One in five people experience a panic attack at least once during their lifetime. Between two and five percent of those people have panic disorder. Panic may occur at any age. It is often under diagnosed in children. Panic often surfaces during the teen years; however the onset may occur at any age. Panic attacks often begin during times of high stress and transition. Panic disorder is twice as common in women as in men.
Experts agree that biology and external factors contribute to the development of panic disorder, however, most theorists stress the physiological basis as the most prevalent factor. Multiple biochemical factors are involved in the development of panic.
PET scans and MRIs indicate that people diagnosed with panic disorder demonstrate alterations of the hippocampus and temporal lobes of the brain.
The nurse may encounter a patient experiencing panic in any health care setting.
Panic is a medical illness. Nurses in emergency departments may see patients experiencing panic presenting with symptoms similar to cardiac patients. Many patients initially seek assistance from their primary care providers so nurses in clinics, and physician’s offices need to be knowledgeable about panic disorder. Nurses in outpatient and inpatient settings encounter patients experiencing panic. When patients are stressed due to hospitalization, medical procedures and illness panic attacks may occur.
Conditions with symptoms that resemble panic include: thyroid and parathyroid disease, cardiac arrhythmias, myocardial infarction, hypoglycemia and temporal lobe epilepsy. Stimulants, including caffeine, illegal medications and withdrawal from SSRI’s may precipitate panic like symptoms.
Panic disorder needs to be differentiated from other types of anxiety disorders. They include: Generalized Anxiety Disorder, Obsessive- Compulsive Disorder, Phobias, Post Traumatic Stress Disorder (PTSD), and Social Anxiety Disorder. Symptoms of anxiety disorders may overlap. People who suffer from panic disorder often present with depression or other anxiety disorders also.
Panic disorder may develop into agoraphobia. Approximately one third of people with panic disorder suffer from agoraphobia. Agoraphobia can be devastating for patients and family members. People suffering from agoraphobia may be unable to leave their homes, obtain employment, or independently take part in common daily activities such as driving or shopping for groceries due to anxiety. Agoraphobia may develop rapidly. It may occur after just one panic attack.
Early diagnosis and treatment is essential as recurrent panic attacks increase the fear of recurrence and development of avoidance behaviors which may result in agoraphobia.
Multiple treatment options are available. A combination of medications with cognitive behavior therapies is frequently prescribed. EMDR, (Eye movement Desensitization and Reprocessing) can be effective. Therapies may include gradual immersion in panic producing situations.
Living with panic disorder as the sufferer or as a family member can be challenging. All family members must learn strategies for self care.
Nurses are in a position to educate patients and family members about the facts regarding panic disorder. Myths and prejudices are common. The nurse can provide clarification and understanding.
Patients suffering from panic disorder may be embarrassed and feel that they are weak. They need reassurance. Ensure patients that they have treatable medical condition.
During a panic attack, stay with the patient and reassure him or her that the panic attack will pass. Many patients experiencing panic fear going crazy or dying. Encourage them to keep their eyes open. Stress slow deep breaths as hyperventilation is prevalent. Reassure the patient that panic is not a sign of going crazy. Reassure them that panic attacks feel horrible, but they do not result in heart attacks or death.
Panic can be a challenging condition for nurses to encounter. The actions and presence of a compassionate nurse can make the panic episode more tolerable and even shorten the length and intensity of this terrifying event for the patient.