Mental Health: Panic Syndrome: Psychiatrist explains how crises and treatment are

Tachycardia, feeling short of breath and fear of losing control are some of the symptoms of panic disorder, popularly known as panic syndrome.

Crises usually appear in late adolescence or early adulthood and are more frequent in women than in men, explains Álvaro Cabral Araújo, a psychiatrist and researcher at the Anxiety Outpatient Clinic (AMBAN) of the Psychiatry Institute of the Hospital das Clínicas, Faculty of Medicine. Medicine at the University of São Paulo (IPq/HC-FMUSP).

Often, without knowing they are experiencing a panic attack, patients go to the emergency room thinking they are having a heart attack.

The diagnosis of panic is made by a mental health professional—psychiatrist or psychologist—after ruling out other medical conditions, such as hyperthyroidism and cardiopulmonary disease.

“It should be noted that panic attacks, in isolation, do not characterize a panic disorder and can occur in other anxiety disorders, in addition to other mental disorders such as, for example, depressive disorders, post-traumatic stress disorder and disorders caused by drug use. chemical substances”, emphasizes Araújo.

Panic disorder is defined when, after a crisis, the person starts to feel constant fear of having a new attack and changes their routine, failing to leave the house alone or avoiding situations that were previously common, such as driving, using public transport, going to school or work, for example.

Treatment is with psychotherapy and may involve the use of medications such as antidepressants and anxiolytics.

“The treatment helps to control panic attacks and other symptoms, allowing the individual to return to their functionality. Panic disorder can have a chronic course, requiring long-term treatment. Even so, it is possible to live with the disorder with rare crises, preserving the quality of life”, says Araújo.

Read the interview with the psychiatrist below.

What is panic syndrome?

Panic syndrome or panic disorder, nomenclature used by diagnostic manuals, is a mental disorder characterized by recurrent and unexpected panic attacks that end up resulting in persistent concerns about the occurrence and consequences of new attacks or maladaptive changes in behavior, aimed at prevent further attacks.

It should be noted that panic attacks, in isolation, do not characterize a panic disorder and can occur in other anxiety disorders, in addition to other mental disorders, such as depressive disorders, post-traumatic stress disorder and disorders caused by substance use. chemicals.

What characterizes a panic attack? How long does a seizure usually last and what happens in a person’s brain while they are having a seizure?

Panic attack is characterized by an abrupt surge of fear or intense discomfort defined by physical symptoms such as palpitations, racing heart, sweating, tremors, feeling short of breath, chest pain, nausea, dizziness, chills and tingling.

Symptoms are often accompanied by a fear of losing control, going crazy, or dying. In some cases, the individual may experience a sense of unreality, as if disconnected from their own body or the environment that surrounds them.

The attacks reach a peak within a few minutes and are of limited duration, usually less than 20 minutes. Although the symptoms are extremely uncomfortable, they are not life-threatening.

From a neurobiological point of view, panic attacks involve the activation of brain structures involved in defense reactions and threat detection, such as the brain amygdala. Dysfunction of fear circuits can trigger physical reactions that prepare us to face danger, such as a fight-or-flight response.

What is the difference between panic disorder and generalized anxiety disorder (GAD)?

Panic disorder is characterized by sudden manifestations of anxiety, while generalized anxiety disorder (GAD) has more chronic features.

Individuals with GAD experience excessive, persistent and difficult-to-control anxiety and worry in many areas of life. Anxiety is often accompanied by symptoms such as restlessness, fatigue, difficulty concentrating, muscle tension, and insomnia.

Is it common for a young person, who has never had a diagnosis of GAD, depression or other psychological disorder, to experience a panic attack without even knowing what it is all about?

Yes. Panic disorder usually starts between late adolescence and early adulthood. Panic attacks often come on unexpectedly, without the need for a specific trigger or stressful event.

What are the symptoms of GAD that make it different from panic?

In GAD, excessive anxiety and worry usually occur on most days for at least six months.

