Pharmacologic Treatment of Panic Disorder

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S12) ◽  
pp. 25-31
Author(s):  
Julie C. Stevens ◽  
Mark H. Pollack
Keyword(s):  
Quality Of Life ◽  
Treatment Outcome ◽  
Panic Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Panic Attacks ◽  
Pharmacologic Treatment ◽  
Comorbid Conditions ◽  
Anticipatory Anxiety ◽  
Norepinephrine Reuptake

AbstractPanic disorder, frequently complicated by agoraphobia in the clinical setting, is a relatively common disorder that is associated with significant morbid burden and dysfunction in affected individuals. PD treatment is focused on the reduction of panic attacks, avoidance behavior, and anticipatory anxiety, as well as the resolution of comorbid conditions, with the goal of normalizing function and improving overall quality of life. Antidepressants, including the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, as well as benzodiazepines, are commonly used as primary pharmacotherapies for the treatment of PD, with a variety of other novel interventions potentially useful as well, to optimize treatment outcome.

Panic: Course, Complications and Treatment of Panic Disorder

2000 ◽  
Vol 14 (2_suppl1) ◽  
pp. S25-S30 ◽  
Author(s):  
M. H. Pollack ◽  
P. C. Marzol
Keyword(s):  
Quality Of Life ◽  
Panic Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Premature Mortality ◽  
First Line ◽  
Anticipatory Anxiety ◽  
Pharmacological Agents ◽  
Compulsive Disorder ◽  
Significant Impairment

Panic disorder is a chronic condition typically associated with significant distress and disability. In addition to the acute distress associated with the panic attack itself, the disorder often leads to distressing anticipatory anxiety and phobic avoidance. Affected individuals experience significant impairment in social and vocational functioning, high utilization of medical resources, constriction of function, premature mortality and diminution in overall quality of life. Panic disorder is frequently comorbid with other conditions, particularly depression, as well as alcohol and other substance abuse, and other anxiety disorders including social phobia, generalized anxiety disorder, obsessive-compulsive disorder and posttraumatic stress disorder. A number of pharmacological agents and cognitive-behavioural treatments have been shown to be effective in the treatment of panic disorder, with the selective serotonin reuptake inhibitors (SSRIs) becoming first-line pharmacotherapy for this condition. Among these, the SSRI sertraline appears effective not only in improving symptoms of panic, but also in reducing anticipatory anxiety and improving multiple aspects of quality of life. For patients who remain partly or fully symptomatic despite adequate first-line treatment, a variety of strategies are emerging for the management of refractory conditions. We provide an overview of the prevalence, presentation and associated complications of panic disorder, review the therapeutic options and discuss the management of refractory patients.

Recurrent episodes of intense fear, shortness of breath, racing heart, and sweating

2021 ◽  
pp. 111-118
Author(s):  
Christina L. Macenski
Keyword(s):  
Panic Disorder ◽  
Gold Standard ◽  
Panic Attack ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Shortness Of Breath ◽  
Intense Fear ◽  
Therapy Intervention ◽  
Norepinephrine Reuptake

Panic disorder consists of recurrent, unexpected panic attacks accompanied by persistent worry about future attacks and/or a maladaptive change in behavior related to the attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes that occurs in conjunction with several other associated symptoms such as palpitations, sweating, trembling, shortness of breath, and chest pain. Features of panic disorder that are more common in adolescents than in adults include less worry about additional panic attacks and decreased willingness to openly discuss their symptoms. All patients with suspected panic disorder should undergo a medical history, physical examination, and laboratory workup to exclude medical causes of panic attacks. Cognitive behavioral therapy (CBT) including interoceptive exposures is the gold standard therapy intervention. Medications including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can also help reduce symptoms.

