Panic Disorder

Question 1

Stahl and Moore, Chapter 9

Answer 1

1. Lifetime prevalence rates of panic disorder range from 1.4- 20.5%- due largely to the ages of the populations surveyed
   a. PD affects 5% of population in the US
2. Present a lot in non-psychiatric medical settings with medical complaints (p. 203).
   a. prevalence rates in primary care up to 7%
3. elevated PD found with comoribd respiratory disorders, vestibular dysfunction, hyper- and hypothyroidism.
4. True remission requires elimination of panic attacks and anticipatory anxiety, as well as a return to avoided situations

Treatments:

1. Antidepressants (SSRIs and then SNRIs)- “no compelling evidence suggesting the superiority of one agent or class over another p. 204).”
2. Benzodiazepines- alprazolam and clonazepam are FDA approved.
   a. often used as augmenting agents; concern about addiction and cogntion
3. Tricycle antidepressants- predates use of SSRIs; not really used now (clomipramine and imipramine
4. MAOIs- no controlled studies
5. RIMAs (reversible inhibitors of monoamine oxidase A
6. Anticonvulsants- a few studies conducted
   a. valproic acid and levetiracetam might be efficacious in PD
   b. studies failed to show efficacy for carbamazepine
   c. low doses of risperidone appear to be as efficacious as paroxetine (p. 206).
7. No overall evidence for the superiority of one of the three classes in the treatment of PD.
8. CBT- first line treatment for PD (psychoeducation, cognitive restructuring, and behavioral interventions).
   a. results maintained for a year
9. Psychodynamic - Panic focused psychodynamic psychotherapy is twice weekly, 12 weeks and manualized
   a. focuses on conflicts commonlnly found in PD
10. Brief exercise programs-short periods of moderate to vigorous exercise result in lower anxiety sensitivity which is a precursor to panic attacks and PD.
11. CBT is more cost-effective than pharmacotherapy and combined therapies.
12. Combination therapy (meds and psychotherapy).

Question 2

W Klugh Kennedy video on Panic Disorder

Answer 2

1. Lifetime prevalence of a panic attack is about 15%
2. Lifetime prevalence of panic disorder is about 2%.
3. Age of onset is late adolescence into 20’s.
4. 1 in 3 comorbid with clinical depression and 1/4 to 1/2 comorbid with agoraphobia.
5. higher morbidity and mortality rates.
6. 1st degree relative is at least 8 more likely to develop PD

Pathophysiology:

1. reduced volume in amygdala
2. decreased metabolism in amygdala, hippocampus, and thalamus
3. reduced BZD receptor density in peri-hippocampal and amygdala areas.
4. Reductions in 5HT1A receptor concentrations.
5. Noradrenergic Model- Locus ceruleus is hypersensitive- so alpha 2 noradrenergic receptors down regulated
6. catecholamine model- genetic polymorphism decreases the effect of COMT
7. GABA receptor model (benzos)- inhibitory neurotransmitter
8. Serotonin differences-