$Unique_ID{BRK04081} $Pretitle{} $Title{Panic-Anxiety Syndrome} $Subject{Panic-Anxiety Syndrome Panic Disorder Anxiety State Anxiety Neurosis} $Volume{} $Log{} Copyright (C) 1986, 1988, 1989 National Organization for Rare Disorders, Inc. 286: Panic-Anxiety Syndrome ** IMPORTANT ** It is possible the main title of the article (Panic-Anxiety Syndrome) is not the name you expected. Please check the SYNONYMS listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Panic Disorder Anxiety State Anxiety Neurosis General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Panic-Anxiety Syndrome is a psychiatric disorder characterized by recurrent and unpredictable anxiety attacks with no apparent cause for the symptoms, such as threat of danger or attack. Symptoms The main feature of Panic-Anxiety Syndrome is the recurrence of panic attacks. Psychological symptoms may include intense apprehension, unreasonable fear of dying or impending doom, fear of becoming insane, or dread of losing control of the self. Physical manifestations are generally those commonly associated with panic or anxiety such as difficulty in breathing, irregular heartbeat, sweating, trembling and faintness. In addition, patients may experience chest pain, feelings of unreality, abnormal sensations (burning or pricking), dizziness, or hot and cold flashes. The symptoms usually become apparent in late adolescence or early adulthood. Attacks, which can occur at any time, usually last only minutes, though in rare cases they may last hours. Complications may develop from the symptoms associated with the disorder. Agoraphobia, the fear of being in public places, may result from the patient's apprehensions about losing control. Between attacks patients affected with Panic-Anxiety Syndrome can suffer from symptoms of nervousness, caused by fear of future attacks; these symptoms include a tensing of the muscles, increased blood pressure and heart rate. Patients may turn to abuse of alcohol or anxiety relieving medications to alleviate their constant nervousness. The result may be Depressive Disorders which can further complicate treatment. Causes Panic-Anxiety Syndrome is believed to be caused by biochemical factors, though the specific cause of the disorder is not yet known. The disorder is possibly caused by excessive secretion of the neurohormone norepinephrine, which stimulates the autonomic nervous system. Another possible cause is a hypersensitivity to lactates (a substance which usually accumulates during physical exertion). Also, studies with caffeine have suggested a link in some cases between Panic-Anxiety Syndrome and abnormalities in the neural systems involving adenosine (a chemical in the body related to caffeine). Researchers have been able to trigger panic attacks in patients by exposing them to carbon dioxide or other substances normally not found in the brain. In 1988, researchers reported that a brain chemical known as cholecystokinin (given to patients intravenously) could trigger panic attacks 20 seconds after injection. It is not clear whether panic anxiety syndrome may be caused by a surge in the natural level of cholecystokinin, or whether brains of people with this disorder are abnormally sensitive to it. Affected Population Panic-Anxiety Syndrome tends to affect females more commonly than males. Related Disorders Different Phobias can cause physical symptoms similar to Panic-Anxiety Syndrome, but they occur only in response to specific stimuli. Panic-Anxiety Syndrome may be differentiated by the unpredictability of the anxiety attacks. Withdrawal from some drugs such as barbiturates and substance intoxications (such as caffeine or amphetamines), may also produce symptoms of Panic Disorder. Generalized Anxiety Disorder is symptomatized by chronic anxiety, like that experienced between anxiety attacks in Panic-Anxiety Syndrome. Panic- Anxiety Syndrome may be distinguished from Generalized Anxiety Disorder by the recurrence of fits of panic. Finally, patients with other mental disorders such as Schizophrenia, Major Depression, or Somatization Disorder may experience symptoms of panic attacks. Therapies: Standard Primarily, there are two drugs used to treat Panic-Anxiety Syndrome: alprazolam and imipramine hydrochloride. Alprazolam acts as a tranquilizer and reduces the patient's hypersensitivity to lactate. The therapeutic efficacy of imipramine hydrochloride, on the other hand, has been linked to its inhibitory effect on norepinephrine (a neurotransmitter associated with anxiety or tension) turnover. Therapies: Investigational Research is ongoing into new therapies for the treatment of Panic-Anxiety Syndrome. This disease entry is based upon medical information available through June 1988. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Panic-Anxiety Syndrome, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 Anxiety Disorders Association of America 6000 Executive Blvd., Suite 200 Rockville, MD 20852 (301) 231-9350 Mental Health Association 1021 Prince St. Alexandria, VA 22314 National Alliance for the Mentally Ill 1901 N. Fort Meyer Dr., Suite 500 Arlington, VA 22209 (703) 524-7600 National Mental Health Consumer Self-Help Clearinghouse 311 S. Juniper St., Rm. 902 Philadelphia, PA 19107 (215) 735-2481 NIH/National Institute of Mental Health (NIMH) 9000 Rockville Pike Bethesda, MD 20205 (301) 443-4515 or (301) 496-1752 (800) 421-4211 (24 hrs.) References DIAGNOSTIC AND STATISTICAL MANUAL OF PSYCHIATRIC ILLNESS; 3rd ed.: Robert L. Spitzer, et. al. eds; American Psychiatric Association, 1980. Pp. 230-2. NEUROENDOCRINE CORRELATES OF LACTATE-INDUCED ANXIETY AND THEIR RESPONSE TO CHRONIC ALPRAZOLAM THERAPY; D. B. Carr et al.: American Journal of Psychiatry, April 1986; 143(4): Pp. 483-494. NORADRENERGIC FUNCTION AND THE MECHANISM OF ACTION OF ANTIANXIETY TREATMENT; D. S. Charney and G. R. Heninger: Archives of General Psychiatry, May 1985, 42(5): Pp. 473-481. INCREASED ANXIOGENIC EFFECTS OF CAFFEINE IN PANIC DISORDERS; D. S. Charney et al.: Archives of General Psychiatry, March, 1985; 42(3): Pp. 233-243.