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Panic Disorders 惊恐病(Reading & Sharing)

Panic disorders aren’t diagnosed after one panic attack. According to Ferri (2018), a person is diagnosed with a panic disorder when they have exhibited a minimum of two panic attacks followed by worrisome behaviors about any future attacks for at least a month if not longer. Panic attacks can be very disabling for those who suffer from them and may even cause them to avoid specific places or situations where they are not able to easily escape. This behavior is referred to as agoraphobia. This diagnosis is typical for onset in women around the age of 28, and in men a bit earlier at the age of 24 (Ferri, 2018).

What is panic disorder?

Panic disorder requires specific guidelines to come up with a diagnosis. The mental illness characterized by recurrent, unpredictable episodes of intense anxiety accompanied by marked physiologic manifestation without any particular reasons and related to physical and emotional (Papadakis & MCPhee, 2017). There is a difference between panic attack and a panic disorder (Ferri’s, 2018 ). A panic attack is a comparatively short, sudden episode of acute fear or apprehension, frequently associated with a sense of hindering portion and various uncomfortable and disturbing physical symptoms. It can be uncued out of the blue (Ferri’s, 2018). The manifestations of panic disorder are what characterizing the problems. The patient might experience agoraphobia which is portraying by fear of being in a place where the cannot escape.

Clinical manifestations of a panic attack vary from person-to-person but may include heart palpitations, diaphoresis, abdominal pain, numbness and tingling of extremities, tachycardia, and chest pain (Sobanski & Wagner, 2017). These symptoms should not be ignored and passed off as anxiety-related until they are explored further. Many symptoms experienced by those having a panic attack can also be experienced by someone having symptomatic coronary heart disease. In a systematic review by Tully et al (2015), the focus was to determine whether panic attacks increase the chances of developing coronary heart disease, but after careful review these authors instead found implications that may influence policies surrounding the way we triage, assess, and manage patients who enter hospitals with these overlapping symptoms. Any patient presenting with chest pain, increased heart rate, or palpitations should receive an ECG, comprehensive metabolic panel, complete blood count, thyroid function testing, and cardiac enzymes. If nothing significant is found through these labs, panic attack/disorder should be an option for an additional differential diagnosis.

Nonpharmacological therapy for panic disorders involves cognitive-behavioral therapy. Cognitive-behavioral therapy (CBT) is based on the belief that the way someone sees the world, themselves, and the future contributes to emotional distress and less-than desired behaviors (Hoffman, Asnaani, Vonk, Sawyer, & Fang, 2012). In order to avoid a panic attack, CBT is developed with the goal of attempting to change the way a person thinks and perceives the world around them. Some researchers believe that desensitization through exposure will decrease the amount of fear exhibited in specific situations but doing so may cause further damage and post-traumatic stress.

Pharmacological therapy is aimed at using anti-anxiety medications such as selective serotonin reuptake inhibitors (SSRI’s) and benzodiazepines. Alprazolam is a benzodiazepine and the recommended dose ranges from 0.25 to 0.5 mg PO as needed every 8 hours. SSRI’s such as paroxetine, citalopram, fluoxetine, and escitalopram are also alternatives but should not be used concurrently with benzodiazepines. Each of these medications must also be tapered prior to stopping their use to prevent rebound or withdrawal symptoms. Pharmacological and non-pharmacological strategies may be used in conjunction and tend to produce positive outcomes. A urine toxicology must be completed prior to beginning pharmacological therapy, and a follow-up should occur within 4 weeks of its initiation. The patient may also benefit from a referral to a psychiatrist who may frequently assess the patient and provide feedback on a weekly basis.

 

References:

Ferri, F. F. (2018). Ferris clinical advisor 2018: 5 books in 1. Philadelphia, PA: Elsevier.

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research36(5), 427–440. http://doi.org/10.1007/s10608-012-9476-1

Papadakis, M. A. & McPhee, S. J. (2017). Current Medical Diagnosis & Treatment (55th ed.). San Francisco, CA: McGraw Hill – Lange.

Sobanski, T., & Wagner, G. (2017). Functional neuroanatomy in panic disorder: Status quo of the research. World Journal of Psychiatry7(1), 12–33. http://doi.org/10.5498/wjp.v7.i1.12

Tully, P. J., Wittert, G. A., Turnbull, D. A., Beltrame, J. F., Horowitz, J. D., Cosh, S., & Baumeister, H. (2015). Panic disorder and incident coronary heart disease: A systematic review and meta-analysis protocol. Systematic Reviews4, 33. http://doi.org/10.1186/s13643-015-0026-2

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