A patient presented in casualty with a history of sudden paplitation, sensation of impending doom and constriction in his chest. This lasted for about 10-15 minutes after which he became all right. The diagnosis is likely to be:
D i.e. Panic attack Feeling of impending doom with sympathetic symptoms (chest discomfo/pain/constriction, anxiety apprehension, breathlessness, sweating, palpitations, tremors etc.) of sudden onset and lasting for few minutes are diagnostic of Panic attackQ. - In generalized anxiety disorder, there must be a period of atleast 6 monthsQ with prominent tension, worry & feeling of apprehension about every day events & problems. The onset is also insidious (not abrupt as in panic attack). Symptoms of anxiety are seen both in panic attack & generalized anxiety disorder; but panic attack is differentiated by sudden onset of symptoms of severe anxiety (like feeling of impending doom) lasting for few minutesQ. Panic Attack Episode (discrete period) of acute anxiety (i.e. intense fear or discomfo) of sudden (abrupt) onset like out of the blue, reaching a peak within 10 minutes and usually lasting for < 1-hour (most commonly diminished with in 30 minutes). The clinical picture is that of acute severe anxiety that builds up quckly and include various features of sympathetic stimulation because hyper ventilation caused by anxiety lit Paco2. >4 of the following symptoms developing abruptly and reaching a peak within 10 minutes are required. Sensation of shoness of breath or smothering (paradoxical feeling of breathlessness)Q Chocking sensation Chest pain or discomfo PalpitationQ, pounding hea, tachycardia (accelerated hea rate) Feeling dizzy, unsteady, light-headed or faint Paresthesias (numbness or tingling) Trembling or shaking or tremor Chills or hot-flushes SweatingQ Fear of dying (impending doom)Q Fear of losing control or going crazy (apprehension)Q Derealization (feeling of unreality) or depersonalization (being detached from oneself) Nausea or abdominal distress Recurrent, unexpected panic attack and at least one of the attack has been followed by >1 month of 1 of the following a) Persistent concern about having additional (fuher) attacks b)Worry about the implications of the attack or its consequences (eg because of physical symptoms patients are likely to fear that they are experiencing a hea attack, stroke or the like; or occasionally patients think they are going crazy or are out of control) c) A significant change in behavior related to attacks (because they think that attacks indicate a serious undiagnosed physical illness). Panic attacks should not be d/t medical disorder, social /specific phobia, OCD, PTSD, or seperation anxiety; but it may or maynot be associated with agoraphobia. Agoraphobia Anxiety about being in places or situations from which escape might be difficult(2 (or embarrassing) or in which help may not be available in the event of having an unexxpected or situationally predisposed panic attack or panic like symptoms. Agoraphobic fears typically involves characteristic clusters of situations that include
Phobia
Personality disorder
Generalized Anxiety disorder
Pannic attack