PANIC DISORDER

In Greek mythology, Pan is a god of shepherds and flocks, represented as semi-human divinity: the bearded, wrinkled face, protruding chin, animalistic expression, the forehead is adorned by two horns; the body is hairy and the legs are goat, paws are thin and nervous. It is endowed with agility, quick in the race, you know conceal himself in the bushes, where it hides to spy on the nymphs and scare them. It is also said that suddenly appeared in the Athenian Agora, during the meetings, to terrorize the people and disrupt the discussions. The word panic derives from Pan and represents an unfounded fear, fright or sudden fear.

CLINICAL AND CURRENT DIAGNOSIS

Panic disorder (also called episodic paroxysmal anxiety) is characterized by recurrent attacks of intense anxiety in unpredictable circumstances. Besides the intense anxiety (panic) the person has the feeling of impending death, loss of control of itself or of being "crazy." This anxiety is accompanied by various somatic symptoms: palpitations, chest pain, dizziness, shortness of breath, dizziness, excessive sweating, feeling of being "air", feeling faint, tingling in the body, heat and cold flashes, nausea, and others. Usually last a few minutes, rarely more than an hour. As panic attacks are unpredictable one develops the fear of having new attacks and will take "preventive" measures to avoid places or situations that implies, can trigger new crises. Develops phobias that are called agoraphobia; often goes to have a limited life, being unable to be alone or to go to public places. Often have a persistent anxiety, anticipatory.

The TP affects about 1-2% of the population, usually begins in adolescence or early adulthood and is more common in women. Often the occurrence of mitral valve prolapse in patients with panic disorder. Some physical diseases such as hyperthyroidism and pheochromocytoma can manifest itself with panic attacks. PD patients may develop secondary depressive disorders or even addiction to drugs or alcohol.

Its causes are unknown. There are predisposing factors and triggering factors of the disease. Heredity seems to have a weight, as TP carriers relatives are more likely to develop the disease. Some psychological factors linked to; early childhood, especially separation anxiety experiences seem to make individuals vulnerable. In susceptible individuals can trigger panic attacks through medications (isoproterol, lactate) demonstrating that they are vulnerable to disease. Furthermore, drugs that act on serotonin (neurotransmitter in the nervous system) can block panic attacks.

The TP can be triggered by emotional factors that lead to stress, drugs (marijuana, cocaine, etc.) and physical ailments. Most of the time the TP becomes autonomous, going to occur regardless of external factors.

Many of the individuals who develop TP have anxiety, insecurity, tension, difficulty relaxing, excessive worry, even before the crisis. These personality characteristics seem to make them more vulnerable to disease.

Many individuals develop quite limiting agoraphobia despite having just had a panic attack. Others continue agoraphobic even after the controlled seizures with medication. It is clear that psychological factors influence rather in how these people deal with their situations of anxiety.

THERAPEUTIC APPROACH

The TP is a disease where there is a clear need for integration between pharmacological and psychotherapeutic approaches to patient care. Panic attacks can be controlled with antidepressant medication in low doses. Already phobic symptoms rarely improve spontaneously, even after the control of seizures, requiring a psychotherapeutic approach.

Antidepressant medications, particularly those with predominant action on the serotonergic system (some tricyclics like clomipramine, selective inhibitors of serotonin reuptake, as p. Eg. Fluoxetine, paroxetine and monoamine oxidase inhibitors), and benzodiazepines (especially alprazolam) provide rapid improvement of panic attacks, with removal of the same in a few weeks in most patients.

Phobic avoidance requires psychotherapeutic approach, so that the patient feels safe to return to their daily activities without the limitations imposed by the fear of having new crises. Psychodynamic aspects of personality will be deepened in order to explore conflicts that may be triggering the crisis. A frightening experience of loss of control over one's emotions seem to be central in these people.

Many of the TP carriers are described as people fearful, nervous and shy in childhood, past experiences discomfort in relation to aggressive feelings, hardly dealing with such feelings and reported that their parents were scary, critics and controllers. Having a fragile personality, often taken by emptiness and helplessness experiences, need another to supply such functions. It psychotherapist task of helping the person build internal references that can promote better integration of experiences, filling the empty space that both anguish.