Panic Disorder

Question 1

Prevalence

Answer 1

lifetime prevalence 1.5-3.7%.
2-3x more likely in women.
Bimodal age onset- 15-24 and 45-54.
Other facs- widowed/divorced, city, lim education, early parental loss, abuse.

Question 2

Px

Answer 2

Recurr attacks of sev anx not restric to partic sit so are unpredic. Secondary fear of dying, loss control, going mad. Us lasts mins. Often accomp by agoraphobia. 15% comorbid dep. 1st attack often spont.
-autonomic-
Tremor, tachyc and p, HTN, sweat, GI.
-worry about CVS or resp death.
-can be undiag in cases of unexplained medical symps eg CP, GI, fatigue, dizziness, headache etc.
-possible impulsivity incl suicide when v anx. Esp if dep or subst misuse.
-often other ADs comorbid eg agorophobia, OCD etc. Also subst misuse, BAD.

Question 3

Investigation

Answer 3

FBC, UE, gluc, TFT, ECG, toxicology, Ca.

Question 4

Mx

Answer 4

-bio- 
SSRI eg citalopram 1st line. 
Unlicensed- SNRI, TCA, MAOI, RIMA.
BDZ not NICE recomm. Possibly ST for sev. 
If succ, 12-18mnth trial. 
-psycho-
CBT- exposure, relaxat, educat.
Psychodynamic. 
Family therapy. 
Self help.
Prob solving.

Question 5

Cause

Answer 5

-bio-
Exagg post syn 5HT resp.
Incr adrenergic activ
Decr GABA R sensitivity
Aberrant metabolic activ induced by lactate
Genetic
False suffocation CO2 hypothesis
Overactive fear network anatomically.
-cbt theory- anx is resp learned from parent behav or classic cond.
-psychoanalytic theories- panic is unsucc defence ag anx provoking impulses.

Question 6

Prognosis

Answer 6

Often late to seek tx
Chronic if no tx
With tx functional recov in up to 75% in 1-2 yr.
LT 50% still get mild symps.
Poor facs- sev init, agoraphobia, low class, less educ, long time untx, poor support, PD.

Question 7

Diffs

Answer 7

Other AD
Subst misuse or withdrawal
Mood disorder
Endocrine eg carcinoid synd, cushings, hyperthyr, hypoglycaemia, hypoPTH, phaeochromo.
Haem eg anaemia
CVS eg arrhythmia, MV prolapse
Resp eg COPD, asthma, HVS
Neuro eg epilepsy

Question 8

Attack vs disorder

Answer 8

-panic attack-
Period intense fear. Symps peak 10 mins. Dont last over 30 mins. Spontaneous or situational. Rarely nocturnal or non fearful.
Symps eg palpitat, sweat, shaking, choking, CP, naus, dizzy, derealisatio, fear of losing control or going mad, fear of dying, parasthesia, chills or hot flushes.
-panic disorder-
Recurr attacks not due to subst misuse, medical cond, or other MH prob. Range of freqs lot per day to few per yr. us persis worry about attack and its conseqs. Sig behav change rel to attack.