Panic Attack
Artist/ Title/ Date
Gustave Courbet. The Desperate Man (Self-Portrait). 1843–1845. Oil on canvas. Private collection.
Description of Disease & Etiology
The etiology of panic attacks involves a complex interplay of genetic and developmental factors.1 Panic Disorder shows high heritability, with increased risk among first-degree relatives and monozygotic twins.1 Genetic predispositions are likely polygenic and may interact with hormonal changes during adolescence to increase vulnerability.1 Developmentally altered connectivity between the prefrontal cortex and subcortical regions such as the amygdala and brain stem centers may impair fear regulation and contribute to panic susceptibility in individuals.1
Signs/Signifiers of Illness
Panic attacks are characterized by sudden episodes of intense fear or discomfort accompanied by a range of cognitive and physical symptoms. Cardiorespiratory responses, such as hyperventilation and tachycardia, are exhibited in patients experiencing an attack.1 Common cognitive features include fears of dying, losing control, or going crazy.1 Panic attacks may be either unexpected (without clear triggers) or expected (linked to specific cues or situations) and they typically peak within 10 minutes.2 The presentation of symptoms is highly variable between individuals and across episodes.
Pathology
Treatment
A variety of cognitive behavioral therapies are considered standard treatments for anxiety disorders. However, the efficacy of individual treatments varies based on the type of anxiety disorder and type of therapy.1 Combinations of exposure therapy and relaxation breathing therapies can be used in combination with pharmacotherapy.1 Benzodiazepine sedatives, such as alprazolam (Xanax) and clonazepam (Klonopin), enhance GABA activity and can provide rapid symptom relief but carry risks of dependence, tolerance, and withdrawal and so are not recommended for long-term use.1 Therefore, selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (NRIs) represent the first-line treatment of panic attacks.1 FDA approved SSRIs include fluoxetine, paroxetine, and sertraline, while venlaflaxine is an approved NRI.1 These medications are recommended for use due to their efficacy in reducing attack frequency and more favorable safety profile for long-term use.1
Social Determinants of Illness
Age (20-54 years at onset), female gender, and lower socioeconomic status have all been implicated as risk factors in the development of panic attacks and panic disorders.3 Additionally, psychosocial factors such as smoking and alcohol addiction, as well as stressful life events in childhood and adulthood, indicate increased risk of developing this condition.3
Author(s): Victoria Rhodes
Citations:
1. Johnson, P. L., Federici, L. M. & Shekhar, A. Etiology, triggers and neurochemical circuits associated with unexpected, expected, and laboratory-induced panic attacks. ''Neurosci. Biobehav. Rev.'' 46, 429–454 (2014).
2. Meuret, A. et al. Do Unexpected Panic Attacks Occur Spontaneously? ''Biol. Psychiatry'' 70, 985–991 (2011).
3. Moreno-Peral, P. et al. Risk factors for the onset of panic and generalised anxiety disorders in the general adult population: A systematic review of cohort studies. ''J. Affect. Disord.'' 168, 337–348 (2014).