**3.1 Biological theories and pathophysiology of panic attacks and panic disorder**

From biological theories, there is a genetic predisposition and disturbance in the functioning of certain neurotransmitter systems in the brain (noradrenergic, serotonergic, dopaminergic, GABA). During panic attack an excessive vegetative reaction, with an increased tonus of sympathetic system is present, and also with increased catecholamine release [20].

The exact pathophysiology of PD is currently unknown. There are theories that functioning of serotonin, norepinephrine, dopamine and gamma-aminobutyric acid (GABA) neurotransmitter systems play a role [42].


## **3.2 Psychological theories**

As a special predisposing characteristic of people who are prone to the development of panic disorder, the existence of anxiety character is emphasized, which is manifest in childhood as a tendency to shame, cold and wet palms, fear of illness, constant need for support, hypersensitivity to the opinions of others, constant fear not to commit mistake, incompetence to accept responsibility, tranquility, scrupulousness, too high expectations of oneself.

Psychological theories speak of separation fears, the austerity of the release of sexual energy, the traumatized trauma, various misconceptions, or irrational thoughts, etc.


#### **3.3 Researches: causes for panic attack and panic disorder**

### *3.3.1 Genetic*

Several studies have shown that the risk of PD is eight times higher in those with first-degree relatives with PD compared to those with no family history [40, 55]. Recent studies examine twins and estimate that the heritability of panic disorder is 30–40%.

**119**

*Panic Attacks and Panic Disorder*

7.7/100 and 20.5/100 [66].

*3.3.2 Environmental*

*3.3.3 Other*

substance abuse.

seek help [27, 36, 43].

the most effective [3].

learn how to cope with them.

**5.1 Psychotherapy**

*DOI: http://dx.doi.org/10.5772/intechopen.86898*

with an increased risk of PD in adulthood [9, 10, 25].

**4. Complications of panic attacks and panic disorder**

with the onset of panic attacks and PD.

**5. Treatment for panic disorder**

A review of family and twin studies shows the highly familial nature of panic disorder and suggests evidence for a genetic etiology. The population-based lifetime rates of panic disorder cross-nationally range between 1.2/100 and 2.4/100, whereas, the lifetime rates in first-degree relatives of panic probands range between

Combination of genetic and environment interactions can produce panic disorder [60]. Major stress and temperament that is more sensitive to stress or prone to negative emotions are connected with a onset of PD including major life transitions such (graduating from college and entering the workplace, getting married, or having a baby), and other severe stress (death of a loved one, divorce, or job loss) [21]. The aversive childhood events such as physical or sexual abuse have been associated

Asthma and smoking also have been associated with an increased risk of PD [13, 28]. Panic attacks can also be caused by medical conditions and other physical causes like mitral valve prolapse or hyperthyroidism [2, 34]. Substance abuse, especially stimulants (amphetamines, cocaine, and caffeine), may also be connected

Complications that panic attacks and panic disorders may cause avoidance of social situations, problems at work or school, depression with suicidal thoughts,

The first contact of patient with PD usually is with a family physician. Due to the presence of numerous physical symptoms of panic attack, many people initially perform different somatic tests, from routine, to more complex, to internal and neurological examinations, and fail to timely initiate treatment. This is why the role of a family physician is important in recognizing and treating the disorder, or referring to a psychiatrist. Unfortunately only a minority of patients with panic disorder receive adequate care. One of the reasons is that about 50% of patients

Treatment of panic disorder should in no way be limited to providing first aid during panic attacks (usually by injection of diazepam intramuscularly as an emergency) without planning a targeted and ongoing treatment. The main treatment options are psychotherapy and medications. Combination of them is considered as

Psychotherapy can help to understand panic attacks and panic disorder and

#### *Panic Attacks and Panic Disorder DOI: http://dx.doi.org/10.5772/intechopen.86898*

A review of family and twin studies shows the highly familial nature of panic disorder and suggests evidence for a genetic etiology. The population-based lifetime rates of panic disorder cross-nationally range between 1.2/100 and 2.4/100, whereas, the lifetime rates in first-degree relatives of panic probands range between 7.7/100 and 20.5/100 [66].

### *3.3.2 Environmental*

*Psychopathology - An International and Interdisciplinary Perspective*

acid (GABA) neurotransmitter systems play a role [42].

trolled anxiety during panic attacks [24, 26].

lousness, too high expectations of oneself.

is "empty" through panic states.

other stressful situations.

**3.3 Researches: causes for panic attack and panic disorder**

increased catecholamine release [20].

**3.2 Psychological theories**

thoughts, etc.

*3.3.1 Genetic*

30–40%.

**3.1 Biological theories and pathophysiology of panic attacks and panic disorder**

From biological theories, there is a genetic predisposition and disturbance in the functioning of certain neurotransmitter systems in the brain (noradrenergic, serotonergic, dopaminergic, GABA). During panic attack an excessive vegetative reaction, with an increased tonus of sympathetic system is present, and also with

The exact pathophysiology of PD is currently unknown. There are theories that functioning of serotonin, norepinephrine, dopamine and gamma-aminobutyric

• The noradrenergic theory assumes that in PD presynaptic norepinephrine auto-receptors are hypersensitive to stimulation by norepinephrine [31].

• Other clinical studies demonstrate that medications increasing the synaptic availability of 5-HT, are effective in the treatment of PD. Rival theories of 5-HT deficiency vs. excess attempt to explain the impact of 5-HT function in PD [41].

• Researches are indicating that GABA may play a role—PD is a result of a lack of central inhibition and decreased GABA concentrations, leading to uncon-

As a special predisposing characteristic of people who are prone to the development of panic disorder, the existence of anxiety character is emphasized, which is manifest in childhood as a tendency to shame, cold and wet palms, fear of illness, constant need for support, hypersensitivity to the opinions of others, constant fear not to commit mistake, incompetence to accept responsibility, tranquility, scrupu-

Psychological theories speak of separation fears, the austerity of the release of sexual energy, the traumatized trauma, various misconceptions, or irrational

• Psychodynamic theory of panic attacks describes a state of regression in which a complete collapse of the defense defeats, anxiety overwhelms the person and

• Behavioral theory stresses that anxiety can be learned through the identification of the parent behavior model, then anxiety that develops after experiencing frightening stimuli, such as accidents, that are transmitted to other stimuli, as well as anxiety due to frustration that becomes a conditioned response to

Several studies have shown that the risk of PD is eight times higher in those with first-degree relatives with PD compared to those with no family history [40, 55]. Recent studies examine twins and estimate that the heritability of panic disorder is

**118**

Combination of genetic and environment interactions can produce panic disorder [60]. Major stress and temperament that is more sensitive to stress or prone to negative emotions are connected with a onset of PD including major life transitions such (graduating from college and entering the workplace, getting married, or having a baby), and other severe stress (death of a loved one, divorce, or job loss) [21]. The aversive childhood events such as physical or sexual abuse have been associated with an increased risk of PD in adulthood [9, 10, 25].

### *3.3.3 Other*

Asthma and smoking also have been associated with an increased risk of PD [13, 28]. Panic attacks can also be caused by medical conditions and other physical causes like mitral valve prolapse or hyperthyroidism [2, 34]. Substance abuse, especially stimulants (amphetamines, cocaine, and caffeine), may also be connected with the onset of panic attacks and PD.
