THE HEALTH | MAY , 2023

MINDTALK

BY DR ROZANIZAM ZAKARIA

Like any fit young man at his age , he rarely gets sick or requires any medical help . Nevertheless , his life turns in a totally different direction when he suddenly wakes up in the middle of the night with an episode of palpitation , shortness of breath , and the sensation of choking . He was profusely sweating and puzzled by what exactly had happened to him . This was when the thought of sudden death , just like what he heard happened to one of his co-workers , crossed his mind . He rushed to the nearest hospital for a check-up . He was discharged not long after that and was told that he was healthy and that there was nothing wrong with him .

The reassurance from the doctor did not help him , as he continued to experience constant worries about future attacks . His life since then has been occupied with multiple episodes of similar situations .

Every time the attack occurred , he would feel as if he was about to die , and no one would be able to help him . He has been avoiding many physical activities that he used to enjoy due to the fear that his heart could suddenly stop working .

His sleep has been terrible , eventually affecting his energy during the day . There have been multiple visits to the doctor ’ s office , from one specialty to another , all with similar answers .

He was told he was having a nervous breakdown and would benefit from psychological help . Initially , the idea did not sink well with him , as he could not comprehend how such a physical experience could be due to the simple stress he could probably have in the workplace . After nearly a year , he finally agreed to see a psychiatrist , who later diagnosed him with panic disorder , an illness that has affected his life in many ways .

WHAT IS PANIC DISORDER ?

Panic disorder is a type of anxiety disorder characterised by sudden and recurrent panic attacks , which are intense episodes of fear or discomfort that can last for several minutes . Panic attacks are often presented with physical symptoms such as sweating , trembling , chest pain , and heart palpitations . Panic disorder can be debilitating and interfere with daily activities , but it is treatable with various forms of therapy and medication .

The prevalence of panic disorder varies across different populations

and regions , but studies suggest that it is a relatively common mental health condition . According to the World Health Organisation ( WHO ), the estimated global prevalence of panic disorder is approximately 2.7 per cent of the population .

In the United States , the National Institute of Mental Health ( NIMH ) reports that approximately 2.7 per cent of adults experience panic disorder at some point in their lives . Women are more likely than men to develop panic disorder , with a lifetime prevalence of 5.2 per cent for women and 2.3 per cent for men .

Panic disorder can occur at any age but often develops in late adolescence or early adulthood . It is also more common in people with other mental health conditions , such as depression or substance abuse disorders .

CRITERIA FOR DIAGNOSIS

According to the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition ( DSM-5 ), the following criteria must be met for a diagnosis of panic disorder :

• Recurrent unexpected panic attacks : The person experiences sudden and unexpected panic attacks , characterised by intense fear or discomfort that reaches a peak within minutes .

• Persistent concern or worry about

Dr Rozanizam Zakaria is a psychiatrist and an Assistant Prof in the Psychiatry Department , International Islamic University Malaysia ( UIAM ). additional panic attacks or their consequences : After experiencing a panic attack , the person may worry about having another attack or the implications of the attack ( e . g ., fear of having a heart attack ).

• Significant maladaptive behaviour change : The person may avoid certain situations or activities out of fear of having a panic attack .

• Exclusion of other medical conditions : The panic attacks are not better accounted for by another medical condition .

RISK FACTORS

Several factors may increase the risk of developing panic disorder , including :

• Genetics : Panic disorder may have a genetic component , as it tends to run in families .

• Brain chemistry : Abnormal levels of certain neurotransmitters in the brain , such as serotonin and norepinephrine , may contribute to the development of panic disorder .

• Stressful life events : Traumatic events , such as the death of a loved one , may trigger panic disorder in some people .

• Personality styles : those who are naturally anxious , avoidant , obsessive and perfectionistic in nature are more likely to develop this condition .

• Other mental health conditions : panic disorder is often comorbid with other mental health conditions , such as depression or substance abuse .

MANAGEMENT

Panic disorder can be managed through various forms of therapy and medication . Some effective treatments include :

Cognitive-behavioural therapy ( CBT ): This form of talk therapy helps people identify and change negative thought patterns and behaviours that contribute to panic attacks . This therapy is conducted by clinical psychologists , psychiatrists and trained mental health professionals .

Medication : Antidepressants , such as selective serotonin reuptake inhibitors ( SSRIs ), and benzodiazepines , such as alprazolam , can help reduce the frequency and severity of panic attacks .

Relaxation techniques : Learning relaxation techniques , such as deep breathing or progressive muscle relaxation , can help manage the physical symptoms of panic attacks .

Lifestyle changes : Regular exercise , getting enough sleep , and avoiding stimulants such as caffeine and nicotine can help reduce the frequency and severity of panic attacks .

Overall , a combination of therapy and medication is often the most effective way to manage panic disorder . – The Health