Panic Disorders (Quiz 2) Flashcards
T/F? Patients with panic disorder take more disability days than those with diabetes, cardiac disease, or renal disease.
True
How much more do patients with panic disorder utilize primary care than other patients?
3x more
What percentage of people have experienced an anxiety disorder in their lifetime? In the last 12 months?
- 9%
17. 2%
What is the most common anxiety disorder?
Social phobia
What is the least common anxiety disorder?
Panic disorder
Rank the following disorders from most to least prevalent. Panic disorder Social phobia Simple phobia GAD
Social phobia
Simple phobia
GAD
Panic disorder
Criteria for a panic attack includes _____ or more of the panic attack symptoms that develop abruptly and peak within _____ minutes.
4
10
What are the panic attack symptoms?
There are a lot, sorry
Palpitations Sweating Trembling SOB Feeling of choking Chest pain Nausea Dizzy Derealization Fear of losing control/going crazy Fear of dying Paresthesias Chills or hot flashes
Panic disorder criteria
Recurrent, unexpected panic attacks
No organic factor
Panic attacks not accounted for by another disorder
At least 1 of the attacks followed by a month of more of: concern for additional attacks, worry about implications or consequences of attacks, significant change in behavior related to the attacks.
Top 5 panic disorder symptoms for men
Heart pounding Sweating Perceive time slower/quicker Chest pain trembling/shaking
Top 5 panic disorder symptoms in women
Heart pounding Trembling/shaking Perceive time slower/quicker Sweating Chest pain
What cardiac condition is associated with panic disorder?
PSVT-67% met criteria for panic disorder in a study
The treatment for PSVT is ablation. Does this also treat the panic disorder?
Yes
Differential diagnosis of panic disorder?
Endocrine disorders Vestibular dysfunction Seizure disorders CNS stimulants or depressants Cardiac conditions Hypoglycemia
First line options for treatment of panic disorder?
SSRIs and SNRIs
T/F? SNRIs, SSRIs, TCAs, and benzos are all comparable in their efficacy for panic disorder?
True
Why are SSRIs or SNRIs preferred over TCAs and benzos for treatment of panic disorder?
Side effect profile of SSRIs and SNRIs are better
Nonpharmacologic treatment for panic disorder?
CBT
What benzodiazepines can be used to treat panic disorder?
Alprazolam (Xanax)
Clonazepam (Klonopin)
Benefits of benzos in treatment of panic disorder?
Short latency of onset
Lack of antidepressant side effects
Can be used as needed
Easy to add to SSRIs SNRIs
Drawbacks of using benzos in panic disorder?
Sedation
Discontinuation difficulties
Potential for abuse
Not effective for comorbid depression
Benefits of SSRIs in treatment of panic disorder?
Low cardiovascular effects
Absence of anticholinergic activity or weight gain
Low overdose and seizure potential
Drawbacks of SSRIs in panic disorder?
Initial anxiety and jitteriness
Nausea, nervousness, insomnia, sexual dysfunction, and headache are common
Benefits of combining antidepressants with benzos for treatment of panic disorder?
Provides rapid anxiolysis during antidepressant lag
decrease early anxiety associated with initiation of antidepressant
How would you discontinue a benzo in a patient with dependence?
Start antidepressant and maximize effect over 12 weeks
Reduce benzo gradually by 10-20% at 2-4 week intervals
May substitute a long acting for a shorter acting benzo
What can patients with agoraphobia have fear or anxiety about?
Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of home alone
Criteria to diagnose agoraphobia?
2 or more of the following: Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of home alone
Patient fears of avoids these situations
Diagnosed irrespective of the presence of panic disorder
Panic disorder can be comorbid with what conditions?
MDD
Irritable bowel syndrome
Bipolar disorder
What are the benefits of providing patient education to patients with panic disorder?
Education alone may relieve some symptoms of panic disorder
2 most common errors made by anxious patients?
Blowing things out of proportion
Jumping to conclusions
If first line treatment of panic disorder is unsuccessful, what can you do next?
Switch to another first line treatment
Add a benzo
Monotherapy or augmentation with gabapentin or a second generation antipsychotic
What other medications can be used to treat panic disorder when patients have failed treatment of several standard treatments?
Mirtazipine
Anticonvulsants such as gabapentin
What is the most common anxiety disorder in bipolar patients?
Panic disorder
What needs to be done before giving a patient with bipolar and panic disorder an antidepressant?
Mood stablization
What type of antidepressants are best in patients with Bipolar and panic?
SSRIs or TCAs
SSRIs
What medication prevents lactate induced panic attacks?
Divalproex
How long should treatment of panic be continued before considering discontinuation?
Why?
At least 1 year to promote further symptom reduction and decrease risk of recurrence
What therapy can be added to facilitate withdrawal from benzos?
CBT
