PANIC DISORDER

INTRODUCTION:

  • It is defined by the 'presence of recurrent and unpredictable panic attacks, which are distinct episodes of intense fear and discomfort associated with a variety of physical symptoms'.
  • Panic attacks have a sudden onset, developing within 10 minutes and usually resolving over the course of an hour, and they occur in an unexpected fashion.
  • The frequency and severity of panic attacks vary, ranging from once a week to clusters of attacks separated by months of well-being.
  • Panic attack is Acute anxiety
  • Panic attack is associated with a disturbance in Serotonin, GABA,Dopamine, CCK, pentagastrin

SYMPTOMS:

  • palpitations,
  • Sweating,
  • Trembling,
  • Shortness of breath, chest pain, dizziness, and
  • A fear of impending doom or death
  • Agoraphobia associated with it
  • Paresthesias, gastrointestinal distress, and feelings of unreality are also common.
  • Presence of recurrent and unpredictable panic attacks, which are distinct episodes of intense fear and discomfort associated with a variety of physical symptoms, including palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and a fear of impending doom or death.
  • Paresthesias, gastrointestinal distress, and feelings of unreality are also common.
  • Panic attacks have a sudden onset, developing within 10 min and usually resolving over the course of an hour, and they occur in an unexpected fashion
  • The frequency and severity of panic attacks varies, ranging from once a week to clusters of attacks separated by months of well-being.
  • The first attack is usually outside the home.
  • Onset is usually in late adolescence to early adulthood.

TREATMENT

  • Achievable goals of treatment are to decrease the frequency of panic attacks and to reduce their intensity. The cornerstone of drug therapy is antidepressant medications.
  • The tricyclic antidepressant (TCA) agents imipramine and clomipramine can benefit 75 to 90% of panic disorder patients.
  • Selective serotonin reuptake inhibitors (SSRIs) are equally effective and do not have the adverse effects of TCAs. SSRIs should be started at one-third to one-half of their usual antidepressant dose (fluoxetine, sertraline, paroxetine).
  • Monoamine oxidase inhibitors (MAOIs) are at least as effective as TCAs and may specifically benefit patients who have comorbid features of atypical depression (i.e. hypersomnia and weight gain).
  • Because of anticipatory anxiety and the need for immediate relief of panic symptoms, benzodiazepines are useful early in the course of treatment.
  • Early psychotherapeutic intervention and psychoeducation aimed at symptom control enhances the effectiveness of drug treatment.
  • Behaviour therapy is useful in it

Exam Question

  • Sudden onset breathlessness, anxiety, palpitation & feeling of impending doom suggest panic attacks
  • Patient showing Chest pain, sweating, restlessness, dyspnoea, and palpitation which is asymptomatic with supportive measures is diagnosed to have panic disorder
  • Patient afraid of dying, experiencing chest pain, a sensation of choking, nausea, and tingling sensations, face is flushed and sweating, high pulse and respirations rate but 15 minutes later symptoms are dissipating & normal ECG suggest Panic disorder
  • Behaviour therapy is useful in panic disorder
  • Panic attack is Acute anxiety
  • Panic attack is associated with a disturbance in Serotonin, GABA,Dopamine, CCK, pentagastrin
  • SSRI is first line treatment for panic disorder
  • Agoraphobia associated with panic disorder
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