Management of panic disorder

Symptoms of panic attack can be found in both medical disease and mental disorder. At least 4 of 13 diagnostic symptoms need to be present to constitute an attack which onset is sudden and unpredictable. The duration of attack usually lasts minutes but sometimes longer. In panic disorder there is recurrent attacks of severe anxiety which are unprovoked and unexpected. Dominant symptoms vary from person to person. The syndrome is likely to be heterogeneous as the biological aetiology may be related to abnormalities in the function of a number of neurotransmitters ie serotonin, noradrenaline, gamabutyric acid, dopamine and cholecystokinin. As such different benzodiazepines and anti-depressants are efficacious in the treatment of the disorder. Medications should be titrated to prevent attacks and restore confidence. Maintenance therapy needs to be balanced with premature termination of treatment. Reassurance is important and there is a place for cognitive behavioural therapy, relaxation exercise and breathing control technique.