Introduction
Anxiety is an alerting signal, which enables a person to become prepared to deal with a threat. Every person experiences anxiety during stressful situations in life. Normal anxiety is a diffuse, unpleasant vague sense of apprehension, which subsides easily. But anxiety becomes pathological, when it interferes with day to day activities of an individual, or necessitates treatment
Panic disorder is a common anxiety disorder. Life time prevalence is 1.5 to 5%. It is twice more common in women than in men.
Significance of Panic disorder in Pregnancy
Several studies have shown that the intrauterine environment can be altered by maternal anxiety which will affect the fetal growth and development. The sympathetic activation and elevated cortisol level during panic attacks will contribute to increased uterine artery resistance. The elevated maternal cortisol during anxiety can also have a direct adverse effect on the development of fetal brain. The antenatal panic disorder is also associated with an amplification of physical symptoms in pregnancy. Panic disorder in pregnancy if not managed at the earliest will have adverse consequences not only for the mother’s health, but also for the developing fetus. Later the mother child interactions will also be negatively influenced.
Aetiology and Pathogenesis of Panic disorder
The major neurotransmitter systems implicated are those for norepinephrine, serotonin and GABA. The limbic system, the prefrontal cortex as well as the noradrenergic neurons of locus ceruleus and the serotonergic neurons of the median raphe nucleus are responsible for the generation of panic attacks. The autonomic nervous system of patients with panic disorder has been reported to exhibit increased sympathetic tone and to respond excessively to emotional stimuli.
Psychoanalytic theories conceptualize panic attacks as arising from an unsuccessful defense against anxiety provoking impulses. Psychodynamic exploration of patients with panic disorder frequently reveals a clear psychological trigger for the panic attacks. The pathogenesis of panic attacks is related to neurophysiologic factors triggered by the emotional problems.
Clinical Features and Diagnosis of Panic Disorder
Panic attack is a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach the peak with in 10 minutes.
• Palpitation
• Sweating
• Trembling
• Sensation of shortness of breath
• Feeling of choking
• Chest pain or chest discomfort
• Nausea or abdominal distress
• Feeling dizzy or unsteady
• Derealisation or depersonalization.
• Fear of losing control
• Fear of dying
• Chills or hot flushes
Panic disorder is diagnosed when a person develops recurrent unexpected panic attacks and has persistent concern about having additional attacks.
Course and Prognosis of Panic disorder
Panic disorder has its onset during late adolescence. If not managed at the earliest it can have a chronic relapsing course. Patient with good premorbid functioning and a brief duration of symptoms tend to have good prognosis.
Treatment of Panic Disorder
Pharmacotherapy can have adverse effect on fetal growth. Hence the preferred treatment for panic disorder in pregnancy is psychological therapy. Several studies have shown that cognitive behavior therapy is effective in producing long lasting remission of symptoms in panic disorder. Relaxation therapy, insight oriented psychotherapy and family therapy are also effectively used in the management of panic disorder in pregnancy. Early diagnosis and management will also help in preventing further panic attacks. Through Life Skills Training to manage the emotional stressors of pregnant women, we can improve maternal health which in turn will lead to better mother child bonding in future life.
Conclusion
Women are at increased risk for panic disorder. Pregnancy contributes to the preponderance of vulnerability to panic disorder. Untreated panic disorder will have far reaching detrimental effects on maternal and child health. Hence panic disorder in pregnancy should be diagnosed and managed scientifically at the earliest. Psychological therapies have an important role in the management of panic disorder in pregnant women.