Respiratory Training Prior to Exposure in vivo in the Treatment of Panic Disorder with Agoraphobia: Efficacy and Predictors of Outcome

1995 ◽  
Vol 29 (1) ◽  
pp. 104-113 ◽  
Author(s):  
Edwin de Beurs ◽  
Alfred Lange ◽  
Pieter Koele ◽  
Richard van Dyck
Keyword(s):  
Treatment Outcome ◽  
Panic Disorder ◽  
Prognostic Value ◽  
Panic Attacks ◽  
Self Report ◽  
Number Of Patients ◽  
Exposure In Vivo ◽  
Respiratory Training

Thirty-two patients suffering from panic disorder with agoraphobia were treated with repeated hyperventilation provocations and respiratory training, followed by exposure in vivo. The treatment was evaluated with a comprehensive set of outcome measures, including self-report questionnaires, a multitask behavioural avoidance test and continuous monitoring of panic. The treatment was found effective for the majority of patients in diminishing the frequency of panic attacks and agoraphobic avoidance. The clinical relevance of the treatment effect was evidenced by the considerable number of patients that recovered. The effect of the treatment was sustained over a three and six month follow-up period. The prognostic value of a number of variables for treatment outcome was also investigated. Three variables accounted for the majority of the variance in treatment outcome: a higher pretreatment level of agoraphobic complaints, use of psychotropic medication and a longer duration of the disorder were associated with poorer outcome. Other variables, such as the therapeutic relationship and the quality of the marital bond, had no prognostic value.

Quality of Life and Treatment Outcome in Panic Disorder: Cognitive Behavior Group Therapy Effects in Patients Refractory to Medication Treatment

2006 ◽  
Vol 75 (3) ◽  
pp. 183-186 ◽  
Author(s):  
Elizeth Heldt ◽  
Carolina Blaya ◽  
Luciano Isolan ◽  
Leticia Kipper ◽  
Betina Teruchkin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Outcome ◽  
Group Therapy ◽  
Panic Disorder ◽  
Cognitive Behavior ◽  
Medication Treatment

Changes in quality of life following cognitive-behavioral group therapy for panic disorder

2010 ◽  
Vol 25 (1) ◽  
pp. 8-14 ◽  
Author(s):  
M. Rufer ◽  
R. Albrecht ◽  
O. Schmidt ◽  
J. Zaum ◽  
U. Schnyder ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Group Therapy ◽  
Panic Disorder ◽  
Well Being ◽  
Panic Attacks ◽  
Cognitive Behavioral ◽  
Cognitive Behavioral Group Therapy ◽  
Sf 36 ◽  
Behavioral Group

AbstractBackgroundData about quality of life (QoL) are important to estimate the impact of diseases on functioning and well-being. The present study was designed to assess the association of different aspects of panic disorder (PD) with QoL and to examine the relationship between QoL and symptomatic outcome following brief cognitive-behavioral group therapy (CBGT).MethodsThe sample consisted of 55 consecutively recruited outpatients suffering from PD who underwent CBGT. QoL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) at baseline, post-treatment and six months follow-up. SF-36 baseline scores were compared with normative data obtained from a large German population sample.ResultsAgoraphobia, disability, and worries about health were significantly associated with decreased QoL, whereas frequency, severity and duration of panic attacks were not. Treatment responders showed significantly better QoL than non-responders. PD symptom reduction following CBGT was associated with considerable improvement in emotional and physical aspects of QoL. However, the vitality subscale of the SF-36 remained largely unchanged over time.ConclusionsOur results are encouraging for cognitive-behavior therapists who treat patients suffering from PD in groups, since decrease of PD symptoms appears to be associated with considerable improvements in QoL. Nevertheless, additional interventions designed to target specific aspects of QoL, in particular vitality, may be useful to enhance patients’ well-being.

scholarly journals Do Panic Symptoms Affect the Quality of Life and Add to the Disability in Patients with Bronchial Asthma?

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
A. D. Faye ◽  
S. Gawande ◽  
R. Tadke ◽  
V. C. Kirpekar ◽  
S. H. Bhave ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Panic Disorder ◽  
Bronchial Asthma ◽  
Functional Disability ◽  
Poor Quality ◽  
Panic Attacks ◽  
Disability Score ◽  
Dsm Iv ◽  
Panic Symptoms

Background. Anxiety and panic are known to be associated with bronchial asthma with variety of impact on clinical presentation, treatment outcome, comorbidities, quality of life, and functional disability in patients with asthma. This study aims to explore the pattern of panic symptoms, prevalence and severity of panic disorder (PD), quality of life, and disability in them.Methods. Sixty consecutive patients of bronchial asthma were interviewed using semistructured proforma, Panic and Agoraphobia scale, WHO Quality of life (QOL) BREF scale, and WHO disability schedule II (WHODAS II).Results. Though 60% of the participants had panic symptoms, only 46.7% had diagnosable panic attacks according to DSM IV TR diagnostic criteria and 33.3% had PD. Most common symptoms were “sensations of shortness of breath or smothering,” “feeling of choking,” and “fear of dying” found in 83.3% of the participants. 73.3% of the participants had poor quality of life which was most impaired in physical and environmental domains. 55% of the participants had disability score more than a mean (18.1).Conclusion. One-third of the participants had panic disorder with significant effect on physical and environmental domains of quality of life. Patients with more severe PD and bronchial asthma had more disability.

