Panic disorder (PD)

Question 1

therapy goals

Answer 1

-reduce the severity & frequency of panic attacks
-reduce anticipatory anxiety & avoidant behavior
-minimize symptoms of depression or other comorbid disorders
-long-term goal is to achieve & maintain remission, and restore overall functioning

Question 2

treatment options

Answer 2

psychoteherapy, meds, or a combination of both

Question 3

agoraphobia

Answer 3

fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless or embarrassed

Question 4

_______ symptoms generally take longer to respond than _____ symptoms

Answer 4

agoraphobic | panic

Question 5

acute phase of PD tx lasts about

Answer 5

12 wks and should markedly reduce or eliminate panic attacks

con’t for an additional 12-14m before attempting discontinuation; if relapse, resume therapy

Question 6

non-pharmacologic therapy

Answer 6

avoid stimulating agents (decongestants, diet pills, and caffeine

Question 7

CBT therapy includes

Answer 7

psychoeducation, self-monitoring, countering anxious beliefs, exposure to fear cues, and modification of anxiety-maintaining behaviors

1st-line tx for PD

Question 8

exposure therapy useful for

Answer 8

pts w/ phobic avoidance

Question 9

pharmacologic therapy

Answer 9

SSRIs, SNRIs, TCAs, MAOIs, or benzodiazepines

SSRIs is the 1st choice*

Question 10

benzodiazepines

Answer 10

used concomitantly with antidepressants, especially early in treatment, or as monotherapy to acutely reduce panic symptoms

Question 11

pts with comorbid depression should be tx w/

Answer 11

antidepressant

Question 12

antidepressants

Answer 12

-req 4 wk for onset of antipanic effect
-optimal response at 6-12 wks
-more likely to experience stimulant-like side effects than pts w/ major depression

Question 13

do antidepressants require tapering off?

Answer 13

Yes (withdrawal sxs: irritability, dizziness, headache, and dysphoria

Question 14

SSRIs and SNRIs

Answer 14

-meds of choice
-venflafaxine xr 75-225mg/day = reduced panic and anticipatory anxiety in short-term (prevemted relapse w/ extended tx over 6m)

Question 15

3rd line of treatment

Answer 15

duloxetine

Question 16

MAOIs

Answer 16

reserved for patients who are refractory to other treatments
-significant side effects that limit adherence coupled with restrictions to avoid tyramine-containing foods and sympathomimetic drugs to prevent hypertensive crisis

Question 17

mirtazapine

Answer 17

considered a second-line option.17 There is insufficient evidence to support the use of bupropion, trazodone, or nefazodone for treatment of PD

Question 18

benzodiazepines

Answer 18

-effective antipanic agents with significant effects on anticipatory anxiety and phobic behaviors
-alprazolam: panic reduction after 1wk therapy

taper at a slower rate and over a long period of time