Essential Information for Patient and Family

• Panic is common and effective treatments are available.
• Anxiety often produces frightening physical symptoms. Chest pain, dizziness, or shortness of breath are not necessarily signs of another disease, they will pass when anxiety is controlled.
• Panic anxiety also causes frightening thoughts (fear of dying, a feeling that one is going mad or will lose control.) These also pass when anxiety is controlled.
• Mental and physical anxiety reinforce each other. Concentrating on physical symptoms will increase fear.
• Do not withdraw from or avoid situations where attacks have occurred; this will strengthen the fear.
  

Specific Counselling to Patient and Family

• Advise the patient to take the following steps if a panic attack occurs:
  • stay where you are until the attack passes
  • concentrate on controlling anxiety, not on medical worries.
• practice slow, relaxed breathing. Breathing too deeply or rapidly (hyperventilation) can cause some of the physical symptoms of panic. Controlled breathing will reduce physical symptoms.
• Tell yourself that this is a panic attack and that frightening thoughts and that sensations will soon pass. Note the time passing on your watch. It may feel like a long time but it will be only a few minutes.
• Discuss ways to challenge these fears during panic (Patient tells himself "I am not having a heart attack. This is a panic attack, and it will pass in a few minutes") See cognitive therapy.
• Identify exaggerated fears which occur during panic (e.g. patient fears that he/she is having a heart attack) and challenge them (cognitive therapy).
• Self-help groups may help the patient manage panic symptoms and overcome fears.
  

Medication

• Many patients with panic will not need medication.
• For patients with infrequent attacks, occasional use of anti-anxiety medication may be helpful (e.g. diazepam 5-10mg). Regular use may lead to dependence and is likely to result in the return of panic symptoms when discontinued.
• If attacks are frequent or severe, or if significant depression is present, antidepressant may be helpful (e.g. imipramine 25 mg at night increasing to 75-150 mg at night after 2 weeks or sertraline 25-100mg or paroxetine 10-40mg daily).
• Avoid unnecessary medical tests or therapies.
  

Specialist Consultation

• Consider specialist consultation if severe attacks continue after the above treatments.
• Referral for cognitive behavioural therapy, may be effective for patients who do not improve.
• Panic commonly causes physical symptoms. Avoid medical consultation for exaggerated medical worries.

What a doctor might say to a person with an panic disorder