Panic disorder in children and adolescents
, MD, Sidney Kimmel Medical College of Thomas Jefferson University
Panic disorders are rare in prepubertal children compared to adolescents.
Panic attacks can occur alone or with other anxiety disorders (e.g. agoraphobia, separation anxiety) or psychological disorders (e.g. OCD) or certain diseases (e.g. asthma). Panic attacks can trigger an asthma attack and vice versa.
Symptoms and discomfort
The symptoms of panic attacks include a sudden onset of intense anxiety, accompanied by somatic symptoms (e.g. palpitations, sweating, tremors, shortness of breath or shortness of breath, chest pain, nausea, dizziness). Compared to those in adults, panic attacks in children and adolescents are often even more dramatic on the outside (e.g. with screaming, crying and hyperventilation). This behavior can be alarming for parents and others.
Panic attacks develop spontaneously, but over time children begin to assign them to specific situations and environments. Affected children then try to avoid these situations, which can lead to agoraphobia. A child is diagnosed with agoraphobia when it is difficult to cope with everyday life (going to school, visiting a shopping center or other typical activities).
Clarification of other causes
Panic disorder is diagnosed based on a history of recurrent panic attacks, usually after a physical exam, to rule out physical causes of somatic symptoms. Many children are subjected to extensive diagnostic tests before a panic disorder is suspected to be the cause. The presence of other diseases, especially asthma, can make diagnosis even more difficult. A careful psychiatric examination should rule out other disorders (e.g. OCD, social anxiety disorder), since one of these disorders can be the primary problem and the panic attacks only the secondary.
In adults, the important diagnostic criteria for panic disorder include fear of the next panic attack, or concerns about its effects and a change in its behavior. However, children and younger adolescents generally lack the insight and experience to develop these concerns. However, they may change their behavior to avoid situations in which they fear a panic attack.
The prognosis is good with one treatment. If left untreated, adolescents may drop out of school, withdraw from society, become closed, and become suicidal.
The severity of panic disorders often increases and decreases for no apparent reason. Some patients are symptom-free for a long time and then suddenly relapse after years.
Usually benzodiazepines or SSRIs accompanied by behavior therapy
Treating panic disorder is usually a combination of medication and behavioral therapy. In children, it can even be difficult to start behavioral therapy before the panic attacks are controlled with medication.
Benzodiazepines are the most effective. However, SSRIs are often preferred because the benzodiazepines have a sedative effect and impair learning and memory. However, the SSRIs do not work quickly enough, and the short-term administration of benzodiazepines (e.g. lorazepam 0.5–2.0 mg po once or three times a day) can help to bridge the time until the SSRI is effective.
Panic attacks are characterized by a sudden increase in intense anxiety, accompanied by somatic symptoms.
Panic attacks in children and adolescents are often more dramatic (e.g. with screaming, crying and hyperventilation) than in adults.
The severity of panic disorders often increases and decreases for no apparent reason.
Treat panic disorders with benzodiazepines or SSRIs to control symptoms, then with behavioral therapy.
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