Cackovic Curt, Nazir Saad, Marwaha Raman
Civil Hospital
Case Western Reserve Un/MetroHealth MC
Panic disorder and panic attacks are two of the most common problems seen in the world of psychiatry. Panic disorder is a separate entity from panic attacks, although it is characterized by recurrent, unexpected panic attacks. Panic attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an abrupt surge of intense fear or discomfort” reaching a peak within minutes. Four or more of a specific set of physical symptoms accompany a panic attack. These symptoms include; palpitations, pounding heart or accelerated heart rate, sweating, trembling or shaking, sensations of shortness of breath or smothering, feelings of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, light-headedness, or faint, chills or heat sensations, paresthesias (numbness or tingling sensations), derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of losing control or "going crazy," and fear of dying. Panic attacks occur as often as several times per day or as infrequently as only a few attacks per year. A hallmark feature of panic disorder is that attacks occur without warning. There is often no specific trigger for a panic attack. Patients suffering from these attacks self-perceive a lack of control. Panic attacks, however, are not limited to panic disorder. They can occur alongside other anxiety, mood, psychotic, and substance use disorder. In order to make an accurate diagnosis of panic disorder, it is important to differentiate the two entities from each other. According to DSM 5, panic disorder can be diagnosed if recurrent unexpected panic attacks are happening, followed by one month or more of persistent concern over having more attacks, along with a change in the behavior of the individual to avoid a situation in which they attribute the attack. Although panic attacks may originate from the direct effects of substance use, medications, or a general medical condition like hyperthyroidism or vestibular dysfunction, they must not derive solely from these. Panic disorder is not diagnosed when the symptoms are attributable to another disorder. For example, when panic attacks occur in the presence of a social anxiety disorder in which the attacks are triggered by social situations like public speaking, it cannot be considered a part of panic disorder. A distinctive finding in patients with panic disorder is related to the fear and anxiety that they experience in a physical manner as opposed to a cognitive one. Panic disorder is not a benign disease, it can significantly affect the quality of life and lead to depression and disability. In addition, these patients are also at a higher risk for alcoholism and substance abuse compared to the general population.
惊恐障碍和惊恐发作是精神病学领域中最常见的两个问题。惊恐障碍是与惊恐发作不同的一种疾病，尽管它的特征是反复出现、不可预期的惊恐发作。《精神疾病诊断与统计手册》（DSM）将惊恐发作定义为“强烈恐惧或不适的突然涌现”，并在几分钟内达到顶峰。惊恐发作会伴随一组特定身体症状中的四种或更多种。这些症状包括：心悸、心跳剧烈或心率加快、出汗、颤抖或摇晃、呼吸急促或窒息感、哽噎感、胸痛或不适、恶心或腹部不适、头晕、站立不稳、眩晕或昏厥、发冷或发热感、感觉异常（麻木或刺痛感）、现实解体（不真实感）或人格解体（与自我分离感）、害怕失去控制或“发疯”以及害怕死亡。惊恐发作可能每天发生数次，也可能每年仅发作几次。惊恐障碍的一个标志性特征是发作毫无征兆。惊恐发作通常没有特定的触发因素。遭受这些发作的患者自我感觉缺乏控制。然而，惊恐发作并不局限于惊恐障碍。它们可能与其他焦虑、情绪、精神病性和物质使用障碍同时出现。为了准确诊断惊恐障碍，将这两种情况区分开来很重要。根据《精神疾病诊断与统计手册》第5版，如果反复出现不可预期的惊恐发作，随后持续一个月或更长时间担心会有更多发作，并且个体行为发生改变以避免他们认为会引发发作的情况，那么就可以诊断为惊恐障碍。尽管惊恐发作可能源于物质使用、药物治疗的直接影响，或甲状腺功能亢进或前庭功能障碍等一般躯体疾病，但不能仅源于这些。当症状可归因于另一种疾病时，不能诊断为惊恐障碍。例如，当惊恐发作出现在社交焦虑障碍中，且发作由公开演讲等社交情境触发时，不能将其视为惊恐障碍的一部分。惊恐障碍患者的一个独特发现与他们以身体方式而非认知方式体验到的恐惧和焦虑有关。惊恐障碍不是一种良性疾病，它会显著影响生活质量，并导致抑郁和残疾。此外，与普通人群相比，这些患者酗酒和物质滥用的风险也更高。
