CLINICAL FEATURES - Panic disorder
The first panic attack is often quite spontaneous, but occasionally may be the result of excitement, exercise, sexual activity or emotional trauma mo awake.
The DSM-IV stresses that, to meet the diagnostic criteria for panic disorder, at least the first attacks of Vono be unexpected (no trigger).
The physician should try to establish any habit or situation that it typically precedes the panic attack in a given patient. These activities may include the use of caf fein, alcohol, nicotine or other drugs, atypical patterns of are no specific environmental or food and situations, like a bright light in the workplace.
Panic attacks often begin with a 10-minute period of rapid increase in the severity of symptoms.
The main mental symptoms are extreme fear and a sense of impending death or doom. Patients usually are unable to report the source of their fear, they feel confused and have difficulty concentrating. Physical signs often include tachycardia, palpitations, shortness of breath and sweating.
Patients often try to leave any situation in which they are to seek help. The attack usually lasts from 20 to 30 minutes and rarely more than an hour. A formal examination of mental condition during a panic attack may reveal rumination, difficulty speaking, such as stuttering, and alteration of memory.
Those affected may experience depression or depersonalization during an attack.
Symptoms may gradually withdraw or rapid heating. Among
an attack and another patient may have anticipatory anxiety concerning the possibility of having another attack.
The differentiation between anticipatory anxiety and generalized anxiety disorder can be difficult, even if the subjects with panic disorder with anxious anticipation, are able to show stimulation of their anxiety.
fears of physical death due to cardiac or respiratory problems may be the main object of the patient during panic attacks. Subjects may believe that palpitations and chest pain indicating the imminence of death. Up to 20% of them did indeed syncopal episodes during a panic attack.
Typically, patients presenting to the emergency room are young (early twenties), in good physical health and yet claim to be persistently on the verge of dying from a heart attack. Instead of immediately diagnose
un'ipocondria, the emergency doctor vrebbe do consider the diagnosis of panic attack.
The hyper ventilation causes respiratory alkalosis and other symptoms. Sometimes it may be helpful to the old practice of breathing the rare patient in a bag.
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