scholarly journals Advancing the Network Theory of Mental Disorders: A Computational Model of Panic Disorder

2019 ◽  
Author(s):  
Donald Robinaugh ◽  
Jonas M B Haslbeck ◽  
Lourens Waldorp ◽  
Jolanda Jacqueline Kossakowski ◽  
Eiko I Fried ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Panic Disorder ◽  
Complex Systems ◽  
Computational Model ◽  
Network Theory ◽  
Research Agenda ◽  
Behavioral Therapy ◽  
Psychological Theory ◽  
Panic Attacks ◽  
Core Components

The network theory of psychopathology posits that mental disorders are complex systems of mutually reinforcing symptoms. This overarching framework has proven highly generative but does not specify precisely how any specific mental disorder operates as such a system. We address this gap in the literature by developing a network theory of Panic Disorder and formalizing that theory as a computational model. We first review prior psychological theory and research on Panic Disorder in order to identify its core components as well as the plausible causal relations among those components. We then construct and evaluate a computational model of Panic Disorder as a non-linear dynamical system. We show that this model can explain a great deal, including individual differences in the propensity to experience panic attacks, key phenomenological characteristics of those attacks, the onset of Panic Disorder, and the efficacy of cognitive behavioral therapy. We also show that the model identifies significant gaps in our understanding of Panic Disorder and propose a theory-driven research agenda for Panic Disorder that follows from our evaluation of the model. We conclude by discussing the implications of the model for how we understand and investigate mental disorders as complex systems.

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.

Panic Attacks During Pregnancy and the Postpartum Period

2014 ◽  
Author(s):  
Cheryl Tatano Beck
Keyword(s):  
Panic Disorder ◽  
Postpartum Period ◽  
Behavioral Therapy ◽  
Child Outcomes ◽  
Panic Attacks ◽  
Antenatal Screening ◽  
Combined Approach ◽  
Qualitative And Quantitative ◽  
Assessment And Treatment ◽  
Target Rates

Panic attacks during pregnancy and the postpartum period are associated with substantial distress and impairment in women. Although perhaps the mostly likely course of perinatal panic disorder (PPD) is that women experience no change in symptoms, there appears to be a substantial minority whose symptoms improve during pregnancy but worsen in the postpartum period. Preliminary research suggests that panic disorder is associated with adverse child outcomes; thus, antenatal screening and diagnosis of panic disorder need to become routine obstetric practice so that treatment can be initiated when indicated. Treatment for PPD often requires a combined approach of pharmacotherapeutics and psychotherapy, such as antidepressants and cognitive behavioral therapy. Much additional research, both qualitative and quantitative, is necessary to target rates of comorbidity in women with PPD, risk factors for PPD, consequences of PPD, and the assessment and treatment of PPD.

scholarly journals Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial

2011 ◽  
Vol 129 (5) ◽  
pp. 325-334 ◽  
Author(s):  
Anna Lucia Spear King ◽  
Alexandre Martins Valença ◽  
Valfrido Leão de Melo-Neto ◽  
Rafael Christophe Freire ◽  
Marco André Mezzasalma ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Panic Disorder ◽  
Cognitive Behavioral Therapy ◽  
Randomized Clinical Trial ◽  
Pharmacological Treatment ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Specific Model ◽  
Panic Attacks ◽  
Cognitive Behavioral

CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

scholarly journals Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

2009 ◽  
Vol 35 (7) ◽  
pp. 698-708 ◽  
Author(s):  
Aline Sardinha ◽  
Rafael Christophe da Rocha Freire ◽  
Walter Araújo Zin ◽  
Antonio Egidio Nardi
Keyword(s):  
Panic Disorder ◽  
Respiratory Symptoms ◽  
Behavioral Therapy ◽  
Respiratory Physiology ◽  
Panic Attacks ◽  
Hyperventilation Syndrome ◽  
Therapeutic Implications ◽  
Challenge Tests ◽  
Respiratory Challenge ◽  
The Relationship

Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.

scholarly journals Nicotine dependence and mental disorders among adults in the USA: evaluating the role of the mode of administration

2008 ◽  
Vol 38 (9) ◽  
pp. 1277-1286 ◽  
Author(s):  
R. D. Goodwin ◽  
M. J. Zvolensky ◽  
K. M. Keyes
Keyword(s):  
Mental Disorders ◽  
Panic Disorder ◽  
Cigarette Smoking ◽  
Nicotine Dependence ◽  
Specific Phobia ◽  
Panic Attacks ◽  
Cigarette Use ◽  
Epidemiologic Survey ◽  
Nicotine Administration ◽  
The Usa

BackgroundTo investigate the association between nicotine dependence (ND), by cigarette smoking and use of smokeless tobacco (UST), and mental disorders.MethodFace-to-face surveys (n=43 093) were conducted in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Nicotine use, ND, and mental disorders were assessed using DSM-IV criteria.ResultsUST-ND was associated with a significantly increased likelihood of any anxiety disorder, specific phobia, alcohol abuse and dependence. Consistent with previous findings, cigarette smoking-ND was associated with an increased likelihood of all mental disorders examined. Among those without ND, cigarette smoking was specifically associated with panic attacks and panic disorder; non-dependent UST was not associated with mental disorders.ConclusionsOur findings suggest that the association between ND and mental disorders is relatively specific to the mode of nicotine administration. Among those who are nicotine dependent, cigarette use is associated with most major psychiatric disorders, whereas UST is associated with dysthymia and specific phobia. Among those who use tobacco but are not nicotine dependent, cigarette use is associated with dysthymia and panic disorder; UST is not associated with any major mood or anxiety disorders. The link between mental disorders and nicotine is complex, and is associated primarily with dependence, and not with non-dependent use.

scholarly journals MANUAL THERAPY AS AN ALTERNATIVE TREATMENT FOR PANIC ATTACKS

World Science ◽  
2019 ◽  
Vol 2 (8(48)) ◽  
pp. 21-28 ◽  
Author(s):  
Sergii Frank ◽  
Michael Frank ◽  
George Frank
Keyword(s):  
Panic Disorder ◽  
Cognitive Behavioral Therapy ◽  
Manual Therapy ◽  
Medical Practice ◽  
Alternative Treatment ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Treatment Resistant

In worldwide medical practice panic attacks are treated mainly by psychological methods and medication. Cognitive-behavioral therapy combined with selective serotonin reuptake inhibitors is considered to be the most effective method of their treatment. However, it has been proven that about a third of patients with panic attacks are treatment resistant. Such people continue experiencing panic attacks and various other symptoms of panic disorder even after receiving the aforementioned treatment. It is this group of patients who are being targeted by the proposed research – manual therapy as an alternative treatment for panic attacks.

Cognitive-Behavioral Therapy for Panic Disorder: A Review of Treatment Elements, Strategies, and Outcomes

CNS Spectrums ◽  
2003 ◽  
Vol 8 (5) ◽  
pp. 356-362 ◽  
Author(s):  
Nadine Recker Rayburn ◽  
Michael W. Otto
Keyword(s):  
Panic Disorder ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Cognitive Behavioral ◽  
Preventive Strategy ◽  
Line Treatment ◽  
First Line ◽  
Term Outcome ◽  
First Line Treatment

ABSTRACTThis article provides an overview of cognitive-behavioral therapy (CBT) for panic disorder. CBT is currently considered a first-line treatment for panic disorder. It offers benefit after short-term intervention, typically consisting of 12–15 sessions conducted in either an individual or a group format. The treatment focuses on the elimination of the patterns that underlie and perpetuate the disorder. Through CBT, patients learn about the nature of the disorder and acquire a set of strategies that counter the fears of panic attacks themselves, and break the recurring cycle of anticipatory anxiety, panic, and agoraphobic avoidance. The collaborative format of treatment, and a focus on elimination of core fears may be factors in enhancing longer-term outcome. In this article, we review the efficacy of CBT as a first-line treatment, a strategy for medication nonresponders, a replacement strategy for patients who wish to discontinue pharmacotherapy, and a potential preventive strategy for at-risk individuals. We also discuss some of the complex issues involved with combination-treatment strategies.