RESULTS OF ENDOVASCULAR MYOCARDIAL REVASCULARIZATION AND QUALITY OF LIFE IN SUCH PATIENTS AGED UNDER 40

2020 ◽  
pp. 44-57
Author(s):  
F.Z. Abdullaev ◽  
F.E. Abbasov ◽  
N.M. Babaev ◽  
L.S. Shikhieva ◽  
G.A. Amrakhova
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Stable Angina ◽  
Myocardial Revascularization ◽  
Overweight And Obesity ◽  
Panic Attacks ◽  
Recurrent Myocardial Infarction ◽  
Stent Diameter

The aim of the paper is to correlate the results of endovascular myocardial revascularization (EMR) in patients under 40 years of age with acute coronary syndrome (ACS) / stable angina, primary EMR age ≤35/36–40 and stent diameter. Materials and Methods. The authors examined 208 patients (24–40 years of age) with coronary artery disease: 157 patients (75.5 %) aged 36–40; 51 patients (24.5 %) aged ≤35. All in all, 165 (79.3 %) patients underwent EMR; 32 patients (15.4 %) underwent coronary artery bypass grafting; 11 patients (5.3 %) refused medical intervention. EMR results and the quality of life were studied in 126 patients (76.4 %) at 10–107 months of observation (62.5±2.6 months). Results. 84 patients with ACS (50.9 %) and 81 patients with stable angina (49.1 %) underwent EMR. There were no any peri-procedural complications. The authors observed 0 % hospital and 30-day mortality. The survival rate of patients for the period up to 9 years was 99.2 %; long-term mortality was 0.8 %; the constancy of results up to 1, 2 and 3 years of follow-up was 90.5 %, 84.1 % and 81.7 %, respectively, and up to 5–9 years it was 79.4 %. An active lifestyle was verified in 74.6 % of patients; a sparing lifestyle was observed in 25.4 %; 86.5 %, of patients returned to work; transient sexual disorders were found in 28.6% of patients. 83.3 % and 27.8 % of patients kept to drug therapy and dietary regimen. 34.1 % and 23.8 % of patients kept smoking and taking power drinks; overweight and obesity were observed in 23.8 % and 19 % of patients. Recurrent myocardial infarction (MI) / angina was verified in 23 % of patients; 20.6 % of patients underwent second EMR. 23 % of patients got depressed due to recurrent myocardial infarction / angina, while 18.3 % of patients were down due to the quarantine (COVID-19); 6.3 % suffered from panic attacks, for fear of recurrent anginous pain. Conclusion. Predictors of recurrent EMR and stability of results were: 1) ACS; 2) patients’ age (≤35); 3) history of MI, ejection fraction ≤35–40 %, diabetes; 4) stent diameter (<28 mm); 5) smoking and taking power drinks. The leading predictor was the aggressiveness of atherosclerosis and diabetes in persons under 40, causing: a) early stent dysfunction; b) native and “protected” coronary vessels damage in case of intact stents patency. Keywords: ischemic heart disease, young patients, risk profile, semiotics of coronary arteries, endovascular myocardial revascularization, quality of life. Цель. Корреляция результатов эндоваскулярных реваскуляризаций миокарда (ЭВРМ) у больных моложе 40 лет с острым коронарным синдромом (ОКС) / стабильной стенокардией, возрастом при первичной ЭВРМ ≤35 лет / 36–40 лет и диаметром стентов. Материалы и методы. Обследовано 208 больных ИБС в возрасте 24–40 лет: 157 (75,5 %) чел. – в возрасте 36–40 лет, 51 (24,5 %) – ≤35 лет. ЭВРМ выполнена 165 (79,3 %) больным, коронарное шунтирование – 32 (15,4 %), 11 (5,3 %) пациентов отказались от вмешательства. Исходы ЭВРМ и качество жизни изучены у 126 (76,4 %) больных на сроках 10–107 мес. (62,5±2,6 мес.) наблюдения. Результаты. ЭВРМ выполнена 84 (50,9 %) больным ОКС и 81 (49,1 %) больному стабильной стенокардией. Перипроцедурных осложнений не выявлено. Госпитальная и 30-дневная летальность составила 0 %. Выживаемость пациентов на сроках до 9 лет – 99,2 %; отдаленная летальность – 0,8 %; сохранность результатов до 1, 2 и 3 лет наблюдения составила соответственно 90,5, 84,1 и 81,7 %, до 5–9 лет – 79,4 %. Активный образ жизни верифицирован у 74,6 % обследованных, щадящий – у 25,4 %, возврат к работе – у 86,5 %, транзиторные сексуальные нарушения – у 28,6 %. Медикаментозную терапию и диетический режим питания соблюдали 83,3 и 27,8 % пациентов. Продолжали курить и принимать энергетические напитки 34,1 и 23,8 % обследованных; избыточный вес и ожирение сохранялись у 23,8 и 19 %. Рецидив инфаркта миокарда (ИМ) / стенокардии отмечен у 23 % пациентов; повторные ЭВРМ выполнены 20,6 % больным. Депрессию из-за рецидива ИМ / стенокардии отмечали 23 % пациентов, ввиду карантина (COVID-19) – 18,3 %; 6,3 % страдали паническими атаками, боясь повторения ангинозных болей. Выводы. Предикторами повторных ЭВРМ и стабильности результатов являются: 1) ОКС; 2) возраст ≤35 лет; 3) анамнез ИМ, фракция выброса ≤35–40 %, диабет; 4) диаметр стентов <28 мм; 5) курение и прием энергетических напитков. Ведущий предиктор – агрессивность атеросклероза и диабета у лиц не старше 40 лет, обусловливающих: а) раннюю дисфункцию стентов; б) при сохранной проходимости стентов – поражение нативных и «защищенных» коронарных сосудов. Ключевые слова: ишемическая болезнь сердца, молодые больные, профиль риска, семиотика коронарных артерий, эндоваскулярная реваскуляризация миокарда, качество жизни.

