Questions and Answers
Cognitive therapy is always more effective than medication in treating panic disorder.
False
Patients should avoid explaining their disorder to friends and relatives.
False
Antidepressant medication should be withdrawn suddenly to avoid side effects.
False
Self-help books based on cognitive behavior principles are available to help patients.
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Patients' preferences do not influence the choice of treatment for panic disorder.
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SSRIs are preferred over tricyclics because they have fewer side effects.
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Alprazolam is not recommended in the UK for treating panic disorder.
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The effectiveness of combined treatment with medication and psychotherapy is not established in the long term.
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The diagnosis of panic disorder was first introduced in the DSM-IV.
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Panic attacks can only occur in response to identified phobic stimuli.
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Hyperventilation is typically associated with an increase in the concentration of carbon dioxide in the blood.
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At least four symptoms are required for a diagnosis of panic disorder according to DSM-5.
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The fear of a heart attack is a common feature during a panic attack.
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Panic attacks were classified under various names before the formal diagnosis of panic disorder was established.
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Panic disorder and agoraphobia are diagnosed as the same condition in DSM-5.
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Symptoms of a panic attack typically include feelings of depersonalization and derealization.
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The last symptom of a panic attack is the feeling of breathlessness, which is paradoxical in nature.
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Paul Wood contributed significantly to the understanding of panic disorder by linking it to anxiety rather than cardiac function.
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Hyperventilation can cause symptoms like dizziness and tinnitus.
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Panic attacks occur only in patients with phobic anxiety disorders.
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The risk of developing panic disorder is not influenced by genetic factors.
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In patients with panic disorder, certain chemical agents can induce panic attacks more readily than in healthy individuals.
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The heritability of panic disorder is estimated to be around 40%.
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Women are less likely to be diagnosed with panic disorder compared to men.
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The gene catechol-O-methyltransferase (COMT) has been identified as a significant factor in panic disorder across all ethnicities.
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The DSM-5 includes criteria for distinguishing panic disorder from secondary attacks.
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The lifetime risk of developing panic disorder is estimated to be 4.7%.
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Panic attacks are solely a result of psychological factors without any biochemical influence.
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Benzodiazepines are primarily used to treat panic disorder in low doses to avoid sedation.
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The first antidepressant shown to be effective for panic disorder was clomipramine.
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Cognitive therapy can help to reduce fears about the physical effects of anxiety.
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Involuntary hyperventilation has been conclusively proven to cause panic disorder.
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About 30% of patients with panic disorder remit without subsequent relapse.
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Antidepressants can produce an initial feeling of apprehension, sleeplessness, and palpitations.
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Safety behaviors assist in the disconfirmation of fearful beliefs in panic disorder.
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Patients with panic disorder and agoraphobia typically experience a much better prognosis than those with panic disorder alone.
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The use of antidepressants should start with a high dose to quickly achieve effectiveness.
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The regulation of the sympathetic nervous system is linked to higher mortality rates from cardiovascular disorders among men with panic disorder.
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Study Notes
Panic Disorder Overview
- Panic disorder recognized officially in 1980, although similar cases existed for over a century under various names.
- Central feature: panic attacks characterized by sudden anxiety and physical symptoms, often with fear of serious medical consequences like heart attacks.
Historical Context
- Early terms included irritable heart, Da Costa's syndrome, neurocirculatory asthenia, reflecting a belief in cardiac issues.
- Post-World War II, cardiologist Paul Wood highlighted it as an anxiety disorder rather than a cardiac one.
- DSM-III introduced "panic disorder" in 1980, distinguishing it from generalized or phobic anxiety disorders.
Diagnostic Criteria
- Requires at least two recurrent, unexpected panic attacks.
- Followed by 4 weeks or more of persistent fear of further attacks or maladaptive behavior changes.
Symptoms of Panic Attacks
- Sudden onset including palpitations, choking sensations, dizziness, chest pain, and feelings of depersonalization.
- The fear of dying or losing control is common.
- Hyperventilation often complicates symptoms, leading to feelings of breathlessness despite excessive breathing.
Treatment Approaches
- Supportive measures alongside medication or cognitive therapy.
- Benzodiazepines: Effective in controlling panic attacks; sedation occurs with most except for alprazolam.
- Antidepressants: Include tricyclics (imipramine, clomipramine) and SSRIs; SSRIs preferred for fewer side effects.
- Cognitive Therapy: Helps reduce physical anxiety fears by educating patients on fear and physical symptoms' sequences.
Cognitive Theories
- Patients often fixate on serious physical or mental illnesses during panic attacks, leading to a cycle of increasing anxiety.
- Safety behaviors may prevent the disconfirmation of irrational fears.
Prognosis
- Studies show a lengthy course of symptoms, with about 30% experiencing remission without relapse.
- Better prognosis for panic disorder without agoraphobia; controlled trials suggest effective treatment improves outcomes.
- Higher mortality rates from unnatural causes and cardiovascular issues linked to sympathetic nervous system changes.
Treatment Effectiveness
- Cognitive therapy analogous in effectiveness to antidepressant medication.
- Combined treatments may yield better acute outcomes, though long-term effects are uncertain.
Differential Diagnosis
- Panic attacks can also occur in generalized anxiety disorder, phobic anxiety disorders, and depressive disorders.
- Key criteria for distinguishing panic disorder include persistent concern about future attacks and worries about catastrophic outcomes from attacks.
Epidemiology
- Reported 12-month prevalence of panic disorder: 2.7% in the US, 1.2% in Europe.
- Higher prevalence in women compared to men; associated with increased rates of other anxiety disorders and depression.
Aetiology
- Familial patterns evident; approximately fivefold increased risk in first-degree relatives.
- Genetic factors contribute significantly with a heritability estimate of about 40%.
- Chemical agents like sodium lactate can induce panic attacks more readily in individuals with panic disorder.
Biochemical Factors
- Abnormalities noted in GABA levels; studies show decreased GABA receptor binding in those with panic disorder.
- Serotonin and noradrenaline mechanisms also implicated, highlighting a complex interrelation of biochemical influences in panic disorder.
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Description
Explore the historical context, diagnostic criteria, and symptoms of panic disorder, officially recognized in 1980. Understand the evolution of its terminology and how it is differentiated from other anxiety disorders. This quiz delves into the details of panic attacks and their physical manifestations.
