How Can You Help Someone With Anxiety And Panic Attacks

Anxiety disorder is characterized by feelings of uneasiness, danger, tension, stress, irritability, or fatigue. Panic disorder is a form of anxiety that is characterized by recurrent panic attacks (i.e., sudden episodes of intense fear or impending doom associated with a variety of somatic symptoms).

1. Panic attacks are often unpredictable, although they may occur commonly in certain situations.

2. First-time panic attacks are rarely seen in patients older than 35 years; organic disorders should be considered in these cases.

CLINICAL FEATURES: Symptoms associated with both generalized anxiety and panic attacks may mimic life-threatening conditions but include palpitations or pounding heart, diaphoresis, sensation of shortness of breath or choking, chest pain or discomfort, nausea, dizziness, light-headedness, numbness, tingling, or chills.

DIFFERENTIAL DIAGNOSES: Many serious medical conditions can mimic the symptoms of panic disorder and need to be considered (Acute myocardial infarction, Cardiac arrhythmias, Pulmonary emboli, Hyperthyroidism and thyroid storm, Pheochromocytoma, Mitral valve prolapse, Alcohol withdrawal Use of central nervous system stimulants, Hypoglycemia, Asthma exacerbation, Stroke or serious intracranial abnormalities), especially in patients older than 45 years.

Evaluation

1. Patient history: A careful history of recurrent, short-lived episodes of panic will usually lead to the correct diagnosis of panic attacks. Anxiety may be harder to determine but is often a diagnosis of exclusion in the ED.

2. Laboratory studies should be guided by the patient history and physical exam as well as age and presentation and may include a serum electrolyte panel and glucose level, and a drug screen. Older patients or those with atypical symptoms should have a thorough workup to detect conditions on a medical basis.

3. Electrocardiography and radiology: An electrocardiogram or chest radiograph may be warranted.

Therapy: Generally, both medications and behavioral therapy are used for patients with anxiety and panic disorders. Usually, medical therapy for panic attacks should be started by the patient’s primary care physician or a psychiatrist, not in the ED. However, commonly used medications include the following:

1. Selective serotonin reuptake inhibitors are first-line therapy for the long-term control of anxiety and panic attacks.

2. Benzodiazepines are both useful for panic attacks and usually produce a response within several hours to days of beginning the medication but should be used sparingly due to abuse and withdrawal potential.

3. Disposition: Most will be discharged, although patients with risk factors for the significant disease should be admitted to the hospital to rule out a life-threatening condition.