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Facts - Panic attacks

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Abstract

 

VOL: 99, ISSUE: 16, PAGE NO: 28

DEFINITIONS -

- A panic attack is an episode of acute anxiety that occurs unpredictably with feelings of intense apprehension and impending doom. Attacks may last from several minutes to an hour and may be stimulated by certain situations.

- Panic disorder is an anxiety disorder in which the person experiences recurrent panic attacks. Physical symptoms of severe anxiety such as tachycardia and hypertension are also present.

AETIOLOGY AND RISK FACTORS -

-It is thought that one in three people can expect to have a panic attack at some stage.

- The exact cause is not known: attacks occur when adrenaline is released to prepare the body for a ‘fight or flight’ situation (see diagram) - even when there are no obvious dangers present. The sympathetic branch of the autonomic nervous system is stimulated, preparing the body for a ‘dangerous’ situation.

- The stressor precipitating the attack may only be identified later upon introspection or therapy - or not at all.

- People with depression, or who have anxiety disorders, asthma or diabetes may be more susceptible to panic attacks.

- Sometimes onset can coincide with a significant life event such as bereavement, unemployment or a medical condition.

- Patients’ fear of encountering the fear can often intensify symptoms.

- Panic disorder can have a familial link.

SIGNS AND SYMPTOMS

- Dyspnoea;

- Sweating;

- Trembling;

- Dizziness;

- Chest pain or palpitations;

- Hot flushes.

- The duration of the symptoms can range from a few seconds to an hour.

- Affected people often live in fear of another attack and may be reluctant to be alone or far from medical assistance.

INVESTIGATIONS

- Routine medical assessment.

- Patients can present in the belief that they are having a heart attack.

TREATMENT -

Benzodiazepine prescription has declined due to research evidence showing habituation and dependency.

- Other treatments have been demonstrated to be effective for the long-term reduction of symptoms, for example cognitive behavioural therapy (see British Association for Behavioural and Cognitive Psychotherapies website).

NURSING IMPLICATIONS

- Health education: support group/counselling information; advice on the importance of regular meal times and avoidance of stimulants; relaxation and stress reduction; breathing techniques.

- A simple explanation of the nature of panic attacks can also help to alleviate patients’ concerns and offer a degree of relief.

- During the panic attack, the patient will require reassurance and advice to control their breathing and avoid hyperventilation.

- Should hyperventilation occur, the patient can address this by breathing into cupped hands or a paper bag.

WEBSITES

MIND, the mental health charity

British Association for Behavioural and Cognitive Psychotherapies

Royal College of Psychiatrists

OMNI (internet resource in health and medicine)

No Panic

No Panic helpline: 0808 808 0545

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