Symptoms, Types, and Etiology of Panic Disorder among Children - Essay Example

Panic Disorder INTRODUCTION Panic disorder is a form of psychiatric condition characterized as a part of anxiety disorders. According to Thom, children with this psychiatric condition undergo recurrent and unexpected moments of intense discomfort or fear, which abruptly develops and reaches its pick in less than 10 minutes. The discomfort or fear is often accompanied by other symptoms such as dyspnea, trembling, and an accelerated heart rate, just to mention a few (Thom n.pag.). The “panic attack” periods could last for hours or just a few minutes, and they often occur without warning. Children that develop such attacks may start to show anxiety most of the time, even when they are not under any attack. A number of these children may also start avoiding places and situations where they fear such panic attacks may take place. They may also avoid places where they feel helpless or spots where they anticipate finding no help in case of an attack. For example, a child may not want to go to school or public places or s/he may not want to be separated from the parents. The avoidance of places and/or situations is termed as “agoraphobia”, and it is a common accompanying characteristic of the disorder in children (Forrest n.pag.). A number of children with this disorder may become depressed and develop suicidal ideation. SYMPTOMS OF PANIC DISORDER AMONG CHILDREN The Fourth Edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-IV) is the basic criterion used to determine whether a child is experiencing a panic disorder. According to the DSM-IV a panic attack denotes a discrete episode in which a child experiences intense discomfort or fear (Ost & Treffers 294). In order for the discomfort and/or fear to constitute a panic attack, the child must also present four of the following cognitive or somatic symptoms. The cognitive signs and symptoms include a sense of losing control, going crazy, and a fear of dying. The somatic symptoms may include nausea, cold or hot flashes, trembling, sweating, numbing or tingling sensation, choking sensations, dizziness, chest pain, dyspnea, and pounding of the heart (Thom n.pag.). TYPES OF PANIC DISORDER According to the DSM-IV panic disorder devoid of agoraphobia and panic disorder with agoraphobia are classified differently. This classification was made by the American Psychiatric Association (APA) in 1994. However, prior to the DSM-IV, prior DSM editions termed the two conditions as the same. Therefore, there are two recognized types of panic disorder, and the distinction is whether the panic attacks are characterized by agoraphobia or not. The essential feature that determines the presence of agoraphobia is the presence of anxiety about being in a situation or a place where escape or help will be difficult to achieve (Forrest n.pag.). Children with agoraphobia tend to avoid certain situations and places. This may be exemplified by their urge to stay locked up at home or in their bedrooms. ETIOLOGY According to Medscape Reference, the onset of panic disorders is a result of a combination of elements, which may include biological, cognitive, psychological and social factors. A combination of biologic vulnerability, stressful events and circumstances in a child’s life has been hypothesized as the possible contributor to the development of the disorder. The temperamental style of behavioural inhibition characterized by avoidance of new stimuli has been cited as a risk factor for the development of panic disorders. Additionally, if the children’s parents are struggling with anxiety, then there is a high risk of children developing this anxiety disorder. Biologically, there is also a possible genetic link to the pre-disposure to anxiety. This has been supported by conducted twin studies (Forrest n.pag.). Apart from this biological link, the social influence of the surrounding, and especially parents, may contribute to the development of the disorder. Parents with anxiety may make a further contribution to high anxiety levels among their children through the modelling of maladaptive coping and anxious behaviour. This psychological influence contributes to the problem. However, the research has not proven that all children with anxious parents develop the disorder (Ost & Treffers 302). Other social factors that contribute to the development of the disorder include the occurrence of stressful events, high stress levels at home or learning institutions and insecure attachment patterns. This has been supported by the fact that the first attack is often preceded by stressful circumstances, such as a change of schools, a death of a parent, or any significant emotional trauma (Forrest n.pag.). THE AGE OF ONSET AND EPIDEMIOLOGY The rate of panic disorder occurrences before puberty is least understood, but somatic indications consistent with the