Panic Disorder with or without Agoraphobia

Transcription

1 Panic Disorder with or without Agoraphobia LPT Gondar Mental Health Group

2 Panic Disorder With and Without Agoraphobia Panic disorder Panic versus anxiety Agoraphobia Agoraphobia without panic

3 3- Panic Disorder Panic attacks: periodic, short bouts of overwhelming panic - occur suddenly, reach a peak, and pass Fear: I ll die, go crazy, or lose control Dysfunctional changes in thinking & behaviour as a result of the attacks Worry persistently about having an attack

4 Panic Disorder w/ Agoraphobia Panic Disorder -accompanied by agoraphobia Greek = fear of the marketplace Afraid to leave home and travel to locations from where escape might be difficult or help unavailable Fear of having a panic attack in public - (humiliation, helplessness)

5 There are three types of Panic Attacks: 1. Unexpected - the attack "comes out of the blue" without warning and for no discernable reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel. 3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

6 Page 14 and 15 Classification

7 Symptoms Develop suddenly and reach peak in about 10 minutes Need 4 of 14 symptoms listed on page 15 In clinical settings agoraphobia may present in 75% of patients with panic disorder- see page 17 Panic disorder is common presentation in general medical settings- 13% in primary care may be due to physical nature of symptoms It is under recognised

8 Panic Disorder The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms: A feeling of imminent danger or doom The need to escape Palpitations Sweating Trembling Shortness of breath or a smothering feeling A feeling of choking Chest pain or discomfort Nausea or abdominal discomfort Dizziness or lightheadedness A sense of things being unreal, depersonalization A fear of losing control or "going crazy" A fear of dying Tingling sensations Chills or hot flushes

9 Assessment Need to distinguish between somatisation disorder and hypochondriasis Panic disorder may be complicated by comorbid conditions- other anxiety disorders, OCD, depression and alcohol abuse Difference from social phobia- focus of the patients core fears- in panic disorder main fear is of having panic attacks- in generalised anxiety disorder worry is about life events and stressors

10 Pathogenesis- Neurochemistry Patients have increased adrenergic activity ) Increased nor adrenalin= norepinephrine)- this system is implicated in the pathophysiology of fear. Serotonin involvement Involvement of GABA system- benzodiazepines block panic attacks, flumazenil induces panic attacks Lactate and CO2 can induce panic attacks Cardiovascular- decreased heart rate variability

11 Neuroanatomy- Important brain structures Amygdala- linked to fear and anxiety behaviours Locus coerulus- stimulation induces fear and anxiety A neuronal network involving hippocampus, the cortex and amygdala

12 Panic and the Brain

13 Management Aim to significantly reduce or eliminate panic attacks, avoidance and anticipatory anxiety and to treat and co morbid conditions Co morbid conditions will affect choice of treatment e.g. If significant depression use antidepressants, if substance abuse avoid benzodiazepines

14 Pharmacotherapy Selective serotonin reuptake inhibitors ( SSRIs) Tricyclic antidepressants ( TCAs) most researched imipramine and clomipramine Do you remember the side effect profile of these drugs? Benzodiazepines- clonazepam and alprazolam used- diazepam also effective- problems with dependence and tolerance Anticonvulsants- valproate and gabapentin effective- carbamazepine is not.

15 Treatment refractory panic disorder Need to find out reason for treatment failure E.g. Comorbid depression, substance misuse, non compliance, medical disorders

16 Cognitive behavioural model of panic disorder Panic attacks are a part of fight or flight alarm system Alarm reactions can happen unexpectedly and in the absence of external danger and may become objects of fear themselves Fear of fear cycle p33

17 Panic control treatment Education about anxiety and panic Identification and correction of maladaptive thoughts ( cognitive restructuring) Training in arousal reduction techniques Graded exposure to bodily sensations Combined treatments CBT and phamacotherapy common. Psychodynamic therapies less used.

18 Panic Disorder: The Cognitive Theory of Panic

19 Provided by The Leicester Gondar Link Collaborative Teaching Project This work is licensed under a Creative Commons Attribution-NonCommercial- NoDerivs 3.0 Unported License.