[Diagnosis, pathogenesis and treatment of panic attacks]

Panic accompanies several diseases both psychological and somatic. It may be secondary, i.e. produced by other symptoms and morbid processes. It may also be primary--"neurotic". In such cases there are two forms of panic: generalized and paroxysmal. Attacks of panic are seen in 1.6-2.9% of women and in 0.4-1.7% of men. Main pathogenetic role is played by the psychologic factors (psychical trauma precedes the onset of diseases). The role of biological factors is also important. It is believed that disorders of the noradrenergic, serotonin-ergic, and GABA-ergic transmission may produce the attacks of panic. Psychotherapy is a treatment of choice. Pharmacotherapy plays only an adjuvant role. Antidepressants (tricyclic of II generation) are most frequently used for this purpose and--exceptionally due to possible addiction--benzodiazepines. The highest impact on the development of disease has first contact physician attitude. Patient and thoughtful listening to the patient, explanation of the complaints and their source often produce and improvement, and even complete recovery.