O '''Transtorno do Pânico''' ou '''Síndrome do Pânico''' é uma condição mental psiquiátrica que faz com que o indivíduo tenha ataques de pânico esporádicos, intensos e muitas vezes recorrentes.

== Sintomas ==

Indivíduos com o transtorno do pânico geralmente têm uma série de episódios de extrema ataques de pânico. Tais eventos podem durar de alguns minutos a horas, e podem variar em intensidade e sintomas específicos no decorrer da crise (como rapidez dos batimentos cardíacos, experiências psicológicas como medo incontrolável, etc.).

Alguns indivíduos enfrentam esses episódios regularmente &ndash; algumas vezes diariamente ou semanalmente. Os sintomas externos de um ataque de pânico geralmente causam experiências sociais negativas como estigma social, ostracismo, etc.). Como resultado disto, boa parte dos indivíduos que sofrem de transtorno do pânico também desenvolvem agorafobia.

== Ocorrência ==

O transtorno do pânico é um sério problema de saúde mas pode ser tratado. Geralmente ela é disparada em jovens adultos; cerca de metade dos indivíduos que têm transtorno do pânico o manifestam antes dos 24 anos de idade, mas algumas pesquisas indicam que a manifestação ocorre com mais freqüência dos 25 aos 30 anos. Mulheres são duas vezes mais propensas a desenvolverem o transtorno do pânico do que os homens.

O transtorno do pânico pode durar meses ou mesmo anos, dependendo de como e quando o tratamento é realizado. Se não tratado, pode piorar a ponto de afetar seriamente a vida social do indivíduo, que tenta evitar os ataques e acaba os tendo. De fato, muitas pessoas tiveram problemas com familiares ou perderam o emprego em decorrência do transtorno do pânico. Alguns indivíduos podem manifestar os sintomas freqüentemente durante meses ou anos, e então passar anos sem qualquer sintoma. Em outros, os sintomas persistem indefinidamente. Existe também algumas evidências de que muitos indivíduos &ndash; especialmente os que desenvolvem os sintomas ainda jovens &ndash; podem parar de manifestar os sintomas naturalmente numa idade mais avançada (depois dos 50 anos). É importante, entretanto, não alterar qualquer tratamento ou medicação em andamento sem um acompanhamento médico especializado.

Para indivíduos que procuram tratamento ativo logo no início, grande parte dos sintomas pode desaparecer em algumas poucas semanas, sem quaisquer efeitos negativos até o final do tratamento.

Transtorno do Pânico é 100% curável.

== Tratamento ==

O transtorno do pânico é real e potencialmente incapacitante, mas pode ser controlado. Em decorrência dos sintomas perturbadores que acompanham o transtorno do pânico, este pode ser confundido com alguma outra salas de emergência quando estão tendo ataques de pânico, e muitos exames podem ser feitos para descartar outras possibilidades, gerando ainda mais ansiedade.

O tratamento do transtorno do pânico inclui profissionais de saúde mental que tipicamente acompanham um indivíduo no tratamento do transtorno do pânico são os conselheiros de saúde mental e assistentes sociais. Para prescrever um tratamento medicamentoso para o transtorno do pânico, o indivíduo deve procurar um médico (geralmente um psiquiatra).

A psicoterapia é tipicamente assistida por um psiquiatra ou um psicólogo. Em áreas remotas, onde um profissional especializado não está disponível, um médico de família pode se responsabilizar pelo tratamento. O psiquiatra é, por formação, o mais preparado para a prescrição de medicamentos, e deve ser o profissional escolhido caso haja disponibilidade.

Medicamentos ou técnicas modernas podem ser utilizadas para quebrar a conexão psicológica entre uma fobia específica e os ataques de pânico. Tais procedimentos podem incluir:

{{Infobox_Disease
 | Name           = Panic disorder
 | Image          = 
 | Caption        = 
 | DiseasesDB     = 30913
 | ICD10          = 
 | ICD9           = , 
 | OMIM           = 
 | MedlinePlus    = 
 | eMedicineSubj  = 
 | eMedicineTopic = 
 | MeshID         = D016584 }}

'''Panic Disorder''' is a psychological and psychiatric condition characterized by recurring panic attacks in combination with significant behavioral change or at least a month of ongoing worry about the implications or concern about having other attacks.(DSM-IV)

==Symptoms==

Panic Disorder sufferers usually have a series of intense episodes of extreme rapid heartbeat, perspiration, trembling, psychological experience of uncontrollable fear, etc.).  Some individuals deal with these events on a regular basis&mdash;sometimes daily or weekly. The outward symptoms of a panic attack often cause negative social experiences (i.e. embarrassment, social stigma, social isolation, etc.). However, experienced sufferers can often have intense panic attacks with very little outward manifestations of the attack occurring.  As many as 36% of all individuals with Panic Disorder also have agoraphobia.

