Panic disorder

In a typical scenario, a thirtysomething year old woman presents with a racing heart, chest pain, shortness of breath, sweating, and a feeling of impending doom. She thinks to herself, “Am I having a heart attack?” or “Am I going to die”? She is rushed to the emergency department, but various investigations show nothing abnormal, and she is later referred to a psychiatrist.

Why has a referral to a psychiatrist been made when the patient has serious physical symptoms, such as palpitations, chest pain, or hyperventilation? This is panic disorder, in which the body and mind interact to produce very unpleasant experiences but which respond to treatment in at least 35% of cases.1

Panic attacks are “sudden sometimes unexpected bursts of extreme anxiety, mostly manifesting as severe physical symptoms: cardiovascular, respiratory, gastrointestinal, neurological, and autonomic.” Panic disorder, on the other hand, means recurrent attacks of panic in a period of at least one month. Symptoms might include palpitations, hyperventilation, chest tightness, sweating, numbness, paraesthesia, depersonalisation, trembling, nausea, feeling of choking, dizziness, fear of losing control or going mad, and fear of dying. These symptoms are not the result of a general medical condition, such as hyperthyroidism or phaeochromocytoma, or of another psychiatric disorder, such as depression, or substance misuse. The different components …