Panic disorder is characterized by recurrent unexpected panic attacks accompanied by intense fear and physical symptoms. During panic attacks, which can last from minutes to an hour, individuals may experience symptoms like a racing heart, difficulty breathing, dizziness and fear of dying. Between attacks, they often worry about when the next attack will occur. Panic disorder can develop suddenly and may be associated with agoraphobia, depression and changes in behavior to avoid triggers of panic attacks. Treatment involves medication, psychotherapy and lifestyle changes.

2. PANIC DISORDER
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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

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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:
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Unexpected, “out of the blue”, or occur spontaneously
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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

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Can result in agoraphobia
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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

5. 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
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6. DSM- IV CRITERIA FOR PANIC
ATTACK
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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

7. ETIOLOGY
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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

8. PSYCHOTHERAPEUTIC
MANAGEMENT

9. 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.
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10. Psychopharmacology
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Selective Serotonin Reuptake Inhibitors (SSRIs)- drug
of choice
Antidepressant
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May be used to block symptoms or to reduce panic
attacks
Benzodiazepine
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Alprazolam (Xanax)
Clonazepam (Klonopin)
Monoamine oxidase inhibitor (MaOI)
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Imipramine (Tofranil)
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

11. Milieu management
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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
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12. KEY NURSING
INTERVENTIONS FOR PANIC
ATTACK

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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.