Panic Neurocircuitry
This brainstem nucleus is the main noradrenergic driver of the autonomic surge in panic.
What is the locus coeruleus?
Sudden, unexpected surges peaking within minutes, with ≥4 symptoms like palpitations and fear of dying.
What is a panic attack?
First step when a patient frames episodes with a cultural idiom of distress (e.g., “nerves”):
What is validate the experience and elicit the patient’s explanatory model before linking to treatment?
The two first-line maintenance treatments for panic disorder.
What are CBT with exposure and an SSRI/SNRI?
Minimum number of symptoms required for a DSM panic attack.
What is four?
This limbic structure tags threat and triggers fear learning; it’s hyper-reactive in panic.
What is the amygdala?
Recurrent unexpected attacks plus ≥1 month of persistent worry or maladaptive behavior change (e.g., avoidance).
What is panic disorder?
This stimulant commonly exacerbates panic symptoms and should be reduced/limited during treatment.
What is caffine
Typical onset of benefit for SSRIs in panic disorder (initial and fuller effect).
What is 2–4 weeks initial, up to 6–8 weeks for fuller effect?
The time course phrase that defines a panic attack’s rise and peak.
What is an abrupt surge that peaks within minutes?
This cortical region provides top-down regulation over amygdala reactivity; reduced control here worsens panic.
What is the medial prefrontal cortex?
Excessive anxiety/worry about multiple domains most days for ≥6 months with restlessness, tension, poor sleep.
What is generalized anxiety disorder (GAD)?
Name one practical lifestyle change that reliably reduces baseline anxiety arousal (non-pharmacologic).
What is regular aerobic exercise / sleep hygiene / nicotine reduction / limiting energy drinks?
Best acute in-clinic step once vitals/ECG are reassuring during a panic attack.
What is coach slow diaphragmatic breathing and provide reassurance?
The “second arm” of panic disorder criteria that must persist ≥1 month after attacks.
What is persistent concern about additional attacks or maladaptive behavior change?
This region encodes contextual memory of where panic occurred, contributing to situational avoidance.
What is the hippocampus?
Marked fear/avoidance of ≥2: public transport, open spaces, enclosed spaces, crowds/lines, being outside alone (≥6 months).
What is agoraphobia?
In some communities, family opinion strongly shapes help-seeking. One high-yield, non-stigmatizing way to include family without undermining autonomy:
What is ask permission to involve a trusted family member in psychoeducation and exposure planning?
Why benzodiazepine monotherapy is not recommended long-term in panic disorder.
What is risk of dependence and interference with exposure-based learning?
Panic attacks can occur across many mental disorders; the DSM uses this add-on label.
What is the panic attack specifier?
This cortical area integrates interoceptive signals (e.g., dyspnea, palpitations), amplifying bodily threat perception.
What is the insula?
Trauma exposure followed by intrusion, avoidance, negative mood/cognition, and arousal for >1 month.
What is post-traumatic stress disorder (PTSD)?
A patient uses “safety behaviors” (e.g., always calling someone during exposures). Why does this impair CBT progress?
What is safety behaviors prevent fear extinction by blocking disconfirmation of threat expectations?
A key CBT element that purposely brings on feared bodily sensations (e.g., spinning, straw breathing) to extinguish fear.
What is interoceptive exposure?
One exclusion criterion that helps distinguish panic disorder from medical/substance causes.
What is attacks not attributable to substances/medical conditions and not better explained by another mental disorder?