Limited symptom attacks are similar to panic attacks, but have fewer symptoms.  Most people with PD experience both panic attacks and limited symptom attacks.

==Occurrence==
Panic Disorder is a serious health problem but can be successfully treated. It is estimated that up to 1.7 percent of the adult American population has Panic Disorder at some point in their lives. It typically strikes in early adulthood; roughly half of all people who have Panic Disorder develop the condition before age 24, especially if the person has been subjected to a traumatic experience. However, some sources say that the majority of young people affected for the first time are between the ages of 25 and 30. Women are twice as likely as men to develop Panic Disorder.<ref></ref>

Panic Disorder can continue for months or even years, depending on how and when treatment is sought.  If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal the condition. In fact, many people have had problems with friends and family or employment while struggling to cope with Panic Disorder.  Some people with Panic Disorder may begin to lie to conceal their condition.  In some individuals symptoms may occur frequently for a period of months or years, then many years may pass symptom-free.  In others, the symptoms persist at the same level indefinitely.  There is also some evidence that many individuals (especially those who develop symptoms at an early age) may experience a cessation of symptoms naturally later in life (i.e. past age 50).

==Substance Abuse and Panic Disorder==
A growing body of evidence exists that shows a link between substance abuse and panic disorder. Several studies have found that cigarette smoking increases the risk of panic attacks and Panic Disorder in young people.<ref>Johnson, J. G., Cohen, P., Pine, D. S., Klein, D. F., Kasen, S., & Brook, J. S. (2000). Association between cigarette smoking and Anxiety Disorders during adolescence and early adulthood. JAMA: Journal of the American Medical Association, 284(risk of panic: Findings from a prospective community study. Archives of General Psychiatry, 60(7), 692-700. </ref><ref>Goodwin, R. D., Lewinsohn, P. M., & Seeley, J. R. (2005). Cigarette smoking and panic attacks among young adults in the community: The role of parental smoking and anxiety disorders. Biological psychiatry, 58(9), 686-693. </ref> While the mechanism of how smoking increases panic attacks is not fully understood, a few hypotheses have been derived. Smoking cigarettes may lead to panic attacks by causing changes in respiratory function (e.g. feeling short of breath). These respiratory changes in turn can lead to the formation of panic attacks, as respiratory symptoms are a prominent feature of panic.<ref>Breslau, N., & Klein, D. F. (1999). Smoking and panic attacks: An epidemiologic investigation. Archives of General Psychiatry, 56(12), 1141-1147.</ref><ref>Johnson, J. G., Cohen, P., Pine, D. S., Klein, D. F., Kasen, S., & Brook, J. S. (2000). Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. JAMA: Journal of the American Medical Association, 284(18), 2348-2351. </ref> Respiratory abnormalities have been found in children with high levels of anxiety, which suggests that a person with these difficulties may be susceptible to panic attacks, and thus more likely to subsequently develop Panic Disorder. Nicotine is also a stimulant which could contribute to panic attacks.<ref>Pine, D. S., Klein, R. G., Coplan, J. D., Papp, L. A., Hoven, C. W., Martinez, J., et al. (2000). Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group. Archives of General Psychiatry, 57(10), 960-967. </ref><ref>Gorman, J. M., Kent, J., Martinez, J., Browne, S., Coplan, J., & Papp, L. A. (2001). Physiological changes during carbon dioxide inhalation in patients with panic disorder, major depression, and premenstrual dysphoric disorder: Evidence for a central fear mechanism. Archives of General Psychiatry, 58(2), 125-131. </ref>
 
