Panic Attack (working)

Feb 23, 2020 admin CẤP CỨU, TÂM THẦN, THẦN KINH 0

Symptoms: Criteria for Panic Disorder

(4 or more required for diagnosis)

Generalized

Diaphoresis
Chills or Hot Flushes

Respiratory

Shortness of Breath
Sensation of Choking or smothering

Cardiovascular

Chest Pain
Palpitations, heart pounding or Tachycardia

Gastrointestinal

Nausea or Abdominal distress

Neurologic

Dizzy, light-headed, unsteady or faint feeling
Paresthesias
Trembling or shaking

Psychologic

Sensation of foreboding: dying or heart attack
Fear or losing control or going crazy
Feelings of unreality (derealization) or being detached from oneself (depersonalization)

MKSAP 18 Notes'

Diagnosis
Diagnose panic attacks when ≥4 of the following are present:
• palpitations, sweating, and shortness of breath
• fear of dying
• chest pain
• nausea or abdominal distress
• unsteadiness, lightheadedness, faintness, paresthesias
• self-detached feeling
Panic disorder involves recurrent, unexpected attacks and persistent worry about future attacks.
Treatment
Cognitive behavioral therapy and SSRIs are first-line treatment. Long-acting benzodiazepines can be used as short-term therapy
for disabling disorders until first-line treatments become effective.
DON’T BE TRICKED
• Do not prescribe benzodiazepines as first-line, long-term treatment for panic disorder

Management of Anxiety / Panic Attack

Anxiety Non-pharmacologic Management
  1. Offer Reassurance
    1. Not a serious physical disease
    2. Not insanity
    3. Not a sign of weakness or failure
    4. Not childishness or overdependency
    5. Not life-threatening
  2. Encourage Acceptance of anxiety as a life-long problem
    1. Innate response with years of reinforcement
    2. Complete calm always is unrealistic goal
  3. Set Goals for Therapy
    1. Decrease level of anxiety and maintain at low level
    2. Modulate future symptom responses
    3. Increase functioning
  4. Daily Physical Exercise (e.g. Walking, Tennis, Aerobics, Bicycling)
    1. Likely effective, although less than with Major Depression, and with inadequate evidence to date
    2. Jayakody (2014) Br J Sports Med 48(3): 187-96 [PubMed]
    3. Stonerock (2015) Ann Behav Med 49(4): 542-6 [PubMed]
  5. Improve sleep quality
    1. Establish good Sleep Hygiene
  6. Consider new hobbies
  7. Avoid harmful intakes (See Anxiety Secondary Causes)
    1. Avoid Alcohol use
    2. Avoid Tobacco use
    3. Avoid Caffeine
    4. Avoid Substance Abuse
  8. Others
    • Psychotherapy
    • Mindfulness and relaxation
    • Progressive Muscle Relaxation (see below)
    • Relaxation Training
    • Biofeedback
    • Breathing retraining (arousal reduction)
      • Take a deep breath
      • Let breath out through pursed lips
      • Abdominal breathing
      • Box breathing for 1-2 minutes
        Inhale slowly for 3-5 seconds and hold for 3-5 seconds
        Exhale slowly for 3-5 seconds and hold for 3-5 seconds
Progressive Relaxation

II. Preparation

  1. Patient sits in chair suitable for complete relaxation
  2. Loosen any tight fitting clothing

III. Technique: Part 1

  1. Now take a deep breath, which will help relax the muscles as you let your breath out again.
  2. Soon you will notice that your Eyelids begin to feel heavy and they will have a tendency to blink.
  3. They may blink more and more.
  4. They will grow heavier and heavier, heavier and heavier.
  5. You will find it harder and harder to hold them open.
  6. You may find your vision growing somewhat blurred.
  7. You may find that you have to swallow from time to time.
  8. The Eyelids are becoming heavier and heavier now.
  9. Soon the eyes will want to close and to shut out the light.
  10. They are getting so heavy now, so awfully heavy, you can hardly hold them open.
  11. Let them close whenever they are ready. Heavy. Still heavier, and they can close now.
  12. NOTE
    1. Instruct patient to close eyes if not already closed

IV. Technique: Part 2

  1. You are probably feeling listless now, a drowsy, listless feeling.
  2. It is very pleasant to feel so listless and drowsy. Let yourself relax still more.
  3. A feeling of well-being gradually comes over you, as though all your cares have rolled away, as though nothing matters, nothing at all.
  4. A feeling of “I don’t care.” You are so listless now.
  5. Give way to the feeling, as it is so pleasant.
  6. Just let yourself go, drifting deeper and deeper.
  7. Deeper with every breath you take. Deeper and still deeper.

V. Technique: Part 3

  1. Pay attention only to my voice – nothing else seems to matter and nothing will disturb you.
  2. Let yourself relax completely, now, let every muscle go loose and limp.
  3. You will notice a growing feeling of heaviness in your arms and legs, perhaps over your whole body.
  4. There may be tingly feelings here and there, perhaps a numbness.
  5. And your breathing is getting slow and easy now. Slow and easy.
  6. NOTE
    1. Call attention to abdominal breathing if present

VI. Technique: Part 4

  1. Give way to the drowsy listlessness. Let go completely.
  2. You are going deeper and still deeper now.
  3. Let all your muscles relax, relax them completely.
  4. Begin with your feet and your legs. Let the muscles go loose and limp.
  5. Relax them all. Now your thighs, and your hips.
  6. Let them relax. Your Shoulders, your arms, and your hands.
  7. Relax them. Now your neck. Let it relax.
  8. Do not mind if your head bows forward or to the side.
  9. It will be perfectly comfortable.
  10. Your facial muscles can relax, and particularly the eye muscles and the lids.
  11. Relax now, completely. Every muscle in your body will relax.

 

 

 

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