Diagnosis and Management

of Panic Disorder in Adults

Locke AB., Kirst N.,2015. American Family Physician, 91(9):617-624.

Karina Puspaseruni
(201710401011032)
 Overvi
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ew
Generalized anxiety disorder GAD and panic disorder
PD are among the most common mental disorders in
the United States and are often encountered by
primary care physicians.

PD is characterized by recurrent and unexpected

panic attacks

It can negatively impact a patients quality of life and

disrupt important activities of daily living
 Epidemiology and
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The 12-month Etiology In this population, the

lifetime prevalence is
prevalence for PD among

♀ 7.0
U.S. adults 18 to 64 years

3.1 of age is

%
%
♂ 3.3
The etiology of PD is not well understood.
The neuroanatomical hypothesis suggests that a genetic environment
interaction is likely responsible. Patients with %
Our PD may exhibit
Goals
irregularities in specific brain structures, altered neuronal processes,
and dysfunctional corticolimbic interaction during emotional
 Typical Presentation and
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Diagnostic Criteria
PD is characterized by episodic,
unexpected panic attacks that occur
without a clear trigger.

Panic attacks are defined by the rapid

onset of intense fear (typically peaking
within about 10 minutes) with at least
four of the physical and psychological
symptoms in the DSM-5 diagnostic
criteria (Table 3).
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Another requirement for the diagnosis

of PD is patient worries about further
attacks or modifies his or her
behavior in maladaptive ways to avoid
them.

The most common physical symptom

accompanying panic attacks is
palpitations.

Although unexpected panic attacks are required for the diagnosis,

many patients with PD also have expected panic attacks, occurring in
response to a known trigger.
 Differential Diagnosis
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and Comorbidity
Medical e.g., endocrine conditions such as hyperthyroidism, or
conditions with hyperparathyroidism; neurologic diseases such as temporal lobe
similar epilepsy or transient ischemic attacks
presentations
Other
psychiatric e.g., other anxiety disorders, major depressive
disorder, bipolar disorder
disorders

Use of such as caffeine, albuterol, levothyroxine, or

substances decongestants
 Treatm
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ent
PSYCHOTHERA
PY
AND
EDUCATIO RELAXATIO
N Medication or psychotherapy is a reasonable
N
THERAPIES initial treatment option for PD.

COMPLEMENT Some studies suggest that combining

ARY AND medication and psychotherapy may be more
ALTERNATIV
MEDICATI E MEDICINE effective for patients.
ON THERAPIES
 Treatment
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(cont.)
Lifestyle recommendations that may reduce anxiety-
related symptoms: identifying and removing possible
triggers (e.g., caffeine, stimulants, nicotine, dietary
EDUCATION triggers, stress), and improving sleep quality/quantity
and physical activity.
Physical activity is a cost-effective. Exercising at 60% to
90% of maximal heart rate for 20 minutes three times
weekly has been shown to decrease anxiety; yoga is also
effective.
 Treatment
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(cont.)
MEDICATION

In the treatment of PD, TCAs are as effective as

SSRIs, but adverse effects may limit the use of
TCAs in some patients.
 Treatment
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(cont.)
Benzodiazepines are effective in reducIng
anxiety, but there is a dose-response
Because of the typical delay in onset of
relationship associated with tolerance,
action, medications should not be
sedation, confusion, and increased mortality.
considered ineffective until they are
titrated to the high end of the dose range
and continued for at least 4 weeks.
Once symptoms have improved, medications
should be used for 12 months before
tapering to limit relapse.
 Treatment
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PSYCHOTHERAPY
AND RELAXATION (cont.)
THERAPIES
Psychotherapy may be used alone or combined
with medication as first-line treatment for PD
based on patient preference.
Psychotherapy should be performed weekly
for at least 8 weeks to assess its effect.
 Treatment
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(cont.)

A meta-analysis of 36
randomized controlled Combined treatment
trials on meditation with medications and
showed that meditative psychotherapy reduces
therapies reduce anxiety relapse even at two
symptoms, years.
 Treatment
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(cont.)
COMPLEMENTARY
AND ALTERNATIVE
MEDICINE
THERAPIES
Evidence indicates that music
therapy, aromatherapy,
acupuncture, and massage are
helpful , but none have been
evaluated specifically for PD.
THANKY
OU