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Panic Disorder
DefinitionPanic disorder is an anxiety disorder characterized by recurrent and unpredictable bursts of terror known as panic attacks. A panic attack is accompanied by physical symptoms that may feel similar to a heart attack or other life-threatening condition. Intense anxiety often develops between episodes of panic. As panic attacks become more frequent, people begin avoiding situations that could trigger them. Panic attacks can lead to agoraphobia, which is the fear of unknown places.
CausesScientists continue to look for the exact cause or causes of panic disorder. It is believed to be related to:
Risk FactorsA risk factor is something that increases your chance of getting a disease or condition.
SymptomsPanic attacks usually occur unexpectedly and repeatedly. They include many of the following symptoms:
DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. Since some panic disorder symptoms are similar to heart, digestive, and/or thyroid problems, a physical exam and tests can rule out physical causes of your symptoms. Tell your doctor about your physical symptoms and how the symptoms make you feel. Your doctor will want to know if your attacks keep you from your normal activities. You should also tell your doctor if you have been feeling sad or hopeless, or have been drinking or using drugs to control symptoms.
TreatmentThe goal of treatment is to decrease the frequency and intensity of panic attacks. Your doctor or mental health care specialist will provide treatment. The following treatments may be provided:
Cognitive-Behavioral TherapyThis can prepare patients for situations that may trigger panic attacks. Therapy focuses on:
MedicationsYour doctor or mental health care specialist may prescribe one or more of the following:
Antidepressants
Benzodiazepines (anti-anxiety medicines)
Dietary ChangesSome people find that avoiding caffeine (found in coffee, tea, chocolate, colas, diet sodas) may help reduce panic attacks.
Prevention
Social Anxiety Disorder(Social Phobia)Definition Social anxiety disorder is the intense fear of social situations. People with social anxiety disorder:
CausesThe exact cause of social anxiety disorder is unknown. Possible causes include:
Risk FactorsA risk factor is something that increases your chance of getting a disease or condition. Risk factors for social anxiety disorder include:
SymptomsPeople with social anxiety disorder may have the following symptoms during social interactions:
DiagnosisYour doctor will ask about your fears and symptoms and may perform a physical exam. You may be referred to a mental health professional for a psychiatric evaluation.
TreatmentTreatments include:
Cognitive-Behavioral TherapyWith this type of therapy, a therapist may:
Medication
Generalized anxiety disorder (GAD)is much more than the normal anxiety people experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They may have the following symptoms:
How common is GAD?About 3 to 4% of the U.S. population has GAD during the course of a year. GAD most often strikes people in childhood or adolescence, but can begin in adulthood, too. It affects women more often than men. What causes GAD?Some research suggests that GAD may run in families, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders. What treatments are available for GAD?Successful treatment for GAD may include a medication called buspirone . Research into the effectiveness of other medications, such as benzodiazepines and antidepressants , is ongoing. Also useful are cognitive-behavioral therapy , relaxation techniques, and biofeedback to control muscle tension. What other physical and emotional illnesses can accompany GAD?
Obsessive-compulsive disorder (OCD) is characterized by anxious thoughts or rituals you feel you can't control. People with OCD are plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. Symptoms of OCD include:
How common is OCD?About 2% of the U.S. population has OCD in a given year. OCD typically begins during adolescence or early childhood. At least one-third of the cases of adult OCD began in childhood. Roughly 1 in 50 people develop OCD and it affects men and women in approximately equal numbers. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the disease is variable-symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families. Depression or other anxiety disorders may accompany OCD. Some people with OCD have eating disorders . In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves.
What causes OCD?There is growing evidence that OCD has a neurobiological basis. It is no longer attributed to family problems or to attitudes learned in childhood - for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the caudate nucleus, a part of the brain. This is graphic evidence that both psychotherapy and medication affect the brain.
What treatments are available for OCD?A combination of the two therapies is often an effective method of treatment for most patients. Some individuals respond best to one therapy, some to another. Pharmacotherapy Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. These drugs include fluvoxamine , paroxetine , sertraline , clomipramine and fluoxetine . All these serotonin reuptake inhibitors (SRIs) have proven effective in treatment of OCD. If a patient does not respond well to one SRI, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of great help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow. Most patients can benefit from a combination of medication and behavioral therapy. Behavior therapy Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called " exposure and response prevention " is effective for many people with OCD. In this approach, the patient is deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand washer may be urged to touch an object believed to be contaminated, and then may be denied the opportunity to wash for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time. Studies of behavior therapy for OCD have found it to produce long-lasting benefits. To achieve the best results, a combination of factors is necessary: The therapist should be well trained in the specific method developed; the patient must be highly motivated; and the patient's family must be cooperative. In addition to visits to the therapist, the patient must be faithful in fulfilling "homework assignments." For those patients who complete the course of treatment, the improvements can be significant. With a combination of pharmacotherapy and behavioral therapy, the majority of OCD patients will be able to function well in both their work and social lives. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families. What other physical or emotional illnesses can accompany OCD?OCD is sometimes accompanied by depression , eating disorders , substance abuse , attention deficit hyperactivity disorder , or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of neurological disorders, such as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.
PreventionThere are no guidelines for preventing social anxiety disorder. However, early diagnosis and treatment can prevent complications such as:
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