During the onset, the individual suffers from the physical and emotional short-term effects mentioned in the previous sections. Headaches, discomfort and lightheadedness are also common.
References Debate continues about whether panic disorder should be treated initially with cognitive therapy or cognitive-behavioral therapy, pharmacotherapy or a combined approach. Although acute treatment effect sizes may vary between treatment options, physicians and patients must consider several factors that go beyond success rates in acute treatment when selecting treatment.
These decisions involve weighing the advantages and disadvantages of each treatment option and how well the options match the patient's presentation, preferences, and personal and financial resources. Although treatment selection guidelines vary, some considerations can be offered.
Regarding the choice of pharmacologic treatment, an evidenced-based approach suggests that the SSRIs are an appropriate first consideration. Although tricyclic antidepressants show similar success rates for acute treatment, their side-effect burden has been greater than that of SSRIs.
A high-potency benzodiazepine given at the minimum therapeutic dose may be a useful adjunct to antidepressant therapy if prompt relief is indicated. However, the treatment plan should include discontinuing the benzodiazepine when the antidepressant's maximal effects are expected i.
Although benzodiazepines are considered an appropriate intervention after SSRIs and tricyclic antidepressants have failed, they should not be prescribed if a history of or current comorbid substance abuse is suspected or if the patient shows comorbid depression.
MAOIs are also an appropriate consideration when comorbid depression or social phobia is evident, although they remain a second choice given the risks they pose. Cognitive-behavioral therapy is an appropriate first-line consideration in patients with mild to moderate panic disorder or panic disorder with situational avoidance.
Although benzodiazepines can be combined temporarily with cognitive-behavioral therapy for prompt relief of severe symptoms, they have been known to interfere with cognitive-behavioral therapy, so their adjunctive use should be minimized.
In situations where severe agoraphobic avoidance precludes participation in cognitive-behavioral therapy, consideration should be given to the combined use of SSRI or tricyclic antidepressant pharmacotherapy with cognitive-behavioral therapy.
Cognitive-behavioral therapy has also been effective in patients who do not respond to pharmacotherapy and can be used in this role as well.
Acute relapse is common when pharmacotherapy for panic disorder is discontinued. Other considerations for selecting a first-line treatment include the patient's preference for an approach that includes medication versus one that does not, as well as the availability of cognitive-behavioral treatment in the community.
Once treatment is selected, patients should be monitored periodically.
When stabilized, patients should be encouraged to reenter previously avoided situations gradually, regardless of the treatment approach being used. If the treatment response is inadequate after approximately eight weeks of therapy, alternatives should be reconsidered.
Finally, patients with panic disorder often need sensitive clinical management. Many of these patients have been ill for several years and tend to have a history of varied, ineffective and failed treatments.
Establishing a therapeutic alliance with patients, as described in Table 8is an important aspect of any treatment selected. Provide the patient with some knowledge about panic disorder e. Discuss the components of panic disorder panic attacks, anticipatory anxiety and avoidance and how treatment targets changes in each component.
Explore and discuss patient's concerns about medications. Explain treatment options and their advantages and disadvantages. Read the full article. Get immediate access, anytime, anywhere.
Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue.Treatment begins with an explanation of what maintains panic, or what keeps it going.
It is thought that people who have PD(A) experience a "catastrophic misinterpretation" of normal bodily sensations (e.g. a pounding heart is a sign of an impending heart attack).
Generalized anxiety disorder has symptoms that are similar to panic disorder, obsessive-compulsive disorder and other types of anxiety, but they're all different conditions. Living with generalized anxiety disorder can be a long-term challenge.
Panic attack treatment can be hindered by deep breathing. Diaphragmatic breathing during panic attacks can increase symptoms & worsen anxiety.
Overweight women limited their weight gain with a diet and exercise program during pregnancy, but it did not lower their rate of complications like gestational diabetes. Panic Disorder (Characterized by Anxiety or Panic Attacks) Fear and worry are the two chief characteristics of panic disorder.
Even with the absence of actual danger, affected individuals undergo physical reactions, such as nausea, heavy breathing and shaking, as if some sort of threat is imminent. To learn more about panic disorder and agoraphobia, check out the lesson Panic Disorder & Agoraphobia: Symptoms, Causes and Treatment.
This lesson covers the following objectives: Determine what.