Panic disorder |
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| 2007-12-24 | No history |  | Add My version | |
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| Mind map Panic disorder (from MedMaps.co.uk) - the online mind map resource for medical students and doctors. Psychiatry. Medicine. | |
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Panic disorder
Characteristics
Causes
Genetic predisposition
extra-sensitive amygdala
Excess caffeine
hyperventilation
induces panic attacks in lab
Drugs/Alcohol
excess or withdrawal
Definition DSM IV
Panick attacks
recurrent attacks
minutes in duration
unexpected
No stimulus
followed by 1 month of (at least 1):
Avoidance of situations
reduce quality of life
affect functioning
Alcohol abuse
change in behaviour
exclusion of organic disorder
eg hyperthyroidism
Prevalence
2-3% in Europe
>
25-44 years
Associations
Mitral valve prolapse
40-50%
persists after cure
not causant
hypertension
depression
50% with PD develop depression
50% with depression develop PD
Migraine
Asthma
Agoraphobia
Pathogenesis
Prognosis
some relapse
majority OK with Rx
Complications
Agoraphobia
Anticipatory fear
loss of control
reluctancy to be alone
Depression
Suicide
Increased risk
esp. if depressed
Increased risk cardiovascular mortality
Biopsychosocial Management
Investigations
Challenge tests
Sodium lactate infusion
CO2 breathing
Treatment
CBT
NICE
7-14 hours
within 4 months
also via internet
"Fear Fighter" programme
Antidepressants
SSRIs first line
may worsen anxiety initially
use small doses
slow withdrawal
6 months after symptom free
Imipramine & chlomipramine
if all else fails
Behaviour change
Self help
avoid caffeine
exercise
muscle relaxation
Breathing exercises
Benzodiazepines
extreme cases only
short-term
Differential
PTSD
Obsessive-compulsive disorder
Agoraphobia
Simple phobia
Social phobia
Depression
S&S
Constant Fear
dying
lose control
madness
"fear of fear"
Acute panick attacks
Autonomics
palpitations
sweating
trembling
abdo disturbance
dizzy
Depersonalisation
Derealisation
chest pain
choking
paraesthesias
chills or hot flashes
Avoidance
threatening situations
Alcohol/drug abuse
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