PANIC DISORDER: A REVIEW OF DSM-IV PANIC DISORDER AND PROPOSALS FOR DSM-V

INTRODUCTION
The purpose of this study was to evaluate Diagnostic criteria for panic attacks and panic disorder (Panic Disorder) collected fromthe DSMIV, and to propose changes to the DSM-V in which the change was based onevidence

Minor changes proposed to the words of the diagnostic criteria for panic attacks tofacilitate the differentiation between panic and anxiety surrounding

DSM-IV criteria for panic attack

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop and peaked within 10 minutes 1. Palpitations, pounding heart, or rapid heartbeat 2. Sweating 3. Trembling or shaking 4. Shortness of breath or smothering sensations 5. feeling choked 6. Chest pain or discomfort 7. Nausea or stomach discomfort

8. Feeling dizzy, unsteady, or faint 9. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 10. Fear of losing control or becoming insane 11. fear of dying 12. Paresthesias (numbness or tingling sensations) 13. Chills or hot flushes

PANIC ATTACKS
Panic attack is currently defined as a brief period of intense fear or discomfort where there are four or more from the list of 13 symptoms, which developed abruptly andreached a peak within 10 minutes. Panic attacks are common to anxiety disorders, and is a significant marker for the risk ofthe development and manifestation of psychopathology in general.

Symptoms most commonly seen is the beating heart'' '(97%) and dizziness (96%), and most often are paresthesias (73%) (refer to support rated as present for at least a fewdegrees).
The most commonly reported symptoms of tachycardia (86.1%), and symptoms ofchoking (31.1%).

From that sample, who monitored 1,805 PAs, palpitations were most frequently endorsed (78%) Paresthesias were least frequently endorsed (26%)

The results indicated that palpitations, being thevmost frequently reported symptom, provided little information about the severity of panic, whereas paresthesias, choking, and fear of dying were good markers of severe PAs

FOUR OR MORE SYMPTOM CUT-OFF

Several studies have shown that patients with PD supports fewer symptoms duringself-monitoring of PA compared with retrospective estimates obtained d uring the diagnostic interview
In a sample of PD patients, approximately 60% of the PA self-monitored during a 6-weekinterval had four or more symptoms.

Optimal sensitivity and specificity achieved with three or more symptoms, but the criteria of four or more symptoms nearly as effective In conclusion, the data still indicate that approximately 5060% of community samplesand patients had to remember four or more symptoms...

To capture the essence of a panic attack as a sudden spike of fear arousal,kriteriaDSM-IV requires that symptoms of panic attacks reached a peak within 10 minutes of the first symptoms
In the data ECA third of individuals who would otherwise meet the criteria for PD are not eligible min 10 min. From the Bremer Adolescent Study of 1035 adolescents, only 35% reported that theirpanic attack symptoms worsened in the first 10 minutes.

SUMMARY AND PRELIMINARY RECOMMENDATIONS FOR DSM-V

These data support the results of the study-13 diagnostic criteria for panic attacks

Specific recommendations
Replace the term'' hot flashes'' with'' heat'' sensations to enhance the validity of theculture To reorder the initial physical symptoms, followed by symptoms of "fear" to enhance theunity of the clinical symptoms. Recommended changes to the phrasing on the criteria followed by the word changes toincrease the difference between PA and generalized anxiety (rather than anxietydisorder).

SHOULD PAs BE A SPECIFIER ACROSS ALL DISORDERS?

Is the PA in the context of any anxiety or anxiety disorders indicate nonclinically relevant information such as predicting response to therapy, comorbidities, etc.. DSM IV explains the PA relevant to all anxiety disorders But the PA as a clinical indicator is still unknown.

Literature review
after a literature study, researchers found that:
Several studies, mostly epidemiological or community samples, have shown that PA can function as a marker of risk for various psychiatric disorders, multimorbidity, and more severe disease status Individuals with PA was reported to have higher levels of anxiety, state anxiety, anddepression dibadningkan with individuals who have never experienced PA.... PA has been associated with a tendency to experience other anxiety disorders, panicdisorders and agoraphobia in addition too. Goodwin et al found that the PA primary is also connected with an increased risk for the incidence of major depression.

