[7] Panic Disorder Flashcards
What is panic disorder?
Panic disorder is a condition characterised by recurrent, episodic, severe panic attacks, which are unpredictable and not restricted to any particular situation or circumstance
What factors play a role in the development of panic disorder?
Biological and cognitive factors, as well as the presence of life stressors
What biological factors are involved in the development of panic disorder?
- Genetics
- Neurochemical abnormality
- SNS
What neurochemical abnormality is involved in the development of panic disorder?
Post-synaptic hypersensitivity to serotonin and adrenaline
How is the SNS involved in the development of panic disorder?
The SNS is stimulated by fear or worry, causing cardiac output to increase, which can lead to further anxiety
Why are cognitive factors important in panic disorder?
They are important in the development and propagation of the disorer
Give an example of a cognitive factor that may contribute to a panic disorder
Misinterpretation of somatic symptoms
What are the risk factors for panic disorders?
- Family history
- Major life events
- 20-30 years old
- White ethnicity
- Asthma
- Cigarette smoking
- Medication, e.g. benzodiazepine withdrawal
What are the symptoms of panic disorders?
- Palpitation
- Abdominal distress
- Numbness/nausea
- Intense fear of death
- Choking feeling
- Chest pain
- Sweating
- Shaking
- Shortness of breath
- Depersonality
- Derealisation
How long do the symptoms of panic disorders last?
They usually peak within 10 minutes, and rarely persist beyond an hour
What are the ICD-10 diagnostic criteria for panic disorder?
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
What investigations are done into panic disorders?
- History
- MSE
- Blood tests - FBC, TFTs, glucose
- ECG - may show sinus tachycardia
- Questionnaires - GAD-2, GAD-7, Beck’s Anxiety Inventory
What are the differential diagnoses of panic disorder?
- 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
What is the first line treatment for panic disorder?
SSRI
What is the second line treatment for panic disorder?
TCAs, e.g. imipramine or clomipramine
