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Panic Attacks and Panic Disorder

A panic attack, as defined by the DSM-IV, is "a discrete period of intense fear or discomfort that is accompanied by at least 4 of 13 somatic or cognitive symptoms. The attack has a sudden onset and builds to a peak rapidly (usually in 10 minutes or less) and is often accompanied by a sense of imminent danger or impending doom and an urge to escape." Ten of the 13 symptoms are primarily somatic: palpitations, chest pain, shortness of breath or smothering, feeling of choking, sweating, shaking or trembling, nausea or abdominal distress, dizziness or lightheadedness, paresthesias, and chills or hot flashes. The three cognitive symptoms are derealization or depersonalization, fear of losing control or going crazy, and fear of dying agoraphobia, panic attacks, panic disorder, agraphobia

Isolated panic attacks may occur as a complication of another anxiety disorder, including specific phobia, social phobia, and post-traumatic stress syndrome. Panic disorder is characterized by the


The full understanding of the cause of panic attack and panic disorder is still unknown, although there is evidence of a familial or genetic pattern. It has been suggested that there may be a


Important advances were reported in the pharmacotherapy and psychotherapy of panic disorder at the 8th Annual Psychiatric Congress. These advances were published in the


Three groups of drugs have proven effective in controlling panic disorder: benzodiazepines (BZDs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Many of these same drugs have been found useful in treating other forms of anxiety disease. Among the BZDs, the higher

Clonazepam has a somewhat longer half life (it can be given twice a day instead of four times a day). The withdrawal for clonazepam is

For many years, the tricyclic antidepressants have also been known to be effective agents in the control of panic disorder. The most frequently reported tricyclic antidepressant is imipramine, but

The third, and newest, group of drugs useful in panic disorder therapy is the selective serotonin uptake inhibitors. These drugs are used widely in the treatment of panic disease, although there is a scarcity of


Psychotherapy may offer preferable alternatives for some patients, or may be used as complementary therapy to

Controlled clinical trials evaluating cognitive behavior approaches to the treatment of panic disorder have demonstrated substantial efficacy for this technique, both in short- and in long-term therapy. As