hardly conclusive. The molecules used are alprazolam, the etizolam, clonazepam, lorazepam. These drugs, however, in the case of panic attacks and agoraphobia, are likely to give highly addictive and maintain the disorder, especially if you do not make a parallel with cognitive-behavioral psychotherapy.
Antidepressants have been shown to be effective in the treatment of panic attacks and agoraphobia tricyclics - TCA - (chlorimipramine eg, imipramine, desipramine), mono amino oxidase inhibitors (MAOIs), and especially the selective serotonin reuptake inhibitors - SSRIs - (eg, citalopram, escitalopram, paroxetine, fluoxetine, fluvoxamine, sertraline), widely used today.

This class of drugs has in fact, than the previous, better handling and fewer side effects.
In cases of panic attacks and agoraphobia who do not respond to treatment with SSRIs, TCAs can be used, although many clinicians use these molecules as therapy of first use.
MAOIs, although very effective drugs, are almost entirely fallen into disuse as a tool to cure panic attacks for serious side effects that can occur if there is the association of certain molecules or non-compliance with the prescribed dietary restrictions.

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