Panic disorder Flashcards
When can’t give propanolol?
Low HR, low BP
Asthma
Medication options for panic disorder
Propanolol - symptomatic
SSRIs - long term
Severe - benxos short term, antipsychotics
Symptoms of panic disorder
Palpitations or increased heart rate
Sweating
Trembling
Sensations of shortness of breath
Feelings of choking
Chest pain
Nausea or abdominal distress
Feelings of dizziness or light-headedness
Chills or hot flushes
Tingling or lack of sensation in extremities (i.e., paraesthesias)
Depersonalization or derealization
Fear of losing control or going mad
Fear of imminent death
What is panic disorder?
Panic disorder is characterised by recurrent unexpected panic attacks that are not restricted to particular stimuli or situations. In addition, panic disorder is characterised by persistent concern about the recurrence or significance of panic attacks, or behaviours intended to avoid their recurrence, that results in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.The symptoms result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.The symptoms result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.
What is a panic attack?
Panic attacks are discrete episodes of intense fear or apprehension accompanied by the rapid and concurrent onset of several characteristic symptoms (e.g. palpitations or increased heart rate, sweating, trembling, shortness of breath, chest pain, dizziness or lightheadedness, chills, hot flushes, fear of imminent death)
What ass condition is ass with more severe and prolonged panic disorder?
Agoraphobia
What are adolescents with panic disorder at higher risk of?
Suicidality, depressive disorder, substance abuse
Stepped care for people with panic disorder
- Step 1 – recognition and diagnosis
- Step 2 – treatment in primary care
- Step 3 – review and consideration of alternative treatments
- Step 4 – review and referral to specialist mental health services
- Step 5 – care in specialist mental health services.
What to do if a patietn presents to A+E with a panic attack?
DO ALL APPROPRIATE PHYSICAL INVESTIGATIONS
Appropriate written info about sources of support including local and national voluntary and self help groups
Referred to primary care
Step 2 - what offer mild to moderate panic disorder
Low intensity interventions:
Individual non facilitated or facilitated self help
Info about support groups
Exercise benefits
Step 2 - what offer mild to moderate panic disorder
Low intensity interventions:
Individual non facilitated or facilitated self help
Info about support groups
Exercise benefits
Step 3 for panic disorder - moderate to severe panic disorder with or without agrophobia - management
CBT or
Antidepressant
Conditions for offering antidepressant for panic disorder in step 3
Long standing disease
Declined or not benefitted from psycholigcal intervention
What length of CBT sessions should be offered for panic disorder?
7-14 hours
What is contraindicatied in panic disorder medication wise?
Benzodiazapines - worse outcomes long term
Sedating antihistamines or antipsychotics
