Integrated treatment of panic disorder

The Efficacy of Information-giving in Cognitive-behavioural Treatment for Panic Disorder

Despite its inclusion as a basic component of the cognitive-behavioural treatment for panic disorder, the effects of the provision of information about panic anxiety have not been separately assessed. This study compared information-giving with self-monitoring of panic alone, on panic-related variables and negative affect for 40 people with panic disorder. In comparison to self-monitoring alone, information-giving together with self-monitoring was associated with reductions in anticipatory fear of panic and negative affect, but not panic frequency. These results suggest that provision of information about panic anxiety is an important component of the cognitive-behavioural approach to panic disorder in reducing anxious and depressive affect. The other cognitive-behavioural components of this intervention are required to impact upon specific panic parameters.

Panic disorder and the heart: a cardiology perspective

Panic disorder is a common condition that includes symptoms that may masquerade as a primary cardiovascular disorder. In addition, many patients with cardiovascular disease may also have panic disorder. To date, no definitive pathophysiological mechanism for panic disorder has been found; however, there are several hypotheses in the literature. Patients with syndrome X, coronary artery disease and/or palpitations, in addition to panic disorder all present to cardiologists. However, many patients go undiagnosed and ultimately place large costs on the health care system as a result. Panic disorder is a treatable condition, and cardiologists could easily identify patients with panic disorder and initiate appropriate therapy and/or referral.

Panic disorder in coronary artery disease patients with noncardiac chest pain

In this study we address the following questions: (1) What percentage of coronary artery disease (CAD) patients that present with chest pain, but whose symptoms cannot be fully explained by their cardiac status, suffer from panic disorder (PD)? (2) How do patients with both CAD and PD compare to patients without CAD and to patients without either PD or CAD in terms of psychological distress? Four hundred forty-one consecutive walk-in emergency department patients with chest pain underwent a structured psychiatric interview (ADIS-R) and completed psychological scales. Fifty-seven percent (250 of 441) of these patients were diagnosed as having noncardiac chest pain and constituted this study's sample. A total of 30% (74 of 250) of noncardiac chest pain patients had a documented history of CAD. Thirty-four percent (25 of 74) of CAD patients met criteria for PD. Patients with both PD and CAD displayed significantly more psychological distress than CAD patients without PD and patients with neither CAD nor PD. However, they did not differ from non-CAD patients with PD. PD is highly prevalent in patients with CAD that are discharged with noncardiac diagnoses. The psychological distress in these patients appears to be related to the panic syndrome and not to the presence of the cardiac condition.

Unexplained chest pain: when is it panic disorder?

Noncardiac chest pain is a common costly phenomenon in the cardiology setting. Recent research suggests that panic disorder, a highly distressful yet treatable anxiety disorder, occurs in a significant proportion of noncardiac chest pain patients. This article reviews research on the prevalence of panic disorder in patients seen in cardiology settings for unexplained chest pain. Financial, psychosocial, and historical aspects of noncardiac chest pain are described. Panic disorder and the potential consequences of its nonrecognition by physicians are examined. Current psychological and pharmacologic treatments are reviewed. Recommendations on the management of panic patients in the cardiology setting are provided.

Panic disorder. When symptoms have no apparent physical cause

Patients with undiagnosed panic disorder often have symptoms of several associated physical and social problems, and they frequently seek help initially from their primary care physician. Therefore, it is important to be knowledgeable in diagnosis and treatment of panic disorder and to consider it in differential diagnosis in patients reporting nonpsychiatric complaints. Although the underlying pathophysiology of panic disorder is still unclear, current research suggests that an imbalance of several neurotransmitter systems may be responsible. Many effective cognitive, behavioral, and pharmacologic methods are available, and patients may require a combination of approaches. Selective serotonin reuptake inhibitors are emerging as first-line therapy because of their demonstrated efficacy and tolerability. Tricyclic antidepressants and monoamine oxidase inhibitors also have been used successfully, and high-potency benzo-diazepines are an option when rapid onset of drug activity is desired. Effective treatment of panic disorder can significantly decrease hospitalizations, reduce unnecessary healthcare expenditures, and improve patient quality of life.

Alcohol and depression in panic disorder

Panic disorder (PD) is a common psychiatric illness, which has many complications such as major depression, increased suicide risk, agoraphobic avoidance behaviour, alcohol abuse and dependence. A number of studies have now documented increased rates of anxiety disorders among alcoholics and of alcoholism among patients presenting with anxiety disorders. In general, it appears that PD is more prevalent in alcoholics than would be expected on the basis of general population rates. Alcohol withdrawal is clearly associated with severe anxiety symptoms. It is suggested that repeated withdrawal episodes may trigger panic through a kindling process by causing subconvulsive stimuli with increasing amounts of electrical excitability or even spontaneous seizures. Serotonergic medications are effective in treating PD and depression. They also diminish interest in drinking in ethanol-dependent patients. Serotonergic agents can also affect conditioning and learning as well as behavioral control and self-administration. The treatment of panic patients with depressive and alcohol problems usually requires long-term treatment.

Panic attacks, complex partial seizures, and multiple meningiomas

A 39-year-old woman presented with typical panic disorder symptoms of two years duration. Imipramine (IMI) treatment yielded complete remission of her symptoms for three years. At that time, however, her symptoms recurred. Neither increasing the IMI dose nor an adequate trial of fluoxetine controlled her symptoms. Further history revealed subtle changes in her symptoms suggestive of complex partial seizures. Scalp EEG was normal, but an MRI revealed multiple meningiomas. Her symptoms remitted completely on carbamazepine. This case illustrates the phenomenologic overlap between panic attacks and complex partial seizures, and a neuroanatomic overlap between the two syndromes is hypothesized.