Panic disorder

Disease Description (Causes and Symptoms)

• Definition: An anxiety disorder in which unexpected panic attacks recur, and persistent anxiety about recurrence or behavioral changes (such as avoidance) occur even when no attack is present, interfering with daily functioning.
• Main causes and pathophysiology: Genetic predisposition, hypersensitivity of the brain’s anxiety (alarm) response, stress and early interpersonal experiences (especially during childhood), and cognitive factors (reinterpretive thinking) act together. Attacks occur when the sympathetic nervous system is unnecessarily activated even in situations without a threat.
• Representative symptoms: Four or more of the following occur acutely along with sudden intense anxiety or fear (symptoms usually peak within 10 minutes and generally disappear within 20–30 minutes; persistence for more than 1 hour is uncommon)
  • Palpitations·pounding heartbeat, chest pain, or chest tightness
  • Feeling unable to breathe·feeling of suffocation
  • Dizziness·lightheadedness·feeling as if about to faint
  • Trembling·chills or hot flashes
  • Nausea·abdominal discomfort
  • Abnormal sensations (tingling·numbness)
  • Derealization·depersonalization
  • Feeling that one may lose control or fear of dying
• Differential diagnoses: Coronary artery disease, arrhythmias (such as supraventricular tachycardia), hyperthyroidism, hypoglycemia, epilepsy, pheochromocytoma, etc.

Treatment Methods

• Medication treatment
  • First-line: Antidepressants (mainly the SSRI class: e.g.) — effects appear gradually and are advantageous for maintenance and relapse prevention. The recommended duration of maintenance treatment is at least 8–12 months after symptom improvement (may be extended at the physician’s discretion).
  • Alternative/adjunctive: SNRIs (e.g., venlafaxine), etc.
  • Short-term symptom relief: Benzodiazepines (e.g., alprazolam, clonazepam) — provide rapid anxiety relief, but should be used for a short period and according to a physician’s instructions because of the risk of dependence and tolerance.
  • Caution: Medication interactions and options differ during pregnancy and breastfeeding. Gradual tapering is recommended when discontinuing medication (withdrawal symptoms may occur, especially with abrupt SSRI discontinuation).
• Psychotherapy
  • Cognitive behavioral therapy (CBT): Includes correcting inaccurate cognitions about panic attacks, exposure (gradual exposure to panic-triggering signals in safe situations), and relaxation and breathing training. Group CBT may be useful.
  • In the early stages, combining it with medication can lead to faster effects and is beneficial for maintenance.
• Lifestyle management and adjunctive treatment
  • Regular sleep·exercise, and limiting caffeine·nicotine·excessive alcohol·stimulants such as amphetamines
  • Breathing·relaxation methods (abdominal breathing, muscle relaxation) training: Helpful in the early stages of an attack
  • Education: It is important to help patients understand that the symptoms can be explained biologically and may improve with treatment.
• Precautions (points to note during treatment)
  • Long-term benzodiazepine use carries a risk of dependence → Avoid long-term prescriptions
  • Take/discontinue antidepressants·antianxiety medications according to the physician’s instructions
  • Check for the possibility of dizziness·drowsiness affecting driving or operating machinery
  • If treatment is delayed, agoraphobia·depression and other conditions may develop as comorbidities, making treatment more difficult

Outpatient Visit Checklist (Including Example Questions)

• Items and documents to prepare
  • A list of all medications currently being taken (including prescription drugs·over-the-counter medications·herbal medicines), with the times and doses taken
  • Copies of previous medical certificates·test results (electrocardiogram, blood tests, thyroid tests, etc.), if available
  • The date and time·frequency·duration·triggering circumstances·symptoms of recent attacks (symptom diary)
  • Family history (psychiatric disorders·cardiovascular diseases·endocrine diseases, etc.)
  • History of allergies and previous medication adverse effects, and whether pregnancy is possible
• Examples of symptom records to organize in advance for the outpatient visit
  • "How many panic attacks have you had in the past month?" (date, circumstances)
  • "Which physical symptoms start first during an attack?"
  • "Did you change your behavior after the attack (avoiding things, visiting a hospital, etc.)?"

Examples of General Questions to Ask the Doctor

• "What are the expected side effects of this medication? How should I respond if they occur?"
• "When do the effects usually begin after starting treatment, and how long will I need to take the medication?"
• "Should I combine medication with other treatments (such as cognitive behavioral therapy)?"
• "Could this affect driving or my work duties?"
• "What treatment options are available during pregnancy·breastfeeding?"

Examples of Disease-Specific Questions

• "Could you explain in detail non-medication coping methods I can use immediately when an attack occurs (such as breathing·relaxation methods)?"
• "Is there a risk of developing dependence even when using benzodiazepine-class medication only for a short period? What is the safest way to reduce it?"

(If necessary, consult a psychiatrist to establish an examination·treatment plan suited to your individual circumstances.)