Panic Attack

Basics

Description

An abrupt surge of intense fear or discomfort, peaking within minutes, with physical or cognitive symptoms

  • Some patients experience panic attacks with physical symptoms only
  • Can be expected (triggered by specific fear), or unexpected (no apparent cause)

Panic Disorder

  • Recurrent unexpected attacks:
    • 1 mo (or more) of 1 or both:
      • Persistent worry or “fear of the fear” of additional attacks
      • Significant behavioral changes, like avoiding exercise or new situations
  • Agoraphobia may co-occur:
    • Intense fear of places where escape is difficult (crowds, public transportation)
  • Linked with higher rates:
    • Depression
    • Substance use
    • Suicidality

Genetics

  • Heritability: 1st-degree relatives of individuals with panic disorder are at higher risk of developing condition
  • Associated gene variants: COMT: Alters dopamine/norepinephrine breakdown; SLC6A4: Changes serotonin uptake

Etiology

Mechanism

  • Dysregulated brain circuits:
    • Involves amygdala, hypothalamus, brainstem
    • Neurotransmitters: Norepinephrine, serotonin, dopamine, GABA
    • Activates “fight-or-flight” response

Risk Factors

  • Major life events within a year before onset: Death of loved one, job loss, financial strain, new baby
  • Traumatic experiences: Accidents, assault, witnessing violence, surviving disasters
  • Often follows physical illness or substance use (may persist postrecovery)
  • Family history of panic/anxiety
  • Twice as common in women

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