[7] Panic Disorder Flashcards

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1
Q

What is panic disorder?

A

Panic disorder is a condition characterised by recurrent, episodic, severe panic attacks, which are unpredictable and not restricted to any particular situation or circumstance

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2
Q

What factors play a role in the development of panic disorder?

A

Biological and cognitive factors, as well as the presence of life stressors

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3
Q

What biological factors are involved in the development of panic disorder?

A
  • Genetics
  • Neurochemical abnormality
  • SNS
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4
Q

What neurochemical abnormality is involved in the development of panic disorder?

A

Post-synaptic hypersensitivity to serotonin and adrenaline

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5
Q

How is the SNS involved in the development of panic disorder?

A

The SNS is stimulated by fear or worry, causing cardiac output to increase, which can lead to further anxiety

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6
Q

Why are cognitive factors important in panic disorder?

A

They are important in the development and propagation of the disorer

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7
Q

Give an example of a cognitive factor that may contribute to a panic disorder

A

Misinterpretation of somatic symptoms

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8
Q

What are the risk factors for panic disorders?

A
  • Family history
  • Major life events
  • 20-30 years old
  • White ethnicity
  • Asthma
  • Cigarette smoking
  • Medication, e.g. benzodiazepine withdrawal
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9
Q

What are the symptoms of panic disorders?

A
  • Palpitation
  • Abdominal distress
  • Numbness/nausea
  • Intense fear of death
  • Choking feeling
  • Chest pain
  • Sweating
  • Shaking
  • Shortness of breath
  • Depersonality
  • Derealisation
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10
Q

How long do the symptoms of panic disorders last?

A

They usually peak within 10 minutes, and rarely persist beyond an hour

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11
Q

What are the ICD-10 diagnostic criteria for panic disorder?

A

Recurrent panic attacks that are not consistently associated with a specific situation or object, and often occur spontaneously. They are not associated with marked exertion or with exposure to dangerous or life threatening situations, They must be characterised by;

  • Discrete episodes of intense fear or discomfort
  • Abrupt start
  • Reaches a crescendo within a few minutes, and leasts at least some minutes
  • At least one symptom of autonomic arousal - palpitations, sweating, shaking/tremor, dry mouth
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12
Q

What investigations are done into panic disorders?

A
  • History
  • MSE
  • Blood tests - FBC, TFTs, glucose
  • ECG - may show sinus tachycardia
  • Questionnaires - GAD-2, GAD-7, Beck’s Anxiety Inventory
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13
Q

What are the differential diagnoses of panic disorder?

A
  • Other anxiety disorders, e.g. generalised anxiety disorder, phobic anxiety disorder
  • Dissociative disorder
  • Bipolar affective disorder
  • Depression
  • Schizophrenia
  • Adjustment disorder
  • Phaeochromocytoma
  • Hyperthyroidism
  • Hypoglycaemia
  • Carcinoid syndrome
  • Arrhythmias
  • Alcohol/substance withdrawal
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14
Q

What is the first line treatment for panic disorder?

A

SSRI

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15
Q

What is the second line treatment for panic disorder?

A

TCAs, e.g. imipramine or clomipramine

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16
Q

When should TCAs be used?

A

If SSRIs are not suitable, or there is no improvement after 12 weeks

17
Q

Should benzodiazepines be used in panic disorder?

A

No

18
Q

What is the psychological intervention of choice in panic disorder?

A

CBT

19
Q

What self-help methods can be employed in panic disorder?

A
  • Bibliotherapy
  • Support groups
  • Encouraging exercise
20
Q

What is Stepped Care Approach in panic disorder?

A
  1. Recognition and diagnosis - making the diagnosis, and identifying the common co-morbidities, such as depression and substance misuse
  2. Treatment in primary care - includes recommendations for psychological therapies, medications, and self-help strategies
  3. Review, and consider alternative treatments - reassessment and consideration of alternative treatments if initial therapy has failed
  4. Review and referral to specialist mental health services - if two interventions have been offered, and there is no improvement in symptoms, then referral should be made to specialists
  5. Care in specialist mental health services