Marks Psychiatry

Panic attacks can be extremely disabling, so much so that often individuals who have had a panic attack have already made a trip to their local emergency department. What is a panic attack? There are many physical symptoms associated with it, but in general it is a discrete period of intense fear accompanied by physical symptoms such as chest pain, racing heart, sweating, nausea, dizziness, and fear of dying to name a few.

With panic disorder, a person has unexpected panic attacks and persistent worry about having future attacks. The age of onset is late teens to early 30’s. It’s unusual to develop panic disorder after age 45, but is possible. The course is usually chronic over a person’s lifetime and waxes and wanes over time. A person can have a cluster of attacks that last for an extended period, and then go years with no symptoms.

Agoraphobia is a preoccupation with having another panic attack such that the person avoids being in situations where they fear they may have an attack and not be able to escape. They fear being trapped while having attack. Sometimes the anxiety associated with the fear of having an attack can become greater than the attack itself. Not everyone with panic disorder develops agoraphobia.

Panic disorder is common in cardiology settings, and typically those suffering with panic disorder have had some type of medical workup. The medical workup is important because there are medical conditions that can cause panic attacks. These conditions would include hyperthyroidism, seizure disorder, vestibular disease (such as inner ear problems), and cardiac disorders such as an irregular heart beat. The lifetime prevalence is generally thought to be 1-3% in the general population, but as high as 10-60% in medical settings.

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