Adult panic anxiety syndrome is a psychiatric disorder characterized by recurrent and unpredictable panic attacks that may last an unpredictable length of time. Such attacks start with intense fear and apprehension, and may evolve into feelings of doom. There is no apparent cause for the symptoms, such as threat of danger or attack. Adult panic-anxiety syndrome appears to be, in a number of cases, caused by biochemical factors. However, like some other anxiety disorders, it may be inherited as an autosomal dominant trait.
The main feature of adult 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 adult 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.
Studies of many families whose members suffer from adult panic-anxiety attacks indicate that, for some people, there is evidence of an inherited component to this disorder. The genetic component is complicated, since genes active in this disorder have been tracked to sites on at least 4 or 5 chromosomes.
Chromosomes, which are present in the nucleus of human cells, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated “p” and a long arm designated “q”. Chromosomes are further sub-divided into many bands that are numbered. For example, “chromosome 22.q11.2” refers to band 11.2 on the long arm of chromosome 22 and chromosome 13q22-q32 refers to a region on the long arm chromosome 13 between bands 22 and 32. The numbered bands specify the location of the thousands of genes that are present on each chromosome.
Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother.
Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new mutation (gene change) in the affected individual. The risk of passing the abnormal gene from affected parent to offspring is 50 percent for each pregnancy regardless of the sex of the resulting child.
Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and, therefore, have an affected child is 25 percent with each pregnancy. The risk to have a child who is a carrier like the parents is 50 percent with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25 percent. The risk is the same for males and females.
All individuals carry a few abnormal genes. Parents who are close relatives (consanguineous) have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder.
Adult panic-anxiety syndrome affects females twice as often as males. Panic disorder affects between three and six million Americans.
Adult panic-anxiety syndrome may be treated with anti-anxiety drugs, antidepressants and/or one or another form of interpersonal psychological therapy. The drugs act upon the brain to decrease the number and intensity of these attacks.
The SSRIs (selective serotonin reuptake inhibitors) are the more commonly prescribed pharmaceuticals for adult panic-anxiety syndrome. If these are ineffective, anti-anxiety medications may be tried.
Among the anti-anxiety medications, the class of drugs known as benzodiaze-pines is frequently prescribed and of these, aprolazam (Xanax) is commonly used. Drugs of this class are addictive so that they must be used only for short periods. Great care must be exercised in prescribing these drugs for children and adolescents.
Behavioral therapies may be helpful and used to supplement drug therapy.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
For information about clinical trials sponsored by private sources, contact:
Research is ongoing into new therapies for the treatment of adult panic-anxiety syndrome. As of May 2006, there were 26 clinical trials involving adult panic-anxiety syndrome listed at www.clinicaltrials.gov.
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1513-15.
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:608-09.
RECENT REVIEW ARTICLES
Taylor CB. Panic disorder. BMJ. 2006;332:951-55.
Hollon SD, Stewart MO, Strunk D. Enduring effects for cognitive behavioral therapy in the treatment of depression and anxiety. Annu Rev Psychol. 2006;57:285-315.
Cayley WE Jr. Diagnosing the cause of chest pain. Am Fam Physician. 2005;72:2012-21.
Wetherell JL, Lenze EJ, Stanley MA. Evidence-based treatment of geriatric anxiety disorders. Psychiatr Clin North Am. 2005;28:871-96.
Brady KT, Verduin ML. Pharmacotherapy of comorbid of mood, anxiety, substance use disorders. Subst Use Misuse. 2005;40:2021-41, 2043-48.
FROM THE INTERNET
McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Panic Disorder 1; PAND1. Entry Number; 167870: Last Edit Date; 4/4/2006.
Panic Disorder – A Real Illness. National Institute of Mental Health (NIMH). October 2005. 10pp.
Smyth A. Panic disorder. MedlinePlus Medical Encyclopedia. Update date: 8/19/2004. 3pp.