What is the pathophysiological mechanism of panic ?

Panic disorder can be diagnosed linked by some unexpected attacks and continuous fear and the fact that attacks could occure again and again. These attacks cause symptoms from mild to severe and last less than 30 minutes. The first attack occurs without warning, during a normal activity (walking on the street, going shopping). Feeling is confusion, that something terrible will happen. There is also the need to leave the place and the withdrawal in a safe area (car, house). Along with these events, physical symptoms occure: difficulty in breathing, fast heart beat, chest pain. Maximum intensity of symptoms takes about 10 minutes. Panic attack symptoms can be similar to those of myocardial infarction. For this reason, many people seek emergency medical treatment.

Panic attacks can be triggered by a particular action  (uses of too much caffeine), situation (high congestion) or without apparent cause. People who have gone through a panic attack develop a fear not to repeat this experience again (anticipatory anxiety) and avoid social activities (agoraphobia). Approximately half of people who have panic disorder, has related to agoraphobia. Isolation interfere with service and interpersonal relations, especially with relatives and close friends.

Other common features related to panic disorders are:

- Use of drugs or alcohol (to inhibit fear and creating a false sense of courage to face difficult situations)

- Depression

- Phobias (unjustified fears )

- Disorders related to anxiety  (post traumatic stress)

- Difficult relationships with people with social position, because of intense anxiety

The first panic attack occurs during a routine activities and, for many people, it is coinciding with a period of their busy stressing life  (life threatening illness, accident, end a relationship, separation from family).

Sometimes, first panic attack occurs after giving birth.

The first attack may occur as a reaction to drugs, nicotine or caffeine. But once the issue which led to attack is resolved , it may return.

Experts believe that stressful circumstances may rise the cycle of panic attacks in people predisposed to panic disorders.

Recurrent panic attacks can be mild to severe and may continue for years, especially when they are combined with agoraphobia. There may be long periods without attacks, but also periods with frequent attacks.Panic-related disorders can follow for life, but symptoms can be controlled with treatment. Most people with this problem recover after treatment and have a normal life. Panic-related disorders may recur if treatment is stopped too early.