Deacon and Valentiner (2000)<ref>Deacon, B. J., & Valentiner, D. P. (2000). Substance use and non-clinical panic attacks in a young adult sample. Journal of substance abuse, 11(1), 7-15. </ref> conducted a study that examined co-morbid panic attacks and substance use in a non-clinical sample of young-adults who experienced regular panic attacks. The authors found that compared to healthy controls, therapeutic alcohol and sedative use was greater for non-clinical participants who experienced panic attacks. These findings are consistent with the suggestion made by Cox, Norton, Dorward, and Fergusson (1989)<ref>Cox, B. J., Norton, G. R., Forward, J., & Fergusson, P. A. (1989). The relationship between panic attacks and chemical dependencies. Addictive Behaviors, 14(1), 53-60. </ref> that Panic Disorder patients self-medicate if they believe that certain substances will be successful in alleviating their symptoms. If Panic Disorder patients are indeed self-medicating, there may be a portion of the population with undiagnosed Panic Disorder who will not 
seek professional help as a result of their own self-medication. In fact for some patients, Panic Disorder is only diagnosed after they seek treatment for their self-medication habit.<ref>Cox, B. J., Norton, G. R., Swenson, R. P., & Ender, N. S. (1990). Substance abuse and panic-related anxiety: A critical review. Behaviour research and therapy, 28(5), 385-393. </ref>

==Panic Disorder in Children==
A retrospective study has shown that 40% of adult Panic Disorder patients reported that their disorder began before the age of 20.<ref>Moreau, D. L. & Follet, C. (1993). Panic disorder in children 
and adolescents. Child Adolesc Psychiatr Clin N Am, 2, 581-602.</ref> In an article examining the phenomenon of Panic Disorder in youth, Diler et al. (2004)<ref>Diler, R. S., Barmier, B., Brent, D. A., Axel son, D. A., Firinciogullari, S., Chiapetta, L., et al. (2004). Phenomenology of panic disorder in youth. Depression and anxiety, 20(1), 39-43.</ref> found that only a few past studies have examined the occurrence of juvenile Panic Disorder. They report that these studies have found that the symptoms of juvenile Panic Disorder almost replicate those found in adults – e.g. heart palpitations, sweating, trembling, hot flashes, nausea, abdominal distress, and chills.<ref>Alessi, N. E. & Magen, J. (1988). Panic disorders in 
psychiatrically hospitalized children. American Journal of Psychiatry, 145, 1450-1452.
</ref><ref>Biederman, J., Faraone, S. V., Marrs, A., & Moore, P. (1997). Panic disorder and agoraphobia in consecutively referred children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 36(2), 214-223.</ref><ref>Essau, C. A., Conradt, J. & Petermann, F. (1999). Frequency of 
panic attacks and panic disorder in adolescents. Depression and Anxiety, 9, 19-26.
</ref><ref>King, N. J., Gallone, E., Tonge, B. J. & Ollendick, T. H. 
(1993). Self reports of panic attacks and manifest anxiety in adolescents. Behavioural Research Therapy, 31, 111-116.
</ref><ref>Macauly, J. L. & Kleinknecht, R. A. (1989). Panic and panic 
attacks in adolescents. Journal of Anxiety Disorders, 3, 221-241.
</ref> The anxiety disorders co-exist with staggeringly high numbers of other mental disorders in adults.<ref>de Reiter, C., Rifkin, H., Garssen, B., & Van Schawk, A. (1989). Comorbidity among the anxiety disorders. Journal of anxiety disorders, 3(2), 57-68. </ref>  The same comorbid disorders that are seen in adults are also reported in children with juvenile Panic Disorder. Last and Strauss (1989)<ref>Last, C. G., & Strauss, C. C. (1989). Panic disorder in children and adolescents. Journal of anxiety disorders, 3(2), 87-95. </ref> examined a sample of 17 adolescents with Panic Disorder and found high rates of comorbid anxiety disorders, major depressive disorder, and conduct disorders. Eassau et al. (1999)<ref>Essau, C. A., Conradt, J. & Petermann, F. (1999). Frequency of 
panic attacks and panic disorder in adolescents. Depression and Anxiety, 9, 19-26.
</ref> also found a high number of comorbid disorders in a community-based sample of adolescents with panic attacks or juvenile Panic Disorder. Within the sample, adolescents were found to have the following comorbid disorders: Major Depressive Disorder (80%), Dysthymic Disorder (40%), Generalized anxiety disorder (40%), Somatoform Disorders (40%), substance abuse (40%), and specific phobia (20%). Consistent with this previous work, Diler et al. (2004) found similar results in their study in which 42 youths with juvenile Panic Disorder were examined. Compared to non-panic anxiety disordered youths, children with Panic Disorder had higher rates of comorbid Major Depressive Disorder and Bipolar Disorder. 

Despite the evidence pointing to the existence of early onset Panic Disorder, the DSM-IV-TR currently only recognizes six anxiety disorders in children: Separation Anxiety Disorder, Generalized Anxiety Disorder, specific phobia, Obsessive-Compulsive Disorder, Social Anxiety Disorder (a.k.a. social phobia), and Post-traumatic Stress Disorder. Panic Disorder is notably excluded from this list. 

