Panic Disorder

Abstract

There may be a precipitating cause of panic-such as being in a confining space (as in claustrophobia) or in public places (as in agoraphobia)-but in many cases, the occurrence of panic attacks is unexpected. Recurring attacks over a period of months or, in many cases, years, form the basis for the diagnosis of a panic disorder. This is a distressing and often very restricting condition, and it can lead to social avoidance behavior. Heart rate and blood pressure increase during a panic attack, primarily because of sympathetic nervous system (SNS) activation and adrenal medullary secretion of epinephrine (EPI). Affected individuals often fear that they have a heart disease because of the nature of their symptoms. Understanding autonomic nervous system (ANS) responses during a panic attack has been seen as relevant clinically because this might provide a rational basis for understanding the symptoms, and through this, for facilitating the treatment that can be based in part on patient self-knowledge as with cognitive behavior therapy. Clinical experience with the cardiologic management of patients with panic disorder has provided case material encompassing the range of cardiac complications that occur. A better understanding of the mechanism of coronary artery spasm in a panic disorder would facilitate therapeutic intervention.