Panic attack

For other uses, see Panic attack (disambiguation).
Panic attack
A depiction of someone experiencing a panic attack being reassured by another person
SpecialtyPsychiatry
SymptomsPeriods of intense fear, palpitations, sweating, shaking, shortness of breath, numbness[1][2]
ComplicationsSelf-harm, suicide,[2] agoraphobia
Usual onsetOver minutes[2]
DurationSeconds to hours[3]
CausesPanic disorder, social anxiety disorder, post-traumatic stress disorder, drug use, depression, medical problems[2][4]
Risk factorsNicotine, caffeine, cannabis, psychological stress[2]
Diagnostic methodAfter other possible causes excluded[2]
Differential diagnosisHyperthyroidism, hyperparathyroidism, heart disease, lung disease, drug use, dysautonomia[2]
TreatmentCounselling, medications[5]
MedicationAcute: Benzodiazepines[6] Preventative: Antidepressants, anxiolytics
PrognosisUsually good[7]
Frequency3% (EU), 11% (US)[2]

Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, otherwise defined as a rapid, irregular heartbeat, sweating, chest pain or discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a sense of impending doom or loss of control.[1][2][8] Typically, these symptoms are the worst within ten minutes of onset and can last for roughly 30 minutes, though they can vary anywhere from seconds to hours.[3][9] While they can be extremely distressing, panic attacks themselves are not physically dangerous.[7][10]

The Diagnostic and Statistical Manual V (DSM-5) defines them as "an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur." These symptoms include, but are not limited to, the ones mentioned above.[11]

Panic attacks function as a marker for assessing severity, course, and comorbidity (the simultaneous presence of two or more diagnoses) of different disorders, including anxiety disorders. Hence, panic attacks can be applied to all disorders found in the DSM.[12]

Panic attacks can be caused by a identifiable source, or they may happen without any warning and without a specific, recognizable situation.[2]

Some known causes that increase the risk of having a panic attack include medical and psychiatric conditions (e.g. panic disorder, social anxiety disorder, post-traumatic stress disorder, substance use disorder, depression), substances (nicotine, caffeine), and psychological stress.[2][4]

Before making a diagnosis, it is important to eliminate other conditions that can produce similar symptoms, such as hyperthyroidism (an overactive thyroid), hyperparathyroidism (an overactive parathyroid), heart disease, lung disease, and dysautonomia, disease of the system that regulates the body's involuntary processes.[2][13]

Treatment of panic attacks should be directed at the underlying cause.[7] In those with frequent attacks, counseling or medications may be used, as both preventative and abortive measures, ones that stop the attack while it is happening.[5] Breathing training and muscle relaxation techniques may also be useful.[14]

Panic attacks often appear frightening to both those experiencing and those witnessing them, and often, people tend to think they are having heart attacks due to the symptoms.[15] However, they do not cause any real physical harm.

It is important to note that previous studies have suggested that those who suffer from anxiety-related disorders (e.g. panic disorder) are at higher risk of suicide.[16]

In Europe, approximately 3% of the population has a panic attack in a given year, while in the United States, they affect about 11%.[2] Panic attacks are more prevalent in females than males and often begin during puberty or early adulthood.[2] Children and older adults are less commonly affected.[2]

  1. ^ a b "Anxiety Disorders". NIMH. March 2016. Archived from the original on 29 September 2016. Retrieved 1 October 2016.
  2. ^ a b c d e f g h i j k l m n o American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 214–217, ISBN 978-0-89042-555-8
  3. ^ a b Bandelow, Borwin; Domschke, Katharina; Baldwin, David (2013). Panic Disorder and Agoraphobia. OUP Oxford. p. Chapter 1. ISBN 978-0-19-100426-1. Archived from the original on 20 December 2016.
  4. ^ a b Craske, Michelle G; Stein, Murray B (December 2016). "Anxiety". The Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
  5. ^ a b "Panic Disorder: When Fear Overwhelms". NIMH. 2022. Archived from the original on 23 March 2022. Retrieved 18 March 2022.
  6. ^ Batelaan, Neeltje M.; Van Balkom, Anton J. L. M.; Stein, Dan J. (April 2012). "Evidence-based pharmacotherapy of panic disorder: an update". The International Journal of Neuropsychopharmacology. 15 (3): 403–415. doi:10.1017/S1461145711000800. hdl:1871/42311. PMID 21733234.
  7. ^ a b c Geddes, John; Price, Jonathan; McKnight, Rebecca (2012). Psychiatry. OUP Oxford. p. 298. ISBN 978-0-19-923396-0. Archived from the original on 4 October 2016.
  8. ^ Lo, Yu-Chi; Chen, Hsi-Han (May 2020). "Shiau-Shian Huang Panic Disorder Correlates with the Risk for Sexual Dysfunction". Journal of Psychiatric Practice. 26 (3): 185–200. doi:10.1097/PRA.0000000000000460. PMID 32421290. S2CID 218643956.
  9. ^ Smith, Melinda; Robinson, Lawrence; Segal, Jeanne. "Panic Attacks and Panic Disorder". HelpGuide. Archived from the original on 9 July 2021. Retrieved 6 July 2021.
  10. ^ Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Giuseppe; Rihal, Charanjit; Y.-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian (7 June 2018). "International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology". European Heart Journal. 39 (22): 2032–2046. doi:10.1093/eurheartj/ehy076. PMC 5991216. PMID 29850871.
  11. ^ Administration, Substance Abuse and Mental Health Services (June 2016). "Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5". www.ncbi.nlm.nih.gov. Retrieved 2024-10-29.
  12. ^ American Psychiatric Association, American Psychiatric Association. "Changes to the DSM-V to the DSM-V-TR" (PDF). Changes to the DSM V to DSM V-TR. Archived (PDF) from the original on 2 September 2018. Retrieved 22 March 2022.
  13. ^ Stewart, Julian M.; Pianosi, Paul; Shaban, Mohamed A.; Terilli, Courtney; Svistunova, Maria; Visintainer, Paul; Medow, Marvin S. (1 November 2018). "Hemodynamic characteristics of postural hyperventilation: POTS with hyperventilation versus panic versus voluntary hyperventilation". Journal of Applied Physiology. 125 (5): 1396–1403. doi:10.1152/japplphysiol.00377.2018. ISSN 8750-7587. PMC 6442665. PMID 30138078.
  14. ^ Roth, Walton T. (January 2010). "Diversity of effective treatments of panic attacks: what do they have in common?". Depression and Anxiety. 27 (1): 5–11. doi:10.1002/da.20601. PMID 20049938. S2CID 31719106.
  15. ^ Tully, Phillip J; Wittert, Gary A; Turnbull, Deborah A; Beltrame, John F; Horowitz, John D; Cosh, Suzanne; Baumeister, Harald (December 2015). "Panic disorder and incident coronary heart disease: a systematic review and meta-analysis protocol". Systematic Reviews. 4 (1): 33. doi:10.1186/s13643-015-0026-2. ISSN 2046-4053. PMC 4376084. PMID 25875199.
  16. ^ Allan, Nicholas P.; Gorka, Stephanie M.; Saulnier, Kevin G.; Bryan, Craig J. (2023-04-01). "Anxiety Sensitivity and Intolerance of Uncertainty: Transdiagnostic Risk Factors for Anxiety as Targets to Reduce Risk of Suicide". Current Psychiatry Reports. 25 (4): 139–147. doi:10.1007/s11920-023-01413-z. ISSN 1535-1645. PMC 10064604. PMID 37000403.