Panic disorder

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Classification according to ICD-10
F41.0 Panic disorder (episodic paroxysmal anxiety)
F40.01 Agoraphobia with panic disorder
ICD-10 online (WHO version 2019)

The panic disorder (also panic syndrome called) is a form of anxiety disorder . Those affected suffer from sudden attacks of anxiety, without objectively speaking there is any real danger. These anxiety attacks take the form of panic attacks , which represent an extreme physical fear reaction ("ready response") out of the blue and are experienced by those affected as an extreme threat to their health.

distribution

The occurrence of isolated panic attacks in life does not in itself constitute a disease. Only when several panic attacks occur per month and an increased "fear of fear" - the so-called fear of expectation - develops and persists over a longer period (at least one month) and leads to impairments in daily life, one speaks of panic disorder according to the criteria of the World Health Organization (WHO, ICD-10).

The fear of suddenly experiencing a panic attack in a situation that cannot be escaped quickly or in which no help is available often leads people to begin to avoid tight spaces, crowds or long journeys. In severe cases, they can no longer leave their own home alone.

Around 3.5 percent (1994 study) to 4.7 percent (2005 study) of all people will develop panic disorder in the course of their lives. The disorder usually breaks out between the ages of 15 and 24, but - especially in women - it can only break out in the third or fourth decade of life. Women are more likely to be affected by the disorder than men. One study found that the prevalence is increasing in younger generations. The fear often manifests itself in thoughts of dying suddenly or the idea of ​​going crazy.

Symptoms

Physical reactions of panic disorder include hyperventilation , tightness in the chest with suffocation, palpitations or -stolpern , sometimes heart pain, tremor , sweating , numbness or tingling, nausea and other symptoms. As a rule, the symptoms improve after about 15 to 20 minutes, analogous to the depletion of adrenaline. Mental symptoms of panic disorder include dizziness , derealization and depersonalization , fear of losing control, going crazy or "freaking out", and fear of dying. General symptoms are feelings of heat or chills with goose bumps .

Diagnosis according to ICD-10

For the diagnosis of panic disorder according to ICD-10 (F41.0), there must be repeated panic attacks and an organic cause must have been medically excluded . A clear diagnosis assumes that severe vegetative anxiety attacks have occurred several times within a month. The situations in which the anxiety attacks occur must be free from objective dangers. Likewise, the anxiety attacks must not relate to situations in which anxiety is known or predictable. Anxiety-free time intervals between panic attacks are also part of the diagnostic guidelines, whereby the fear of the next panic attack that often occurs must be taken into account.

A panic attack is defined as a single episode of intense anxiety or discomfort that begins abruptly, reaches a maximum within a few minutes, lasts for at least a few minutes, and is accompanied by at least four (out of a list of fourteen) anxiety symptoms. At least one symptom of this must be vegetative (palpitations / racing heart, sweating, tremors or dry mouth). Panic disorder is often diagnosed in association with agoraphobia and then classified under F40.01 (agoraphobia with panic disorder).

Differential diagnosis

Before the diagnosis of panic disorder in the sense of a mental disorder can be made, physical causes such as endocrinological , neuropsychiatric , cardiological or oncological diseases must be medically excluded. Panic can appear as a symptom of numerous physical illnesses. It is then not a psychological disorder, but a neuropsychiatric symptom of a physical disorder. This applies in particular to endocrinological diseases and diseases of the central nervous system , thyroid , heart , adrenal glands and numerous tumor diseases such as B. the pheochromocytoma . What these diseases have in common is that they lead in various ways to changes in the activity of the sympathetic nervous system and / or an altered release of adrenaline , noradrenaline and / or cortisol , which can also be demonstrated in the laboratory and which cause panic symptoms. If there are organic causes, the diagnosis is an organic anxiety disorder (ICD 10: F06.4). The therapy of organically caused panic symptoms takes place medically by eliminating the disease causing them.

In the next step, panic attacks that occur in connection with phobias or in the context of a depressive disorder must also be diagnosed .

Origin and causes

Inheritance

Twin studies show a familial accumulation, whereby a specific genetic transmission of the panic syndrome has not yet been proven. Rather, it is assumed that unspecific genetic vulnerability to “ neurotic disorders ” is inherited, the shape of which is determined by environmental factors. As physiological disposition , an increased sensitivity of α is 2 - adrenergic receptors and the central chemoreceptors adopted.

trigger

The first panic attack often occurs as a result of stressful experiences such as the loss of a loved one, the end of an important relationship, job loss or criminal victimization . Aversive learning experiences can lead to the build-up of fear of one's own anxiety symptoms (including anxiety sensitivity ), which is considered to be a significant risk factor for the development of panic disorder.

Behavioral model

Various researchers developed psychological, psychophysiological and cognitive models to explain panic syndrome. Panic is seen here as a particularly intense form of fear that is created within the framework of a "vicious circle":

  1. Physical or psychological change , e.g. B. change in heart rate, dizziness, concentration problems (as a result of internal or external stressors, e.g. heat, caffeine)
  2. Perception of this change.
  3. Association with danger (as a result of interoceptive conditioning / type B conditioning or cognitive evaluation processes, e.g. "I am having a heart attack").
  4. Fear / panic .