Dynamics of quality of life of patients as a method of evaluating surgical treatment outcome in oral and oropharyngeal cancer

2021 ◽  
Vol 59 (1) ◽  
pp. 31-35
Author(s):  
N. Trizna ◽  
Z. Kaliadich ◽  
E. Zhaleika ◽  
A. Evmenenko
Keyword(s):  
Quality Of Life ◽  
Treatment Outcome ◽  
Physical Functioning ◽  
Oropharyngeal Cancer ◽  
Individual Therapy ◽  
Quality Of Life Indicators ◽  
Eortc Qlq C30 ◽  
Oral And Oropharyngeal Cancer ◽  
Eortc Qlq

Study of the quality of life indicators is an important part of a comprehensive analysis of new diagnosis, treatment, and prevention methods. It can serve as an additional criterion for selecting individual therapy or rehabilitation, examining the ability to work, and identifying psychological problems. Purpose of the study: The authors took a clinical case to demonstrate the use of внтфьшс monitoring of the quality of life indicators for the assessment of surgical and reconstructive treatment outcome for oral and oropharyngeal cancer. Results: The anticancer treatment effects were reflected in the physical functioning score according to the EORTC QLQ-C30 questionnaire (reduced to 80 points) and some symptomatic scores according to the EORTC QLQ-C30 and EORTC QLQ-H & N35 questionnaires. Medical rehabilitation measures resulted in positive dynamics of physical functioning scores according to the EORTC QLQ-C30 questionnaire (increase to 93.3 points) and symptomatic scores according to the EORTC QLQ-H & N35 questionnaire related to nutrition. At that, the patient has stopped having difficulty eating in public places; his body weight increased. The absence of pain and refusal to take analgesics also testified to successful treatment and improved quality of life. Conclusion: A subjective assessment of the various quality of life aspects in a particular patient provides valuable information about the individual response to the conducted treatment.

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