Panic disorder
For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like Im losing control in a very extreme way. My heart pounds really hard, I feel like I cant get my breath, and theres an overwhelming feeling that things are crashing in on me.It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying.
In between attacks there is this dread and anxiety that its going to happen again. Im afraid to go back to places where Ive had an attack. Unless I get help, there soon wont be anyplace where I can go and feel safe from panic.
Definition: is an anxiety disorder characterized by repeated unpredictable attacks of sudden sever fear for no reason and usually associated with physical symptoms like tachycardia, chest pain, chocking and dizziness.
Clinical picture:
Sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending death, or a fear of losing control.
People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They cant predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack.
Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited.
People who have full-blown, repeated panic attacks can become very disabled by their condition and should seek treatment before they start to avoid places or situations where panic attacks have occurred. Someone with panic disorder may develop agoraphobia that could change the life of the patient.
Early treatment can often prevent agoraphobia, but people with panic disorder may sometimes go from doctor to doctor for years and visit the emergency room repeatedly before someone correctly diagnoses their condition. This is unfortunate, because panic disorder is one of the most treatable of all the anxiety disorders.
Treatment:
In acute attack the patients need reassurance and sedation usually valium 10mg I.V. slowly.
For continuous treatment :
SSRIs like fluoxetine 20-60mg\day or sertraline 50-150mg\day
Tricyclic antidepressants like clomipramine 75-200mg\day or imipramine 75-200mg\day
Benzodiazepines like lorazepam , chlordiazepoxide (libiruim)
B-blockers like inderal 10-40mg\day
Cognitive therapy
Behavioral therapy
Phobic disorders
Definition: continuous irrational fear from certain situation or object leads to avoidance of that situation or object.
Categories
Agoraphobia: Agoraphobia is fear of and anticipatory anxiety about being trapped in situations or places without a way to escape easily and without help if intense anxiety develops. The situations are avoided or they may be endured but with substantial anxiety. Agoraphobia can occur alone or as part of panic disorder.
Agoraphobia without panic disorder affects about 4% of women and 2% of men during any 12-months period. Peak age at onset is the early 20s; first appearance after age 40 is unusual. Common examples of situations or places that create fear and anxiety include standing in line at a bank or at a supermarket checkout, sitting in the middle of a long row in a theater or classroom, and using public transportation, such as a bus or an airplane. Some people develop agoraphobia after a panic attack in a typical agoraphobic situation. Agoraphobia often interferes with function and, if severe enough, can cause a person to become housebound.
Social phobia (social anxiety disorder): Social phobia is fear of and anxiety about being exposed to certain social situations.
Social phobia affects about 9% of women and 7% of men during any 12-mo period, but the lifetime prevalence may be at least 13%. Men are more likely than women to have the most severe form of social anxiety.
Often the concern is that anxiety will be apparent through sweating, blushing, vomiting, or trembling (sometimes as a quavering voice) or that the ability to keep a train of thought or find words to express oneself will be lost. Situations in which social phobia is common include public speaking, acting in a theatrical performance, and playing a musical instrument. Other potential situations include eating with others, or using public bathrooms. A more generalized type of social phobia produces anxiety in a broad array of social situations.
Specific phobias:
Specific phobias are the most common anxiety disorders Specific phobias affect about 13% of women and 4% of men during any 12-mo period. Among the most frequent are fear of animals (zoophobia),
heights (acrophobia),
thunderstorms (astraphobia, brontophobia).
fear of snakes (ophidiophobia) in a city dweller, unless he is asked to hike in an area where snakes are found.
(claustrophobia), such as elevators, in a person who must work on an upper floor of a skyscraper.
Phobia of blood (hemophobia),
injections and pins (trypanophobia, belonephobia),
injury (traumatophobia)
People with a phobia of blood, needles, or injury, unlike those with other phobias or anxiety disorders, can actually faint because an excessive vasovagal reflex produces bradycardia and orthostatic hypotension.
Prognosis
If untreated, agoraphobia usually waxes and wanes in severity. Agoraphobia may disappear without formal treatment, possibly because some affected people conduct their own form of exposure therapy. But if agoraphobia interferes with functioning, treatment is needed. Social phobia is almost always chronic, and treatment is needed..
Treatment
exposure therapy
Cognitive-behavioral
benzodiazepine (eg, lorazepam0.5 to 1.0 mg)
β- blocker (propranolo10 to 40 mg /day)
SSRIs
Tricyclic antidepressants
Post traumatic stress disorder
Definition: Posttraumatic Stress Disorder is a condition characterized by intense fear, helplessness, or horror (or disorganized or agitated behavior in children) resulting from the exposure to extreme trauma. The characteristic symptoms include :
persistent re-experiencing of the traumatic event,
persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness,
and persistent symptoms of increased autonomic arousal
the full symptom picture must be present for more than 1 month,
and the disturbance must cause clinically significant distress
impairment in social, occupational, or other important areas of functioning.
Course: Posttraumatic Stress Disorder can occur at any age, including childhood. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before symptoms appear. Frequently, the person first has an Acute Stress Disorder in the immediate aftermath of the trauma. The duration of Posttraumatic Stress Disorder varies, with complete recovery occurring within 3 months in approximately half of the cases, with many others having persisting symptoms for longer than 12 months after the trauma. In some cases, the course is characterized by waxing and waning of symptoms. Symptom reactivation may occur in response to reminders of the original trauma, life stressors, or new traumatic events. The severity, duration, and proximity of an individual's exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme.
Treatment
Medications
Antidepressants can help symptoms of both depression and anxiety. They can also help improve sleep problems and improve concentration. SSri usually used as the first line drugs .Tricyclic antidepressants are the 2nd line.
Anti-anxiety medications also can improve feelings of anxiety and stress.
Psychotherapy
Cognitive behavioral therapy
Exposure therapy