Psychiatry
Panic Disorder
공황장애
Recurrent unexpected panic attacks with anticipatory anxiety
- How common
- Lifetime 2–3%
- Typical age
- Late 20s
What is it?
Amygdala-centric fear circuit hypersensitivity, LC noradrenergic surge, CO2 hypersensitivity.
Commonly affected: Amygdala, locus coeruleus, hippocampus, PFC
How it develops
- VulnerabilityAnxiety sensitivity, family history
- False suffocation alarmKlein's hypothesis: CO2 sensor hypersensitivity
- Amygdala/LC surgeSympathetic burst → physical symptoms
- Anticipatory anxiety/avoidanceFear of attack → agoraphobia develops
Symptoms
- PalpitationsSudden pounding heart
- Dyspnea/hyperventilationCannot catch breath
- Fear of dyingSense of impending doom
- DepersonalizationFeeling detached from self
- Anticipatory anxiety/avoidanceFear of next attack, agoraphobia
How it is examined
- DSM-5 panicRecurrent unexpected panic attacks + ≥1 mo anticipation/avoidance
- PDSSPanic Disorder Severity Scale
- Rule out cardiac/thyroidEKG, TSH, caffeine/drug screen
Imaging
No imaging required; fMRI shows amygdala hyperactivity.
- Amygdala hyperactivity
CO2 inhalation challenge: hypersensitive response.
- CO2 hypersensitivity
Non-surgical care
- SSRI first-lineSertraline, paroxetine - start low, titrate up
- CBT (gold standard)Interoceptive exposure, cognitive restructuring, breathing
- Short-term benzodiazepinesAlprazolam, clonazepam - acute 2–4 wk
- Exposure for agoraphobiaGraded exposure to avoided situations
- Avoid stimulantsStop coffee/energy drinks/cocaine
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Treatment-resistant panic disorder
Procedures that may be discussed
- SNRI (venlafaxine)
- TCA (clomipramine)
- MAOI (rarely)
Outlook
70–90% remission with CBT+SSRI. 30% chronic course.