4. Panic Disorder

Question 1

Describe the mechanism of GABA agonists

Answer 1

Binds GABA-BDZ receptor complex = enhanced GABA

Question 2

Give examples of benzodiazepines (GABA agonists)

Answer 2

Diazepam

Lorazepam

Question 3

What are the ADRs of benzodiazepine?

Answer 3

Drowsiness, dizziness, psychomotor impairment

Tolerance = need to increase dose to achieve the same effect

Withdrawal = insomnia, agitation, anxiety

Question 4

How can benzodiazapine be toxic?

Answer 4

Cleft lip/palate if used in preg

If taken late in preg = resp depression, feeding diff in baby

Question 5

How is a benzodiazepine overdose treated?

Answer 5

Flumazenil = antagonist/partial inverse agonist at BDZ receptors may be useful in reversing effects

Question 6

What is panic disorder?

Answer 6

Anxiety disorder characterized by reoccurring unexpected severe panic attacks, which are unpredictable and not related to a particular situation

Question 7

How does panic disorder present?

Answer 7

Palpitations

Dizziness

Dyspnoea

Sweating

Shaking

SOB

Numbness

Anxiety

+/- agoraphobia

Question 8

How should suspected panic disorder be diagnosed?

Answer 8

The ICD-10 diagnostic criteria:
The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.

The dominant symptoms include:

• sudden onset of palpitations
• chest pain
• choking sensations
• dizziness
• feelings of unreality (depersonalization or derealization)
• secondary fear of dying, losing control, or going mad

Question 9

Outline the best management for panic disorder

Answer 9

CBT

1st line: SSRIs (if not suitable or no improvement after 12w then TCA clomipramine)

ACUTE - benzo

Beta-blockers - propranolol can make Sx worse!!!