The individual with GAD finds it difficult to control anxiety and worry, which are associated with three or more of the following six symptoms, at least some of which have been present on most days in the last six months: restlessness or feeling on edge skin rash, fatigability, difficulty concentrating or “white” sensations in the mind, irritability, muscle tension and sleep disturbance.

Is agoraphobia one of the typical symptoms in panic?

Agoraphobia is a mental disorder characterized by marked fear or anxiety about situations from which it may be difficult to escape or get help if you experience panic-like symptoms or other disabling or embarrassing symptoms.

The most feared situations usually include using public transport, staying in open or closed spaces, standing in lines and leaving home unaccompanied. Individuals tend to avoid these situations or face them with great suffering.

It is very common for individuals with panic disorder to also have agoraphobia, but these conditions can be diagnosed differently, with cases of agoraphobia without panic disorder.

With the social isolation caused by the Covid-19 pandemic, have you noticed in the IPq or in clinical care an increase in cases of agoraphobia and panic attacks, especially when people start to leave the house and return to their normal routines?

Ongoing epidemiological studies seek to identify whether there has been a real increase in cases of mental disorders with the Covid-19 pandemic.

The impression I share with some experts is that the demand for care for anxious and depressive symptoms has increased.

At the moment when the person is experiencing a panic attack, what can he do to be more confident to face the crisis?

Some relaxation exercises, such as diaphragmatic breathing, can be used during the crisis. It is important for the individual to avoid hyperventilation [respiração acelerada]as it can aggravate some physical symptoms such as feeling faint and tingling in the body.

It is always good to remember that the panic attack will pass after a few minutes and that it will not have more serious consequences — the individual will not die, lose control or go crazy, which are often the frequent fears during a crisis.

The use of anxiolytics, always under medical prescription, can be a useful resource in the control of crises.

How is panic disorder treated?

The treatment of panic includes psychoeducation about the disorder, medications, psychotherapy and aerobic physical activities.

The most used drugs are antidepressants which, despite their name, are often used in the treatment of anxiety disorders and do not promote dependence.

Anxiolytics can be used in the acute phase of treatment or as emergency medication, but the continued use of this class of medication is avoided due to the risk of abuse and dependence.

Among the various approaches to psychotherapy, cognitive-behavioral therapies stand out for producing the largest number of scientific studies that demonstrate their effectiveness.

Is it possible to completely cure panic or is it something that the person learns to manage and deal with throughout life?

The treatment helps to control panic attacks and other symptoms, allowing the individual to return to their functionality. Panic disorder can have a chronic course, requiring long-term treatment. Even so, it is possible to live with the disorder with very rare crises, preserving the quality of life.

Are there foods or habits, such as smoking and not getting enough sleep, that make panic worse?

Sedentary lifestyle, insufficient sleep, use of stimulant substances such as caffeine, nicotine and some drugs of abuse can cause increased anxiety and trigger the disorder in patients who are predisposed to the condition.

On the other hand, is there any kind of diet and habits that can improve the disorder?

Healthy lifestyle habits, care with sleep and food, in addition to the practice of aerobic physical activities are strong allies in coping with most illnesses, including panic disorder.

Meditation and relaxation practices have also been used with good results in the treatment of anxious conditions.

Is it true that panic is more common in women than men? Why?

Yes, women are affected more often than men, at a ratio of around 2:1. The reasons for this marked difference in prevalence are not clear, and may include biological and sociocultural factors.

Does panic occur due to a genetic factor or is it more related to the environment in which the person lives? For example, a teenager who faces a lot of family demands or who lives in a family where there are a lot of fights at home?

The cause of mental disorders is usually multifactorial, involving a genetic predisposition and triggering environmental factors.

Panic follows the same rule, is more prevalent in individuals who have first-degree relatives with the disorder, and can be triggered by periods of increased exposure to stress.

Follow the Mental Health blog on twitteron Instagram and Facebook. ​