Panic Disorder

Some patients with panic disorder have chronic, persistent symptoms. Take the quiz and learn more.

This tale involves a “clever” inmate. He enjoyed the respectable rung of bank robber, but found he had suddenly descended to approximately the level of a sex offender. The reason for his slippage was the inmate code, which demands allegiance to other inmates under virtually all circumstances. “Ratting out” a fellow inmate may cost one his life, or at the very least, result in a decidedly anxious, paranoid existence.

After scoring high on the Panic Disorder Severity Scale, this patient sought panic-focused psychodynamic therapy.

Exposure-based therapies are highly effective for patients with anxiety disorders, to the extent that exposure should be considered a first-line, evidence-based treatment for such patients. In clinical practice, however, these treatments are underutilized, which highlights the need for additional dissemination and training.

Mixed states constitute a wondrously variegated universe of psychopathology. These states are characterized by the intrusion of features characteristic of depression into states of hypomania or mania and the converse. Mixed states assume a myriad of forms that as a family may be among the most commonly encountered states of affective illness.

Research emerging from the field of emotion science suggests that individuals who have anxiety and mood disorders tend to experience negative affect more frequently and more intensely than do healthy individuals, and they tend to view these experiences as more aversive, representing a common diathesis across anxiety and mood disorders.1-5 Deficits in the ability to regulate emotional experiences, resulting from unsuccessful efforts to avoid or dampen the intensity of uncomfortable emotions, have also been found across the emotional disorders and are a key target for therapeutic change.

The cardiovascular properties of serotonin (5-HT) have been known for some time-its name reflects its presence in serum and its action in increasing vascular tone. Serotonergic medications are routinely used to treat depressive and anxiety disorders, and the association of depression with cardiovascular disease has become well established.2 Recent studies have confirmed the colloquial wisdom that anxiety (especially panic) and hypertension are linked.

Because numerous diseases- infectious, endocrinological, metabolic, and neurological, as well as connective-tissue disease-can induce psychiatric and/or behavioral symptoms, clinicians need to distinguish these neuropsychiatric masquerades from primary psychiatric disorders, warned José Maldonado, MD, the director of Stanford University’s Psychosomatic Medicine Service.

The 2 most common anxiety disorders are generalized anxiety disorder (GAD) and panic disorder. Approximately 5.7% of people in community samples will meet diagnostic criteria for GAD in their lifetime; the rate is about 4.7% for panic disorder (with or without agoraphobia).1 GAD-which is characterized by excessive and uncontrollable worry about a variety of topics (along with associated features such as trouble sleeping and impaired concentration)-is often chronic and is associated with significant costs to the individual and to society.

The ocurrence and severity of anxiety disorders have been correlated with fluctuations in female sex steroid levels in both epidemiological and experimental studies.1-5 Female reproductive hormones play a role not only in the development and course of anxiety disorders but also in treatment response.

Panic disorder with or without agoraphobia is a chronic, debilitating psychiatric illness that affects about 4.7% of the general US population.

Both cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.

In this article, we examine the relationship between anxiety disorders and SDs, using DSM-IV-TR categories, although we are conscious of the limits of this approach. In doing so, we will consider not only the dichotomy between normal and pathological functioning but also the issue of sexual satisfaction as part of wellness.

Worsening anxiety is a common symptom that may result in psychiatric consultation or evaluation in an emergency setting. Aneurysms are rarely considered in the medical differential for anxiety disorders, and the available literature and research regarding this possible connection are very limited. Overlooking this diagnosis, however, can have disastrous consequences. Here we present 2 case reports as well as a review of the literature regarding a possible relationship between aortic and thoracic aneurysms and psychiatric symptoms.

Chronic primary daily headache may not be a singular disorder but rather one with various subtypes. Chronic migraine (also referred to as evolved migraine or transformed migraine), chronic tension-type headache, newly defined daily persistent headache, hemicrania continua, and post-traumatic headache are now recognized as subcategories of chronic daily headache

Panic disorder occurs in about 1 in 5 individuals who have bipolar disorder. Anxiety amplifies the distress caused by depression and mania, but pharmacological approaches are tricky and under-studied. Frequent comorbidity and evidence of a possible genetic relationship of bipolar and panic disorders are suggestive of a causal relationship between the 2. Thus, it may be fruitful to look more closely at evidence for common biological abnormalities in both disorders to find a pathophysiological mechanism that links mania, depression, and panic attacks. Mood episodes and panic attacks can both be modeled as the result of deficits in amygdala-mediated emotional conditioning. From this model, some insight may be gained for potentially helpful treatment strategies for the 2 disorders when they occur together.

Psychotic symptoms--delusions, hallucinations, paranoia, thought disorder--are mostly attributed now to aberrations in brain structure and function.

Anxiety disorders are the most common mental conditions in the general population, including in children and adolescents. Young people can present with a pattern of anxiety symptoms somewhat different from that typically seen in adults. One of the most common aspects of this difference is that children (especially younger ones) may not report overt worries or fears, but instead manifest pronounced physical symptoms.

Panic disorder is a common psychiatric illness that can have a chronic, relapsing course. The question of whether pregnancy represents a time of increased risk for recurrence of panic symptoms has been a matter of debate.

According to National Comorbidity Survey data, panic disorder is 2.5 times more prevalent in women than in men. Do physiological changes for women during the perimenstrual and perimenopausal phase play a role in this disorder?

With the advent of computer technology, new forms of therapy have emerged that can help patients. How can a virtual reality environment enable patients to overcome panic disorder and agoraphobia, and what are the advantages to such forms of therapy?

Dr. Genova offers the antidote to the complexities of manualized and proceduralized psychotherapy that have arisen in imitation of procedural, technology-driven medicine. Supportive, directive and relational types of therapy and their correlation with various power structures within the doctor-patient relationship are described.

By the time I interviewed Robyn in the emergency room, her panic attack had all but passed. But this 21-year-old woman was still shaken and tearful. This was her first panic attack, and she did not know what hit her. She thought she was having a heart attack. She had a tight feeling in her chest, she was hyperventilating. Her fingers and feet were numb and tingling. She experienced what she called a "closing in feeling." Robyn thought she was going to die.

Three reports on olanzapine (Zyprexa) as a possible treatment for bipolar affective disorder, presented at a National Institute of Mental Health-sponsored meeting in June, reflected pursuit of this indication-despite the initial "nonapprovable" letter from the U.S. Food and Drug Administration that was issued October 1998.

The findings are disturbing. The Substance Abuse and Mental Health Services Administration (SAMHSA), in an effort to measure substance use and abuse among women, compiled data from its National Household Survey on Drug Abuse into a new report, Substance Use Among Women in the United States, which was released in September 1997. What they found is a worrisome indicator that substance use in this country is a significant problem for women, particularly among young girls ages 10 to 14.

Many of the advantages of the MAOIs are seen with selective serotonin reuptake inhibitors, which have become the drugs of choice in the treatment of panic disorder.

Temporal lobe epilepsy (TLE), now more commonly called complexpartial seizure disorder so as to include seizures that originatein the frontal foci, straddles the borderland between psychiatryand neurology.