Panic disorder

Panic disorder

DSM-5

1. Recurrent & unexpected panic attacks with ≥4 of the following:
   • Palpitations
   • Sweating
   • Trembling or shaking
   • Shortness of breath or smothering sensation
   • Choking sensations
   • Chest pain or discomfort
   • Nausea or abdominal distress
   • Dizziness or light-headedness
   • Chills or heat sensations
   • Paresthesias
   • Derealization or depersonalization
   • Fear of losing control or “going crazy”
   • Fear of dying
2. At least 1 attack followed by 1 or both of the following for >1 month:
   • Worry about additional panic attacks or consequences
   • Changes in behavior related to attacks (ie, avoidance)
3. Panic attacks not attributable to another mental illness or substance abuse

Treatment of panic disorder

• Immediate: Benzodiazepines
• Long-term: Selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor &/or cognitive behavioral therapy

Comorbidities commonly associated with panic disorder include:

• major depression
• bipolar disorder
• agoraphobia
• substance abuse

Patients are also at a higher risk of suicide attempts and suicidal ideations.

Panic Attacks and Hysteria

Panic attacks -> hyperventilation -> decreased pCO2 (hypocapnia) -> decreased cerebral perfusion

CO2 is a potent cerebral vasodilator.

An increase in the pCO2 from 25 to 100 mmHg causes a linear decrease in cerebral blood flow and a decrease in the pCO2 causes a linear decrease in cerebral perfusion.