The fear reaction is in turn associated with physical and psychological changes (see point 1), which are perceived etc. This quickly leads to a build-up process (positive feedback process) with an increase in panic. This cycle can be run through several times and usually runs very quickly. He can be interrupted by

Sometimes the process also starts at point 2 (perception), e.g. B. when the person concerned lies down and thereby perceives their own heartbeat better without it having changed.

treatment

psychotherapy

The psychogenic panic disorder can be very effectively treated with psychotherapy, as a rule, especially cognitive-behavioral treatments have proven to be effective. The patient must be informed that the anxiety attacks run naturally and that they subside on their own after a while - and that they are not in serious danger at any point during the anxiety attack. He will not fall over, he will not lose his mind, the heart will not stop, nothing like that will happen. He has to recall this prediction from his therapist / doctor again and again during the attack.

The long-term goal of therapy is that those affected learn to trust their bodies again. You learn to divert attention away from constant introspection to external events, but also not to evaluate the body's reactions as signs of a heart attack, for example. In addition, those affected learn to consciously relax their body through breathing and relaxation processes. The avoidance behavior often associated with anticipatory anxiety is usually successfully treated in this context with so-called exposure or confrontation therapy (see Interoceptive Conditioning ).

Psychotropic drugs

In parallel with behavior therapy, an antidepressant is usually prescribed because it suppresses the excessive fear until the patient is able to recognize the panic disorder as such and effectively counter the fear with psychotherapeutic methods. There are different types or classes of antidepressants. Selective serotonin reuptake inhibitors ( SSRIs ) and serotonin norepinephrine reuptake inhibitors ( SNRI ) are the best studied and proven to be most effective for the treatment of panic disorder. Examples of Drugs: SSRIs: Paroxetine ; Citalopram , escitalopram ; Fluvoxamine , fluoxetine , sertraline ; SNRI: venlafaxine . In addition, tricyclics are prescribed. After stopping medication, the likelihood of relapse is generally high.

If you have a severe panic disorder, you can temporarily use anxiolytics (anti-anxiety drugs) such as benzodiazepines . Since regular use of benzodiazepines can lead to the development of addiction, their use is limited to acute therapy (for a maximum of four to six weeks).

Panic disorder in pregnancy

Patients who previously had only minor fears can experience a massive accumulation of severe panic attacks during pregnancy.

See also

literature

  • Jürgen Margraf, Silvia Schneider: Panic Syndrome and Agoraphobia. In: J. Margraf: Textbook of behavior therapy. Volume 2, 2nd edition. 2005, ISBN 3-540-66440-8 , pp. 1-27.

Web links

Individual evidence

  1. ↑ James N. Butcher, Susan Mineka, Jill M. Hooley: Clinical Psychology. Pearson Studium, 2009, p. 243.
  2. ^ Nina Heinrichs, Georg W. Alpers, Alexander L. Gerlach: Evidence-based guideline for the psychotherapy of panic disorder and agoraphobia. Hogrefe Verlag, Göttingen 2009, p. 22ff.
  3. ↑ Panic disorder. from: gehirn-und-geist.de , accessed on June 20, 2014.
  4. ↑ H. Dilling, W. Mombour, MH Schmidt (Ed.): WHO - International Classification of Mental Disorders. ICD -10 Chapter V (F), 4th edition. Verlag Hans Huber, 2000, ISBN 3-456-83526-4 , p. 160 f.
  5. ↑ Jürgen Margraf, Silvia Schneider: Textbook of behavior therapy. Volume 1: Basics, diagnostics, procedures, framework conditions. 3. Edition. Springer Verlag, Heidelberg 2009. Chapter 26.3, p. 453.
  6. ↑ Hans-Peter Volz, Siegfried Kasper: Psychiatry and Psychotherapy compact: The entire specialist knowledge. Thieme Verlag, Stuttgart 2008.
  7. ↑ Final spurt clinic script 4: Internal and surgery: endocrine system, metabolism, kidneys, water, electrolytes. Georg Thieme Verlag, 2013.
  8. ↑ Hans Reinecker: Textbook of clinical psychology and psychotherapy. Models of mental disorders. Hogrefe Verlag, 2003.
  9. ↑ Hans-Peter Volz, Siegfried Kasper: Psychiatry and Psychotherapy compact. The entire specialist knowledge. Georg Thieme Verlag, 2008.
  10. ^ J. Margraf, S. Schneider: Panic syndrome and agoraphobia. 2005, p. 11.
  11. ↑ James N. Butcher, Susan Mineka, Jill M. Hooley: Clinical Psychology. Pearson Studium, 2009, pp. 244–245.
  12. ^ NB Schmidt, MJ Zvolensky, Maner JK: Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. In: Journal of Psychiatric Research. Volume 40, No. 8, 2006, pp. 691-699.
  13. ^ J. Margraf, S. Schneider: Panic syndrome and agoraphobia. 2005, p. 9 ff.
  14. ↑ Sigrun Schmidt-Traub, Tina P. Lex: Anxiety and Depression: Cognitive Behavioral Therapy for Anxiety Disorders and Unipolar Depression . Hogrefe Verlag, 2005, ISBN 978-3-8409-1906-0 , pp. 49 ( limited preview in Google Book search).
  15. ↑ N. Kern, A. Ströhle: Psychopharmacotherapy for anxiety disorders . In: Psychotherapy Issue 8 . 2003, p. 104-113 .
  16. ^ A b James N. Butcher, Susan Mineka, Jill M. Hooley: Clinical Psychology. Pearson Studium, 2009, p. 251.
  17. ↑ Anke Rohde, Almut Dorn: Gynecological Psychosomatics and Gynecological Psychiatry - The textbook. Schattauer, 2007, p. 152.