BY: ABDULAZIZ AL-HUMOUD FIFTH YEAR MEDICAL STUDENT. MCST Panic

Objectives Discuss the Epidemiology & Comorbidity for Panic disorder. Be aware of Pathogenesis Of the Disorder. Be aware of the clinical manifestations. Discuss Agoraphobia traits. Suicide relation with the disorder. How to diagnose and manage the disorder.

INTRODUCTION Panic attacks and panic disorder are common problems in both primary and psychiatric specialty care.

Epidemiology & Comorbidity Lifetime prevalence estimates for panic disorder in US adults range from 2.0% to 6.0%. The 12-month prevalence in adults is 2.7%, of which 44.8% are classified as “severe” cases. Panic disorder often coexists with mood disorders, and mood symptoms potentially follow the onset of panic attacks. Lifetime prevalence rates of major depression in panic disorder may be as high as 50-60%. Other psychiatric disorders that occur comorbidly with panic disorder include schizophrenia, obsessive-compulsive disorder, specific phobias, social phobia, and agoraphobia

PATHOGENESIS The pathogenesis of panic disorder fits a stress-diathesis model (ie, the combination of an underlying predisposition interacting with or triggered by life stress). Vulnerability factors include specific genetic factors, childhood adversity, and several personality traits, including anxiety sensitivity and neuroticism. Current stressful life events in association with one or more of these vulnerability factors often precipitate development of panic attacks.

CLINICAL MANIFESTATIONS Panic attacks typically present with spontaneous or triggered, discrete episodes of intense fear that begin abruptly and last for several minutes to an hour. In panic disorder, patients experience recurrent panic attacks, at least some of which are not triggered or expected, and one month or more of either worry about future attacks/consequences, or a significant maladaptive change in behavior related to the attacks, such as avoidance of the precipitating circumstances or of situations where they would be unable to escape or obtain help were they to panic. Patients may present with autonomic symptoms of a panic attack such as chest pain or shortness of breath.

Also.. Panic attacks may occur in other anxiety disorders, where they are specifically triggered by the occurrence or recollections of feared objects or situations (eg, trauma, phobic exposure or in obsessive compulsive disorder, contamination)

Panic pt. Manifest :-

Agoraphobia Patients with panic attacks can develop agoraphobia; ie, anxiety about and avoidance of situations where help may not be available or where it may be difficult to leave the situation in the event of developing panic- like symptoms or other incapacitating or embarrassing symptoms.

Suicide attempts Most studies have shown a higher likelihood of suicide attempts among people with panic disorder compared with the general population.

Diagnosis DSM-5 diagnostic criteria for a panic attack are described below:- An abrupt surge* of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following 13 symptoms occur: ●Palpitations, pounding heart, or accelerated heart rate ●Sweating ●Trembling or shaking ●Sensations of shortness of breath or smothering ●Feelings of choking ●Chest pain or discomfort ●Nausea or abdominal distress ●Feeling dizzy, unsteady, light-headed, or faint ●Chills or heat sensations ●Paresthesias (numbness or tingling sensations) ●Derealization (feelings of unreality) or depersonalization (being detached from oneself) ●Fear of losing control or "going crazy" ●Fear of dying * The abrupt surge can occur from a calm state or an anxious state.

Management Pharmacotherapy( SSRI citalopram,TCA’s imipramine ), cognitive- behavioral therapy (CBT), and other psychological treatment modalities are used to manage panic disorder. The American Psychiatric Association (APA) recommends treating patients with panic disorder when symptoms cause dysfunction (eg, work, family, social, leisure activities) or significant distress.

Sum Up Panic attacks and panic disorder are common problems in both primary and psychiatric specialty care. Lifetime prevalence estimates for panic disorder in US adults range from 2.0% to 6.0%. The pathogenesis of panic disorder fits a stress-diathesis model. Patients may present with autonomic symptoms of a panic attack such as chest pain or shortness of breath. Agoraphobia = STAY AT HOME. studies have shown a higher likelihood of suicide attempts among people with panic disorder. DSM-5 diagnostic criteria. (4 or more ). TTT : ( SSRI citalopram,TCA’s imipramine ), (CBT).

DON’T PANIC IT’S AN EASY TOPIC

References