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Panic Disorder

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Definition

A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being 'stressed out' that most people experience. If someone is suffering from a panic disorder, it means that he or she experiences recurrent panic attacks, which are not caused by medical conditions, substance misuse, or another psychiatric disorder. The frequence may vary from many attacks a day to only a few attacks a year. Furthermore, they usually worry about having another attack and/or about the consequences of the attacks, and subsequently try to avoid certain places or situations. 

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Symptoms

Symptoms of a panic attack may include:

  • Racing heartbeat
  • Difficulty in breathing; feeling of 'not getting enough air' 
  • Dizziness or lightheadedness or
  • Nausea
  • Trembling, sweating or shaking
  • Feelings of choking 
  • Chest pains
  • Hot flashes, or sudden chills
  • Tingling in fingers or toes ('pins and needles' or 'numbness')
  • Fear of losing control or going crazy
  • Fear of dying 

 

In addition to the above symptoms, a panic attack is marked by the following conditions:

  • It occurs suddenly, without any warning and without any way to stop it.
  • The level of fear is way out of proportion to the actual situation; often, in fact, it is completely unrelated.
  • The panic attacks normally pass in about 15 to 30 minutes. However, repeated attacks can continue to recur for hours.
  • Persistent worry about getting another attack or about the consequences of the attack.
  • Some people may avoid certain places and situations because they are worried that they may get a panic attack in those situations.

 

A panic attack is not dangerous, but it is, most of the times, a very frightening experience. Some people with panic disorder will develop other problems such as phobias, depression, or substance abuse.

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Fact

Panic disorder is a serious condition with a prevalence rate of 3% to 5% in the normal population. Women are more likely to be affected than men.

 

One study found that people sometimes see 10 or more doctors before being properly diagnosed, and that only one out of four people with the disorder receive the treatment they need. Hence, it is important to know what the symptoms are, and to make sure you get the right help.

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When to seek medical advice

Many people experience occasional panic attacks. However, it is unlikely to pose a reason to worry about even if you have had one or two such attacks previously. The key symptom of panic disorder is the persistent fear of having future panic attacks. If you suffer from repeated (four or more) panic attacks, and especially if you have had a panic attack and are in continued fear of having another, you may need help. 


Many people with panic disorder show 'situational avoidance' associated with their panic attacks. For example, you might have an attack while driving, and start to avoid driving until you develop an actual phobia towards it. In worst case scenarios, people with panic disorder develop agoraphobia - fear of going outdoors - because they believe that by staying inside, they can avoid all situations that might provoke an attack, or where they might not be able to get help. The fear of an attack is so debilitating, that they prefer to spend their lives locked inside their homes. Even when you do not develop these extreme phobias, your quality of life can still be severely affected by untreated panic disorder.


The good news is that panic disorder can be treated successfully. It is advisable to visit a healthcare professional if the quality of your life is influenced by the panic attacks.

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Treatment and drugs

Most panic disorder specialists agree that a combination of medicines and psychotherapy are the best treatment for panic disorder. Furthermore, a support group or workshop with others who suffer from panic disorder can be very helpful to some people. 

 

Medications:

  • Antidepressants - although you may not be depressed at all, this group of drugs is useful in reducing panic attacks, and helps in feeling less worried.
  • Anti-anxiety drugs
  • Or a combination of the above 


The most common psychotherapy used to treat panic disorder is the Cognitive-Behavioural Therapy (CBT). It usually includes anxiety management training - for example, teaching people techniques such as deep breathing to control their levels of anxiety. Another important aspect of treatment is called cognitive restructuring, which involves helping individuals identify their misjudgments and develop more realistic expectations of the likelihood of danger. The last part, called behavioural therapy, is used to expose yourself to situations which you are avoiding, to overcome the avoidance and anxiety related to it.

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Appointment and Enquiry

In NUH, we run a specialised clinic for anxiety disorders. In this clinic, you can expect the latest evidence-based care for anxiety disorders. Anxiety workshops will also be provided on a regular basis. If needed, rating scales will be used to objectify your symptoms.  A psychologist and nurse are part of the team.

 

To make an appointment, call the NUH Neuroscience Clinic at 6772 4850.

For more information on anxiety disorders, visit the website of the Anxiety Disorders Association of America: http://www.adaa.org/

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