Panic disorder with agoraphobia

Definition

Panic disorder is an anxiety disorder characterized by repeated and unexpected attacks of intense fear and anxiety.

Panic attacks are usually not related to a particular situation and typically peak within ten minutes of onset. The anxiety experienced by patients with social and specific phobias is usually expected or cued to a recognized stimulus.

Agoraphobia refers to a fear of being in places where escape might be difficult, or where help might be unavailable in case of a panic attack.

Causes

The exact cause of panic disorder is unknown, but it is associated with many different factors. Panic disorder can occur with or without agoraphobia

The development of agoraphobia may involve learned behavior, because it reflects a fear of experiencing panic attacks in unprotected settings. Sometimes, panic attacks are associated with the areas where they have happened in the past.

Panic disorder can occur in children, but the average age of onset is 25 years old. Panic disorder affects middle-aged and older adults as well. Studies have shown that women are 2 to 3 times more likely to be affected.

Symptoms

Panic attacks involve limited periods of intense symptoms, such as those listed below, which peak within 10 minutes of their onset:

• Shortness of breath
• Dizziness or faintness
• Palpitations
• Trembling
• Sweating
• Choking
• Nausea or other abdominal distress
• Numbness or tingling
• Chest pain or discomfort
• Hot flushes or chills
• Fear of dying
• Fear of being out of control
• Fear of "going crazy"

Symptoms of agoraphobia include:

• Anxiety about being in places where escape might be difficult
• Avoiding or enduring situations with marked stress or anxiety about having a panic attack
• Fear of being alone
• Fear of losing control in a public place
• Becoming house-bound for prolonged periods
• Feeling detached or estranged from others
• Feeling helpless and dependent on others

Exams and Tests

A physical examination and a psychological evaluation will be performed to arrive at a diagnosis. People with undiagnosed panic disorder may truly feel as if they are dying. Often, they will go to emergency rooms or other urgent care centers because they think they are having a heart attack.

Given the physical nature of symptoms and the possibilities for misdiagnosis, it is critical that any underlying medical disorders be ruled out. Cardiovascular, endocrine, respiratory, neurologic, and substance abuse disorders may be suspected and can coexist with panic disorders. Diagnostic tests will done depending on the symptoms.

Treatment

The goal of treatment is to help the person function effectively. The success of treatment usually depends in part on the severity of the agoraphobia.

Antidepressant medications are effective treatments for many people with panic disorder -- selective serotonin reuptake inhibitors (SSRIs), such as Paxil, have become the effective treatments. Other antianxiety medications may also be prescribed.

Behavioral therapies that may be used in conjunction with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive behavioral therapy to restructure distorted and potentially harmful interpretations of the experience of severe anxiety.

Other psychological counseling and therapy techniques may help individuals gain an understanding of the illness and the specific factors that serve as protectors or triggers for them.

Outlook (Prognosis)

Most patients can expect improvement with medications or behavioral therapy. However, without early and effective intervention, the disorder may become more difficult to treat.

Possible Complications

• Panic disorder may coexist with other anxiety disorders or depression
• Patient may develop inability to function at work or in social situations
• Patient may abuse alcohol or other drugs in an attempt to self-medicate
• Patient may feel isolated or lonely, depressed, or suicidal

When to Contact a Medical Professional

Call for an appointment with your provider if you are experiencing episodes that suggest panic attacks.

Prevention

If you are prone to panic attacks, early intervention is essential. It is very important to prevent the development of agoraphobia, which may significantly interfere with your ability to work, or to deal with social situations outside the home.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:162-163.

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:1440.