PANIC DISORDER Patient experiences recurrent panic attacks and are

worried about having more attacks. Accompanied by intense fear and discomfort and lasts from

minutes to approx. an hour Panic attacks- severe, frightening, incapacitating Symptoms of anxiety may last for hours Usually develops suddenly, often with no obvious

precipitating factor, and reaches a peak in approximately 10 minutes

Panic attacks may vary in intensity and occurrence: ranging from experiencing multiple episodes for several months at a time to daily attacks for a brief period, with months separating the next episode

Patient may fear they are losing control over themselves, “going crazy,” having a heart attack or dying

Can occur in sleep (resulting to exhaustion) Panic attacks may be:

Unexpected, “out of the blue”, or occur spontaneously Sudden onset of unanticipated intense anxiety generated

arousal of the SNS such as tachycardia, diaphoresis, parestehesias, and a sense of “doom”

Are situationally bound Patient may become preoccupied with their health

because of the physical symptoms they experience

Can result in agoraphobia May fear having a panic attack in place where

embarrassment could occur, where help might not be available, or where escape is impossible

Patient restricts activity outside home or require another person to be with them when outside home

Affects 1/3 of people with panic disorders, twice as often in females than in males

Feelings of depression can occur Rarely in peripubertal period; probably

begins by adolescence or young adulthood; women are two to three times more likely to suffer as compared to males

DSM- IV CRITERIA FOR PANIC DISORDER

Recurrent, unexpected panic attacks Panic attacks are followed by a month

or more of worry about having additional attacks, worry about the result of attacks, and behavioral changes related to attacks

Panic disorder can be accompanied by agoraphobia

DSM- IV CRITERIA FOR PANIC ATTACK

Increased heart rate, palpitations or chest pain Chills or hut flushes, sweating, trembling, dizziness

or light- headedness Feeling of choking, smothering or shortness of

breath Nausea or abdominal distress Numbness or tingling Fear of dying, “going crazy”, or losing control Derealization or depersonalization

ETIOLOGY May be genetically transmitted Genetic factors + environmental factors may be associated

with vulnerability Brain and chemical factors may count for its development

Bursts of activity in raphe nuclei (serotonin) and the locus ceruleus

--> anxiety formation Abnormalities in the brain’s benzodiazepine receptors

May be induced by caffeine, carbon dioxide or sodium lactate

Pt. are less likely to panic when informed about the symptoms they will experience

PSYCHOTHERAPEUTIC MANAGEMENT

Nurse- patient relationship Centered on the same issues and

interventions discussed for patients with GAD

Help patient get through the panic attack safely with as little discomfort as possible.

Reduce anxiety to a more manageable level. Educate about panic disorder to reassure

that they are not losing their minds or dying during an attack.

Cognitive restructuring.

Psychopharmacology Selective Serotonin Reuptake Inhibitors (SSRIs)- drug

of choice Antidepressant

Imipramine (Tofranil) May be used to block symptoms or to reduce panic

attacks Benzodiazepine

Alprazolam (Xanax) Clonazepam (Klonopin)

Monoamine oxidase inhibitor (MaOI) Phenelzine (nardil)

Pt. may resist drug therapy because it may mean a loss of control at a time when they are struggling to maintain control over themselves and their symptoms

Milieu management When panic anxiety decreases from the

panic level to other levels, gross activities are helpful to decrease tension and anxiety

Walking Jogging Basketball Volleyball Stationary bicycle

KEY NURSING INTERVENTIONS FOR PANIC

ATTACK

Stay with the patient who is having a panic attack and acknowledge the patient’s discomfort.

Maintain a calm style and demeanor. Speak in short, simple sentences, and give one

direction at a time in a calm tone of voice. If the patient is hyperventilating, provide a brown

paper bag and focus on breathing with the patient. Allow patients to pace or cry; this enables the

release of tension and energy. Communicate to patients that you are in control

and will not let anything happen to them. Move or direct patients to a quieter, less

stimulating environment. DO NOT TOUCH THESE PATIENTS. Touching may increase feelings of panic.

Ask patients to express their perceptions of fears about what is happening to them.