Panic disorder

Question 1

Define panic disorder. What is it often comorbid with?

Answer 1

This is a disorder which is characterised by short episodes of intense anxiety which occur unpredictably

• Unpredictable
• Aka episodic paroxysmal anxiety
• Often comorbid with agoraphobia

aka episodic paroxysmal anxiety

Question 2

How common is panic disorder? Who is most affected?

Answer 2

• F>M (2:1)
• lifetime prevalence = 1-3 %
• age range 25-44

Question 3

What are the symptoms of panic disorder?

Answer 3

• Panic attacks lasting a few minutes
  
  • Fear of suffocating / dying
  • Hyperventilation
  • Trembling/shaking
  • Sweating
  • Dizziness
  • Depersonalisation/derealisation
  • Palpitations
  • Desire to flee
• Anticipatory fear of…
  
  • dying
  • losing control
  • going mad

Question 4

What investigations should be done for panic disorder?

Answer 4

• Rule out organic causes (incl. thyroid), alcohol, drug withdrawal
• Urine drug screen
• Bloods e.g. TFTs
• ECG

Question 5

What is the management of panic disorder? What treatment is NOT recommended?

Answer 5

• Education and active monitoring
• CBT / Relaxation training e.g. breathing techniques
• SSRI (1st line)
  
  • If C/I or no response after 12 weeks: offer clomipramine or imipramine (TCA)

Benzos are not recommended due to risk of tolerance and dependence (NICE)

Question 6

What does CBT for panic disorder involve?

Answer 6

• Panic may be triggered by misinterpretation of physical anxiety symptoms as signs of major catastrophe
• Safety behaviours may be adopted which reinforce beliefs (e.g. avoiding situations)
• CBT educates the patient on the true meaning of the symptoms (i.e. panic not perish)
• Helps them test whether their behaviours keep them safe and whether their beliefs are true or misinterpretations

Question 7

If the patient has depression and panic disorder, what should the main diagnosis be?

Answer 7

Panic disorder should not be given as the main diagnosis if the patient has a depressive disorder at the time the attacks start; in these circumstances the panic attacks are probably secondary to depression.

Question 8

What does applied relaxation therapy involve?

Answer 8

Used for people with anxiety disorders + is based on the premise that these patients have lost the ability to relax

Consists of a series of exercises that teach the patient how to:

1. Spot the signs and feelings of tension
2. Relax your muscles and relieve tension
3. Use these techniques in stressful situations to prevent you feeling tense and panicky

Consists of 12-15 weekly sessions