It is also well documented that a person who experiences panic attacks during childhood increases the likelihood of experiencing other anxiety disorders and major depression later in life.<ref>Andrade, L., Eaton, W. W., & Chilcoat, H. D. (1996). Lifetime co-morbidity of panic attacks and major depression in a population-based study: Age of onset. Psychological medicine, 26(5), 991-996. </ref><ref>Regier, D. A., Rae, D. S., Narrow, W. E., Kaelber, C. T., & Schatzberg, A. F. (1998). Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry. Special Issue: Recognition and Management of Anxiety Syndromes, 173(Suppl 34), 24-28. </ref><ref>Goodwin, R. D., & Gotlib, I. H. (2004). Panic attacks and psychopathology among youth. Acta Psychiatrica Scandinavica, 109(3), 216-221. </ref>. Age of onset also appears to impact the occurrence of comorbid disorders.<ref>Goodwin, R., Lipsitz, J. D., Chapman, T. F., Mannuzza, S., & Fyer, A. J. (2001). Obsessive-compulsive disorder and separation anxiety co-morbidity in early onset panic disorder. Psychological medicine, 31(7), 1307-1310.</ref> In a study examining children of Panic Disorder patients, Goodwin et al. (2001) found that an early onset of Panic Disorder is associated with increased co-morbid occurrences of Obsessive-Compulsive Disorder, and Separation Anxiety Disorder. In a study conducted by Biederman, Rosenbaum, Bolduc, and Faraone (1991)<ref>Biederman, J., Rosenbaum, J. F., Bolduc, E. A., & Faraone, S. V. (1991). A high risk study of young children of parents with panic disorder and agoraphobia with and without comorbid major depression. Psychiatry research, 37(3), 333-348. </ref>, the authors found that parental Panic Disorder with Agoraphobia increased the risk of their children developing an anxiety disorder later in life. Interestingly, while parental Panic Disorder with Agoraphobia increased the risk of Major Depressive Disorder developing in their offspring, parental depression alone did not increase the risk of their children developing other anxiety disorders. This finding is further supported with later work done by Biederman et al. (2006)<ref>Biederman, J., Petty, C., Faraone, S. V., Henin, A., Hirshfeld-Becker, D., Pollack, M. H., et al. (2006). Effects of parental anxiety disorders in children at high risk for panic disorder: A controlled study. Journal of affective disorders, 94(1), 191-197. </ref> in a 5-year longitudinal follow-up study. The authors suggest that the high prevalence of several anxiety disorders in children of Panic Disorder patients provides evidence for a general “anxiety proneness” that may be transmitted from parent to offspring. It was also found that Separation Anxiety Disorder, Specific Phobia and Generalized Anxiety Disorder were the most common anxiety disorders found in the children of parents with Panic Disorder, which is consistent with the findings of Lipsitz, Martin, Mannuzza, and Chapman (1994)<ref>Lipsitz, J. D., Martin, L. Y., Mannuzza, S., & Chapman, T. F. (1994). Childhood separation anxiety disorder in patients with adult anxiety disorders. American Journal of Psychiatry, 151(6), 927-929. </ref>, who suggested that Separation Anxiety Disorder may be a specific precursor to the development of Panic Disorder later in life. The results of Beiderman et al. (2006) show a pattern in the development of Panic Disorder in which a string of precursor disorders emerge, starting with Separation Anxiety Disorder that eventually progresses to Panic Disorder. For the children in the study, the median age for the first anxiety disorder was 4 years of age. It is clear that not only does Panic Disorder appear to occur in children, but the consequences of early onset Panic Disorder can extend beyond the disorder itself.

==Treatment==
Panic Disorder is real and potentially disabling, but it can be controlled and successfully treated. Because of the intense symptoms that accompany Panic Disorder, it may be mistaken for a life-threatening physical illness. This misconception often aggravates or triggers future attacks. People frequently go to hospital emergency rooms when they are having panic attacks, and extensive medical tests may be performed to rule out these other conditions, thus creating further anxiety. 

The current treatment suggested by the mental health counselors, and general practice physician ("family doctor") may be competent to manage the pharmacological ("medications") treatment in coordination with a psychologist or LCSW.  A psychiatrist is, by training, better prepared than a general practice physician in pharmacological treatment and should be sought out if available.  A psychologist is not a medical doctor and cannot prescribe medication.  

