Panic disorder is a type of anxiety disorder, where the patient experiences episodic periods of intense fear and anxiety, combined with physical changes of fear. The onset is sudden and not related to a specific situation, and there is no ‘true’ physical disorder. People with panic attacks experience sensation of ‘going to die’ or ‘going mad’ during the episode.
Some people may experience recurrent episodes of panic attacks, and then it is called panic disorder. Around 20% of the population experience at least one attack during their life time. An isolated panic attack is not defined as a mental disorder, but panic disorder is a type of mental disorders.
Diagnosis of panic attack/disorder is made based on ICD-10 diagnostic guidelines.
(a) In circumstances where there is no objective danger.
(b) Without being confined to known or predictable circumstances.
(c) With comparative freedom of anxiety symptoms between attacks.
• Discrete episode of intense fear or discomfort
• Starts abruptly
• Reach the crescendo within few minutes and lasts at least few minutes
• At least four symptoms must be present from list below
• Autonomic arousal symptoms-
(a) Palpitation/ pounding heart/ accelerated heart rate
(c) Trembling/ shaking
(d) Dry mouth
• Symptoms related to chest and abdomen
(a) Difficulty in breathing
(b) Feeling choking
(c) Chest pain or chest discomfort
(d) Nausea or abdominal distress
• Symptoms related to brain and mind
(a) Feeling dizzy, unsteady, faint or light headed
(b) Feeling that objects are unreal, feeling not really here
(c) Fear of losing control, going crazy, or passing out
(d) Fear of dying
• General symptoms
(a) Hot flushes or cold chills
(b) Numbness or tingling sensation
Although it doesn’t seem so, panic attacks can be quite common in day to day life and leads to a large number of unnecessary emergency admissions. Intense fear and combined autonomic symptoms may really frighten the victim as well as bystanders of a very serious medical condition (e.g. heart attack). Recognition of such an event from a true medical condition requires proper first aid training, and isolated panic attacks can be easily managed at first aid care level without hospitalization. This is specially helpful with a person who is prone to develop such attacks. However, one must be quite sure of absence of a ‘real’ emergency to manage these patients at community setting.
First aid Management-
1. First talk to the patient after introducing yourself and confirm that you are going to help but not to do harm.
2. If the patient had experienced panic attacks previously or known patient with panic disorder, it is more likely to have a panic attack this time as well.
3. But if the patient having above symptoms for the first time do not suspect a panic attack because those can be symptoms of a serious and life threatening event like a heart attack. Therefore call for emergency medical services.
4. Check whether the patient is having/ wearing medical alert card, bracelet or a necklace, if so act accordingly.
5. If you are sure this is a panic attack (in patient with previous episodes) reassure the patient and keep him/ her in a comfortable place and in a comfortable position.
6. Reassure the patient that he/ she is experiencing a panic attack this time also. And it will pass out within few minutes.
7. Keep others calm and quiet and calm down yourself as well.
8. Loosen the patients’ clothing and encourage breathing in and out slowly and deeply.
9. If unable to calm down the patient call for emergency services.
10. Explain that the symptoms arise purely due to anxiety and the condition is not life threatening.
11. Encourage the patient to proceed with relaxation therapy; psychological team would have taught these techniques to patients with panic attacks/disorder on previous encounters. Whenever a patient feels anxiety symptoms, relaxation therapy will slow the heart rate, reduce the blood pressure, slow the respiratory rate, increase the blood supply to major muscle groups and improve concentration.
12. Methods of relaxation therapy-
A. Deep breathing exercises;
o Sit comfortably in a chair and keep the back straight.
o Keep one hand on the abdomen and the other on chest.
o Take a deep breath noticing the hands on the abdomen and chest rise.
o Exhale through your mouth and pushing out as much as air while contracting your abdomen.
o Continue to breathe through your nose and exhale through your mouth.
B. Progressive muscle relaxation;
o Start from feet and progress up to face gradually.
o Lie on a bed without a pillow or on floor and loosen tight cloths and other wear.
o Take deep breaths in and out to relax the mind and the body.
o When relaxed, concentrate attention to the right foot and contract foot muscles for few seconds to see how it’s felt.
o Then shift the attention to other leg and follow the same step.
o Slowly move up the body, contracting and relaxing muscle groups one at a time.
o Sequence of muscle groups- right foot, left foot, right calf, left calf, right thigh, left thigh, hips and buttock, stomach, chest, back, right arm and hand, left arm and hand, neck and shoulders, face.
ICD-10 diagnostic guidelines
Oxford text book of Psychiatry