Pathophysiology
1) episodic, unpredictable attacks of intense fear, agitation, and discomfort (especially agoraphobic) 2) onset must occur over a 10 minute period 3) attacks generally occur for < 1 hour 4) exact cause is unknown, but genetic predisposition occurs
Signs and Symptoms
presence of at least four of the following during attack – 1) tachycardia/palpitations 2) trembling/shaking 3) sweating 4) shortness of breath 5) dizziness 6) chest pain 7) choking sensation 8) chills or hot flushes 9) abdominal pain or diarrhea 10) sense of impending doom or death 11) feelings of anxiety
Biochemistry
1) altered autonomic functioning 2) increased noradrenergic discharge from locus ceruleus
Inheritance/Epidemiology
onset is usually in late adolescence to early adulthood
Treatment
1) SSRIs (sertraline and fluoxetine) 2) benzodiazepines for short period of time until SSRIs reach therapeutic levels 3) psychotherapy – behavior modification and relaxation techniques like breathing exercises
Tips for USMLE
if question mentions a 19 year old man who is studying in the college library and suddenly develops feelings of anxiety, sweating, palpitations, paresthesias and 5 minutes later has acute diarrhea and by the time she is seen in student health she is feeling much better and does not know why she experienced this episode, think panic disorder
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