Reviewed September 2024 Authors: Rodolfo Albuquerque and Maria José Pestana It is important to know their cause of so they can be properly treated with medical support. What are panic attacks? Panic attacks are periods of extreme anxiety, together with physical symptoms: Palpitations; Tachycardia (increased heart rate); Diaphoresis (excessive sweating); Dyspnea (difficulty in breathing); Feeling of chest tightness; Dizziness; Nausea. These symptoms are accompanied by altered states of consciousness: Derealisation; Depersonalisation; Fear of dying; Fear of losing control; Fear of no one being around to help; Fear of going mad. They all arise suddenly, usually reaching maximum intensity in 10 to 15 minutes. What causes panic attacks? Several theories and models have been used to try and explain their origin. It appears that there are changes in the multiple neurotransmitter systems of the central nervous system. There are also changes in the neuron networks between the amygdala, anterior cingulate cortex, frontal cortex and hypothalamus. Some experts think that it could involve a state of chronic hyperventilation together with hypersensitivity of the central receptors to carbon dioxide, as is the case with smokers. What are the signs of a panic attack? According to cognitive theory, there are certain body sensations (physiological symptoms) that can be involved in normal responses to anxiety (increased heart rate). These body sensations are interpreted catastrophically (the perception of palpitations as an indication of acute myocardial infarction). This leads to an increase in fear (an emotion that is present) and, consequently, to an increase in the intensity of symptoms. Various types of stimuli can trigger panic attacks: these can be external , for example a situation in which the individual has previously experienced an attack (e.g. in a lift or a shopping centre) or internal stimuli (thoughts, body sensations, images). Whenever these stimuli are perceived as a threat, fear rises and the response is a state of alert. This state of alert occurs in relation to physiological symptoms that, in another individual with normal and adaptive anxiety, would go unnoticed or be dismissed. How can panic attacks be dealt with? More than 80% of sufferers have a favourable prognosis with the combination of a psychopharmacological approach and cognitive-behavioural psychotherapy. Among the most commonly used psychopharmaceuticals are benzodiazepines (alprazolam, clonazepam) which are used only in the acute phase and for short periods. Some antidepressants may also be recommended (paroxetine, escitalopram) for maintenance of the condition. Cognitive-behavioural intervention can help to modify negative/catastrophic thinking with regard to body sensations. This is because the thinking process, in addition to being a trigger factor, will mean the symptoms go on for longer. The use of rational/logical thinking breaks the vicious circle. The main objective is to modify the catastrophic interpretation of physiological symptoms. Panic attacks and panic disorder If, more than a month after the panic attack, there is persistent concern about its consequences or the possibility of a new attack, or there are still signs of significant behavioural changes (agoraphobia), this probably indicates the existence of a panic disorder. It should be noted that the prevalence for suffering panic attacks at some point in life is 3.5%-6%, and 1.5%-5% for panic disorder. There is frequent comorbidity (the coexistence of a health problem with the patient’s primary diagnosis) with regard to mood disorders, in particular with major depressive disorder , in 50%-60% of patients who initially experienced a panic disorder. A diagnosis of panic disorder may also be made in the context of other general medical conditions (5% to 40% of patients with asthma, 15% to 20% of patients with migraine). Meet the psychiatry team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