attacks have been reported. The disorder is considered more prevalent during the young adulthood and adolescence. The peak start of the disorder is pegged at 15-19 years old, however; earlier occurrences are possible for children. The rate of occurrence of the disorder is an estimated 0.6% per cent among adolescents. Age Predilection: age estimates on the onset of the condition vary according to different studies. According to a 2001 study the mean onset age was 11.6-15.6 noticed in a number of sampled studies (Ost & Treffers 298). However, the disorder tends to be frequent during the young adulthood and late adolescence, with a peak of the onset at 15 – 19. Race and Gender Predilection: there are no known differences in occurrence based on race. However, the condition is less common in post-pubertal boys than post-pubertal girls. PROGNOSIS The prognosis of the disorder could worsen if parents do not assist with the children’s treatment. The parents’ absence due to the death could also lead to worsening of the condition if there is a lack of a guardian to appropriately oversee the treatment. The inability of parents to model adaptive coping or manage their anxiety because of their untreated psychiatric conditions or untreated anxiety could also worsen the state of a child (Forrest n.pag.). In a study consisting of a clinical sample of ten children that met the DSM-III-R for panic disorder, there was a recovery rate of 70% in a 3 to 4-year long period of follow up (Last et al. 1510). However, 30% per cent of the remaining children acquired new psychiatric disorders instead of recovering (Last et al. 1510). The outcome forms the worst prognosis for panic disorder with a start in childhood. However, the prognosis with the continued treatment is not known and may have turned favourable owing to the advances in psychotherapy and psychopharmacology. If there is a lack of intervention, children with the condition, especially the ones with co-morbid agoraphobia, may have a worsening of symptoms with time. Serious adverse effects include occupational, academic, and interpersonal impairments (Forrest n.pag.). TREATMENT There are two common approaches to the treatment. They include psychotherapy and a psychopharmacological approach. Under the psychopharmacological approach antidepressants, beta-blockers, and anti-anxiety medications (benzodiazepines) are commonly used (Ollendick, Mattis & King 145). Antidepressants are commonly used in the treatment of depression, but they can also be used in treating anxiety disorders such as panic disorder. Examples include Tofranil (imipramine). Benzodiazepines, which are anxiety disorder medications, are also used in treating the conditions, and a common example used is (Ativan) Lorazepam. The beta-blockers are commonly used in the control of the physical symptoms, which manifest in sweating and trembling (Ollendick et al. 146). Cognitive behavioural therapies are also employed under the psychotherapy approach in treating panic disorders. These approaches are meant to alter the false interpretation of somatic sensations that accompany the condition (Ollendick et al. 149) DIFFERENTIAL DIAGNOSIS Conditions considered in the differential diagnosis of the disorder include substance-induced anxiety disorder and anxiety disorder resulting from a general medical condition. In cases when a child develops anxiety disorder after taking a certain substance or drug, there is a high likelihood that the panic disorder is a result of the substance rather than an actual panic attack (Damsa, Lazignac & Iancu 407). Similarly the presence of other underlying medical conditions of a psychological nature may present signs and symptoms similar to a panic attack. Therefore, if these are earlier diagnosed, their presence would be an indicator that the attack is not a panic disorder. Works Cited Damsa, Christian, Lazignac, Coralie, & Ruhandra Iancu. "Panic Disorders: Differential Diagnosis and Care in Emergencies." Rev Med Suisse Journal, 4. 144 (2008): 404–6. Print. Forrest, Jeffrey S. “Pediatric Panic Disorder.” Medscape Reference, 16 Dec. 2011., n.pag. Web. 4 Apr. 2013. Last, Cynthia G., Perrin, Sean, Hersen, Michael, & Allan E. Kazdin. “A Prospective Study of Childhood Anxiety Disorders.” Journal of the American Academy of Child and Adolescent Psychiatry, 35.11(1996):1502-10. Print. Ollendick, Thomas H., Mattis, Sara G., & Neville J. King. “Panic in Children and Adolescents: A Review.” Journal of Child Psychology and Psychiatry, and Allied Disciplines, 35.1 (1994): 113-34. Print. Ost, Lars-Goran, and Philip D.A. Treffers. “Onset, Course, and Outcome for Anxiety Disorders in Children.” Anxiety Disorders in Children & Adolescent. Eds. Wendy K. Silverman & Philip D.A. Treffers. Cambridge: Cambridge University Press, 2001. 293-312. Print. Thom, Lindsay. “Childhood Panic Disorder.” Frostburg.edu, n.d., n.pag. Web. 4 Apr. 2013. Read More