Medications can be used to break the psychological connection between a specific phobia and panic attacks.. Medications can also be used to treat Panic Disorder.  Medications can include:
* SSRIs, MAOIs, etc.): these are taken regularly every day, and build a resistance to the occurrence of the symptoms.  Although these medications are described as "antidepressants", nearly all of them have anti-panic properties as well—many panic sufferers do not have classical symptoms of depression, and may be misled by the name "antidepressant" into believing these drugs are not targeted to their symptoms, when they are often the most effective treatment in combination with psychotherapy.
* Anti-anxiety drugs (benzodiazepines): these drugs are taken during or at the onset of panic attacks or before challenging/anxiety provoking situations. Some sufferers also take them daily to prevent panic attacks from occurring. These drugs may be habit-forming. They are often most effective at the beginning of treatment when the resistance properties of the antidepressants have not yet built up, and are generally utilized less and less as other parts of the treatment (antidepressants, psychotherapy) become more effective.

A panel of over 50 peer-nominated internationally recognized experts in the pharmacotherapy of anxiety and depression judged benzodiazepines, especially combined with an antidepressant, as the mainstays of pharmacotherapy for anxiety disorders.<ref> Uhlenhuth EH, Balter MB, Ban TA, Yang K (1999). "International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997". Depress Anxiety 9 (3): 107–16. PMID 10356648.</ref><ref> </ref><ref> </ref><ref> </ref>

Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety, benzodiazepines have remained a mainstay of anxiolytic pharmacotherapy due to their robust efficacy, rapid onset of therapeutic effect, and generally favorable side effect profile.<ref>  </ref> 
Treatment patterns for psychotropic drugs appear to have remained stable over the past decade, with benzodiazepines being the most commonly used medication for panic disorder.<ref> </ref>

In the case of Panic Disorder with Agoraphobia, multiple exposures to the phobia trigger without a resulting panic attack (due to medication or relaxation training) can often break the phobia-panic pattern, allowing people to function around their phobia without the help of medications. Minor phobias can often be eliminated without medication through monitored cognitive-behavioral therapy or simply by exposure.

Usually, a combination of psychotherapy and medications produces good results. Some improvement may be noticed in a fairly short period of time—about 6 to 8 weeks. Often, it may take longer to find the right pair of medications and mental health professional. Thus appropriate treatment by an experienced professional can prevent panic attacks or at least substantially reduce their severity and frequency—bringing significant relief to 70 to 90 percent of people with Panic Disorder.<ref></ref> Relapses may occur, but they can often be effectively treated just like the initial episode.

In addition, people with Panic Disorder may need treatment for other emotional problems. suicide attempts are more frequent in people with panic disorder, although this research remains controversial. More extensive treatment is required for people with treatment-resistant Panic Disorder, which may not respond to many drug and behavior therapies.

Experimental treatment for Panic Disorder has included nutritional consultation and the use of substances such as inositol, amino acid gamma-aminobutyric acid (GABA), glycine, glutamine, and the calming amino acid L-theanine. Treatment with GABA is both questionable and controversial, as orally ingested GABA cannot cross the blood-brain barrier. Orthomolecular therapy useful in the treatment of depression or which enhances the healthy functioning of the brain may have a role in the treatment of this condition. 
About 30% of people with panic disorder use alcohol and 17% use psychoactive drugs.<ref></ref>  This is in comparison with 61% (alcohol)[http://www.cdc.gov/nchs/fastats/alcohol.htm] and 7.9% (other psychoactive drugs) [http://www.cdc.gov/nchs/fastats/druguse.htm] of the general population who use alcohol and psychoactive drugs, respectively.  It often varies between individual cases whether any observed drug use worsens the condition, or is initiated by the sufferer to alleviate the condition ("marijuana present a special case—at low doses there may be some anti-anxiety psychological effects comparable to those of benzodiazepines, whereas at some undefined threshold (as dose is increased), marijuana has been shown to produce extreme anxiety on its own, with an intensity potentially comparable to that of the Panic Disorder symptoms themselves.[http://www.yale.edu/opa/newsr/04-06-14-01.all.html] However, generally only new marijuana users experience anxiety because they are not used to their heart rate temporarily being increased.[http://homepages.poptel.org.uk/DrDrew/health.html#mind]

As with many disorders, having a support structure of family and friends who understand the condition can help increase the rate of recovery. During an attack, it is not uncommon for the sufferer to develop irrational, immediate fear, which can often be dispelled by a supporter who is familiar with the condition. For more serious or active treatment, there are support groups for anxiety sufferers which can help people understand and deal with the disorder.