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DescriptionMost sufferers of panic attacks report a fear of dying, "going crazy", having a heart attack, fainting, vomiting or losing control of emotions or behavior. These feelings generally provoke a strong urge to escape or flee the place where the attack began ("fight or flight" reaction) and, when associated with chest pain or shortness of breath frequently result in the sufferer seeking medical attention, often in an emergency room. Panic attacks have been linked to high quantities of acetylcholinesterase in the blood.[citation needed] Also the release of adreno-cortisols aid in catalyzing the panic attacks.[citation needed]
When the sufferer experiences more than four bodily symptoms at once it is said that they have had a full-blown panic attack, while experiencing four or fewer symptoms constitutes a limited symptom attack. DurationA panic attack typically lasts ten minutes according to the American Psychological Association. More severe panic attacks may form a series of episodes waxing and waning every few minutes, lasting for a period of up to two hours, only to be ended by physical exhaustion and sleep.[citation needed] In conditions of chronic anxiety, one panic attack can roll into another, leading to nervous exhaustion over a period of hours or even days. Trigger
Hyperventilation alone can bring about some of the symptoms of a panic attack. However, the person experiencing the panic attack often does not realize this and sees these symptoms as further evidence of how serious their condition is. An ensuing positive feedback loop of adrenaline release fuels worsening physical symptoms and psychological distress. Panic disorder has been found to run in families, and this may mean that inheritance genes plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. Often the first attacks are triggered by physical illnesses, a major life stress, or certain medications. <http://healthlink.mcw.edu/article/930977314.html/> Sometimes panic attacks may be a listed side effect of medications such as Ritalin (methylphenidate). It may be a temporary side effect only occurring when a patient first starts a medication, or could continue occurring even after the patient is accustomed to the drug, which likely would warrant a medication change in either dosage, or type of drug. Physiological explanationThe various symptoms of a panic attack can be understood as follows. First, there is the sudden onset of fear with little provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response wherein the person's body prepares for strenuous physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, burning and lightheadedness. It is also possible for the person experiencing such an attack to feel as though they are unable to catch their breath, and they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the blood. SymptomsPhysical
Mental
Emotional
Perceptual
MnemonicThe symptoms of a panic attack can be remembered with the mnemonic: STUDENTS FEAR the 3 Cs: Sweating, Trembling, Unsteadiness/dizziness, Derealization/depersonalization, Elevated heart rate (tachycardia), Nausea, Tingling, Shortness of breath,FEAR of dying, FEAR of losing control, FEAR of going crazy, 3 Cs - Choking, Chest pain, Chills. AgoraphobiaPeople who have had a panic attack in certain situations — for example, while driving, shopping in a crowded store, or riding in an elevator — may develop irrational fears, called phobias, of these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where individuals with panic disorder are unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. This can be one of the most harmful side-effects of panic disorder as it can prevent sufferers from seeking treatment in the first place. Agoraphobia of this degree is extremely rare. It should be noted that upwards of 90% of agoraphobics achieve a full recovery. Agoraphobia is actually not a fear of certain places but a fear of having panic attacks in certain places, where escape would be difficult and/or embarrassing. Panic disorderPeople who have repeated attacks or feel severe anxiety about having another attack are said to have panic disorder. Panic disorder is strikingly different from other types of anxiety disorders in that panic attacks are often sudden and unprovoked.[1] An episode is often categorized as a positive feedback loop where the mental symptoms increase the physical symptoms, which increase the mental symptoms, and so on. TreatmentBenzodiazepines like diazepam, lorazepam, alprazolam or clonazepam can be prescribed to be taken at the onset of the panic attack. Sometimes, the psychological knowledge of knowing that such medication is close at hand may be enough to prevent the panic attack. However, this form of treatment may be considered unfavorable by some doctors, because of the potential for abuse. Additionally, benzodiazepines will not treat the cause of the panic attacks. As such, some doctors may prefer to prescribe an antidepressant, particularly an SSRI (such as paroxetine or sertraline), which after an initial titration period may be effective at reducing anxiety. NaSSAs such as mirtazapine have also been found effective, particularly with individuals whose anxiety and panic causes insomnia. Individuals can also treat themselves during panic attacks by breathing into a paper bag (to decrease effects of hyperventilation), doing diaphragmatic breathing applying ice to the face or massaging the body to help stop the physiological reactions. Panic attacks are completely treatable and can be overcome with the correct combination of medication and therapy.One particularly helpful form of therapy is Cognitive Behavioral Therapy (CBT). Techniques used may include those based upon the concept that intentional exposure to the symptoms will help decrease the sufferer's fear of panic attacks (Symptom Induction). The therapist and patient discuss the nature of their attacks, and the symptoms which they fear most. The CBT typically consists of several sessions in which these symptoms are intentionnally induced until the patient is less fearful. Inductions generally occur for one minute and may include: intentional hyperventilation, spinning in a chair, straw breathing, breath holding etc. The key to the induction is that the exercises should mimic the most frightening symptoms of a panic attack. Prior to inducing symptoms (hyperventilation, for example), the therapist asks the patient to rate their level of anxiety. Following the exercise, they rate their resulting level of anxiety. This is repeated at least five times until the anxiety rating is low. The patient's worst symptoms are focused on in this fashion, and the symptom induction cycle is repeated for each symptom. Many people overcome panic disorders and sudden panic attacks on their own. It takes time, but in a sense, they ride out the panic attacks and eventually learn that nothing is going to happen during one. Often, they 'taper off' until they are not noticeable any longer. It is for this reason that some psychologists helping people with panic disorders induce them into an attack, so they can see for themselves that indeed, nothing will happen. Notes
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