PANIC DISORDER

By :
Madona Clara Yosinta Faritz Subiyaktoro Aqita Islamiah

Definition
Panic disorder (PD) is characterized primarily by the presence of recurrent and unexpected panic attacks, followed by at least 1 month of persistent concern about

other attacks, the possible consequences of

attacks and a significant behavioral change

related to the attacks

Panic attacks are a period of intense fear in which 4 of 13 defined symptoms develop abruptly and peak rapidly less than 10 minutes from symptom onset.

 During the episode, patients have the urge to flee or escape and have a sense of impending doom (as though they are dying from a heart attack or suffocation).

Other symptoms may include headache,

cold hands, diarrhea, insomnia, fatigue,

intrusive thoughts.

Neurobiology of Panic Disorder

The neurocircuitry of fear includes two pathways for processing of sensory information.
The shorter path : rapid spread of autonomic and behavioral responses in potentially hazardous situations. The major regions : anterior thalamus and the central and lateral regions of the amygdala.

The longer path : the information passes through several regions, including the cortex, which allows for a more refined analysis of inputs.

Physical Examination
No signs on physical examination are specific for panic disorder If the patient presents in an acute state of panic :
Nonspecific signs:
Hypertension Tachycardia Mild tachypnea Mild tremors.

The attack normally lasts 20-30 minutes from onset, although in rare cases it can go on for more than an hour.

Physical Examination
Appearance : anxious Somatic concerns of death from cardiac or respiratory problems may be a major focus of patients during an attack. Patients may end up in an emergency department. Mental Status Examination As with the physical examination, no results on the Mental Status Examination are specific for panic disorder.

Planning Diagnose
No invasive procedures are required to diagnose panic

disorder, although they may be useful in eliminating

other differential diagnoses.

As previously mentioned, history, collateral information, and physical examination/Mental Status Examination

remain the diagnostic cornerstones for panic disorder

Laboratory Test
Laboratory studies that can exclude medical disorders other than panic disorder include the following:

Serum electrolytes to exclude hypokalemia and acidosis Serum glucose to exclude hypoglycemia

Cardiac enzymes in patients suspected of acute coronary syndromes

Serum hemoglobin in patients with near-syncope Thyroid-stimulating hormone (TSH) in patients suspected of hyperthyroidism

Urine toxicology screen for amphetamines, cocaine, and phencyclidine in patients suspected of intoxication

General Treatment
Panic Disorder Monitoring Treatment Compliance
It has a direct impact on disability, resulting in increased absenteeism, decreased productivity and reduced ability to carry out daily activities.

Improvements in functioning, as well as in symptoms, should be part of evaluating treatment effectiveness.

Panic Disorder patients tend to stop treatment when they become anxious about somatic sensations from medications.

Level of Care

If there is a high risk of danger to self or others or grave disability, consider inpatient hospitalization.

Unstable patients may respond to structured, multi-disciplinary treatment that emphasizes skills training, family involvement, psychoeducation and psychiatric management

Medications
SSRIs, SNRIs, tricyclic antidepressants, benzodiazepines

(only appropriate as monotherapy in the absence of a

comorbid mood disorder) and/or cognitive-behavioral psychotherapy (CBT) have been shown generally to be equally effective in the acute phase (first 12 weeks) of treatment

Psychotherapy
Consider including psychotherapy if there: has been a previous positive response to

psychotherapy
is an incomplete response to an adequate trial of medication are excessive medical risks of medication is evidence that coping skills are inadequate to manage

psychosocial stressors

Prognosis
Long-term prognosis is usually good, with almost 65% of patients with panic disorder achieving remission, typically within 6 months. Appropriate pharmacologic therapy and

cognitive-behavioral therapy, individually or in

combination, are effective in more than 85% of

cases.

Gracias..
God Bless You ^_^