Literature review
Data recent prospective study showed that the PA associated with more severepsychiatric symptoms and persistent. On a broad cross sectional study, a sample of adults in Colorado, over a lifetime history of PA is also associated with an increase in alcohol dependence (not abuse alcohol) an ddrug dependence.

PAs to CLINICAL PRESENTATION

PA may increase the severity of symptoms and comorbidities and the possibility ofsuicide.
For example: PA in the context of social phobia associated with increased distress andimpairment Roy-Byrne et al found that individuals with comorbid depression PA showed more severe symptoms of depression and increased suicide attempts than individuals withdepression without PA.

PA related to TREATMENT
There is an increasing severity of PA appears to negatively affect several disorders, including unipolar depression, bipolar and oth er psychotic disorders.

PANIC DISORDER
DSM-IV criteria for panic disorder with (and without) agoraphobia A. Both (1) and (2)
1. Recurrent unexpected Panic Attacks 2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

a. Persistent concern about having additional attacks b. Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, going crazy) c. A significant change in behavior related to the attacks B. The presence (or absence) of Agoraphobia C. The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) D. The panic attacks are not better accounted for by another mental disorder, such as social phobia (e.g., occurring on exposure to feared social situations), specific phobia (e.g., on exposure to a specific phobic situation), obsessivecompulsive disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic stress disorder (e.g., in response to stimuli associated with a severe stressor), or separation anxiety disorder (e.g., in response to being away from home or close relatives)

DSM-IV-TR text description of types of panic attacks

There are three characteristic types of panic attacks: unexpected (uncued), situationallyb ound (cued), and situationally predisposed. Each type of panic attack is defined by the relationship between the onset of the attackand the presence or absence of circumstances that can cause different causes, includingexternal (for example, an individual with claustrophobia to have an attack while trapped inside a stalled elevator) or internal (eg, cognitions about the consequences of heartpalpitations a beat)

Panic Attacks
Unexpected panic attack is defined as that where there is no association with internal or external situational trigger (ie, the attack was considered to be spontaneous or''sudden'').

Panic Attacks
Panic attacks are defined as an attack depends on the situation that almost always occurimmediately when there is exposure, or to anticipate, situational cues or t riggers (eg,people with social phobia have panic attacks when thinking or will hold talks in public).

Panic Attacks
Situationally predisposed panic attack similar to panic attacks depending on the situation but does not always relate to the situation or occur immediately after exposure(eg, attacks often occur when people dri ve, but there are certain times when no attack occurs when the patient is driving or attack occurs after a person driving after half anhour.)

Pada masa perkembangan

PA is found in low frequency in children and adolescents. PA increased gradually with age (increasing in adolescents, particularly among girls aspuberty). Although the low sample frequency, the study proves the DSM-IV criteria can be applied to children and adolescents.

SUMMARY AND PRELIMINARY RECOMMENDATIONS FOR DSM-V

that there is less research evidence supporting the existence of differences in the criteria of PA and PD in each age group.

Drugs
Imipramine Clomipramine Moclobemide Sertraline Fluoxetine Parocetine Fluvoxamine Citalopram

Kesimpulan
Researchers trying to find flaws in the DSMIV conducted through literature studies andforward criteria for the diagnosis of PA and PD can be improved in DSM-V. 13 criterias for the diagnosis of PA is supported by research data on this journal, although there is little need to revise the formulation of criteria and the wording of the criteria for improvement in the DSM-V There is not enough evidence to support to change 4 or more symptom criteria todistinguish between "full blo wn" with "PA with limited symptoms".

Kesimpulan
PA may be able to serve as a diagnostic indicator for other problems th at would arisesuch as anxiety, affective disorders / mood, eating disorders, and substancedependence.