Panic disorder and fear

Panic, fear and anxiety is a highly prevalent mental illness nowadays. One of the most important features of anxiety or panic comes in the form of sudden seizures causing shortness of breath, rapid heartbeat, trembling hands, lack of physical energy and a sense of weakness, tension, exaggerated fear; yet the patient tends to relate his panic attacks to a specific subject such as congestion, hospitals, open spaces, mixing with people, separation from a particular person, heights or flying, and many other reasons.

Anxiety and fear are normal physical reactions, were at most of the time and medication or medical help shouldn’t be taken, but if anxiety and fear are causing damage to the patient’s family, social, and practical life, we can classify it as a mental illness. At this stage you should consult a doctor and start taking medications in addition to psychological rehabilitation and many ways to treat stress and anxiety.

According to the fifth diagnostic and statistical guide for mental disorders, fear and anxiety disease is divided into several types, the most important types are:

Separation anxiety disorder

Excessive anxiety or fear resulting from patient’s separation from home, relative or anything related to him strongly.

Selective silence

Selective or optional silence is complete silence in the case of shame, confusion from the society and friends. Children between 4 and 8 years of age are clearly affected. Selective or optional silence in children is manifested to fear and anxiety followed by social isolation and loneliness and sometimes insistence on an opinion, nervousness or aggression.

Specific phobia

It’s a panic or a feeling of fear of something specific such as heights, congestion, socializing with people, facing the crowd, spiders and insects, examinations and tests in addition to the opposite gender. The cause may be associated from a past trauma were it can occur at any age.

social phobia

It’s a feeling of anxiety, fear and shyness due to the fear observation from others. The patient feels confused when meeting others and believes they are monitoring his actions and words causing for him tension and increased heartbeats with rapid breathing, which causes the patient to leave the meeting.

Panic Disorder

Can be recognized as unexpected frequent panics that suddenly comes in seizures accompanied with sweating, increased heartbeats, shortness of breath, a sense of death, trembling limbs and possibly fainting. Panic disorder often appears in adolescents and the elderly.

Agoraphobia

It is an anxiety caused by being in places where the patient feels insecure, open areas or a closed market maybe overcrowded. In other words, anxiety and phobias resulting from insecurity, where the patient feels that he is alone without assistance, away from sources of help, in a place without psychological support, which causes him/her confusion to the extent of escaping to a safe place.

General anxiety

It is general anxiety and fear. The word general means that there is no place or thing that causes anxiety, but it is an anxiety and fear of several things. Generalized anxiety disorder appears in children and at puberty as well that maybe accompanied by obsessive-compulsive disorder or bipolar disorder, making it difficult to be treated.

Treatment

An international review of the psychiatrists managements for patients with generalized anxiety disorder reported that the preferred medicines therapies are off the first steps of treatment were selective serotonin re-uptake inhibitors (SSRIs) (80%), followed by serotonin re-uptake inhibitors (SNRIs) (43%), and pregabalin (35%) are given. Preferred second-step medicines were serotonin and noradrenaline uptake inhibitors (41%) and pregablin (36%).

  • Selective serotonin reuptake inhibitors

Medicines treatment for generalized anxiety disorder include selective serotonin reuptake inhibitors (SSRIs). This is the preferred first step of treatment. Serotonin retardant inhibitors used for this purpose include acetalopram and paroxetine.

Common side effects include: Nausea, ED, headache, diarrhea, constipation, insomnia, increased risk of suicide in young people and adolescents, overdose of these drugs can lead to serotonin syndrome.

  • Benzodiazepines:

Benzodiazepines are often prescribed for people with generalized anxiety disorder. Researchers showed that these medicines give some relief at least in the short term. However, they have some risks such as cognitive and motor impairment in addition to psychological and physical addiction that makes it difficult for patients to stop them.

‏It was noted that people taking benzodiazepines are not in good condition at work or school. In addition, these medications may impair the ability to drive and are often associated with falls and tripping for the elderly, leading to fractures of the hip bones.

These disadvantages make the use of benzodiazepines restricted to alleviate short-term anxiety. CBT and medications have similar efficacy in the short term, but CBT has benefits over a long-term than  medications.

Benzodiazepines are quick acting hypnotics, performing as tranquilizers that are also used to treat generalized anxiety disorder and other anxiety disorders where it shows beneficial short-term effects.

‏Benzodiazepines to be used for this purpose includes alprazolam, lorazepam, and clonazepam. The WCC doesn’t recommend long-term use of benzodiazepines as they are associated with the development of addiction, cognitive impairments, memory impairment, and withdrawal syndrome. Side effects does  include drowsiness, a decrease in motor coordination and problems with balance.

  • Gabapentin and pregablin

Pregabalin (Lyrica) works on calcium channels to reduce the release of neurotransmitters such as glutamate and norepinephrine, where their therapeutic effect appears after a week of use and they are similar in efficacy to lorazepam, alprazolam, and venlafaxine; but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for symptoms of psychological and physical anxiety.

Long-term trials have shown continuous efficiency without engaging in symptoms of addiction, in addition to that; unlike benzodiazepines, they do not interfere with sleeping and how it produces less cognitive, motor and psychological impairment, as they also have a low risk of abuse usage and maybe preferred over benzodiazepines for these reasons. The effects of anxiety removal after pregabalin appear quickly after administration, closer to benzodiazepines at the start time (perhaps an hour slower), giving pregabalin an advantage over many antidepressant medications such as antidepressants.

‏Gabapentin (Neurontin), is a medicine closely associated with pregabalin with the same mechanism of action, which also showed efficancy in the treatment of generalized anxiety disorder, although, unlike pregabalin, it is not specifically approved for this purpose.

However, they are likely to be of similar benefits in controlling this disorder, as they have the advantage of being much less expensive in comparison. Accordingly, gabapentin is often prescribed off-label for the treatment of GAD.

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