Depression and Comorbidity with Panic Disorder

2014 ◽  
Author(s):  
Natalie Castriotta ◽  
Michelle G. Craske
Keyword(s):  
Major Depression ◽  
Panic Disorder ◽  
Childhood Abuse ◽  
Depressive Episode ◽  
Help Seeking ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Suicide Attempts ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Seeking Behavior

Comorbidity between panic disorder and major depression is found in the majority of individuals with panic disorder and a substantial minority of individuals with major depression. Comorbidity between panic disorder and depression is associated with substantially more severe symptoms of each of the disorders, greater persistence of each disorder, more frequent hospitalization and help-seeking behavior, more severe occupational impacts, and a significantly higher rate of suicide attempts. These two disorders share many risk factors, such as neuroticism, exposure to childhood abuse, informational processing biases, and elevated amygdala activation in response to negative facial expressions. Research on the temporal priority of panic disorder and major depression has most frequently found that panic attacks and other symptoms of anxiety predate the onset of the first major depressive episode, but the first depressive episode predates the onset of full panic disorder. Treatment studies indicate that cognitive behavioral therapy (CBT) is the most effective treatment for panic disorder. Other forms of treatment include medication, particularly selective serotonin reuptake inhibitors. Comorbid depression does not appear to affect the outcome of CBT for a principal diagnosis of panic disorder, and CBT for panic disorder has positive, yet limited, effects on symptoms of depression.

Models and Treatment of Panic: Behavioral Therapy of Panic

1991 ◽  
Vol 5 (3) ◽  
pp. 199-214 ◽  
Author(s):  
Michelle G. Craske
Keyword(s):  
Panic Disorder ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Post Treatment ◽  
Panic Attacks ◽  
Wait List ◽  
Global Functioning ◽  
Wait List Control ◽  
End Of Treatment ◽  
Behavioral Treatments

In this presentation, the results from two studies examining the effectiveness of behavioral treatments for panic disorder are presented. In the first study, a dismantling treatment study design was used to compare relaxation training, exposure and cognitive procedures, the combination of relaxation plus expoosure and cognitive procedures, and a Wait-List control. Subjects with panic disorder and mild or no agoraphobic avoidance were compared immediately after the 15-week treatment program and 6 months and 24 months later. Overall, exposure and cognitive procedures were found to be more effective than relaxation for the control of panic attacks in the short term and over the long term. In the second study, the combination of relaxation plus exposure and cognitive procedures was compared to Alprazolam, Placedbo, and Wait-List control conditions. Overall, the Cognitive-Behavioral therapy condition showed strongest improvements by the end of treatment in terms of panic, general enxiety and global functioning. Finally, it was noted that although exposure and cognitive procedures effectively controlled panic attacks in approximately 80% of subjects (immediately post treatment and 24-months post treatment), only 50% of the subjects were no longer distressed in general.

WCA Recommendations for the Long-Term Treatment of Panic Disorder

CNS Spectrums ◽  
2003 ◽  
Vol 8 (S1) ◽  
pp. 17-30 ◽  
Author(s):  
Mark H. Pollack ◽  
Christer Allgulander ◽  
Borwin Bandelow ◽  
Giovanni B. Cassano ◽  
John H. Greist ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Term Treatment ◽  
Integrated Treatment ◽  
Panic Attacks ◽  
Cognitive Behavioral ◽  
Increased Risk ◽  
Long Term Treatment

ABSTRACTWhat are the symptoms of panic disorder and how is the disorder most effectively treated? One of the most commonly encountered anxiety disorders in the primary care setting, panic disorder is a chronic and debilitating illness. The core symptoms are recurrent panic attacks coupled with anticipatory anxiety and phobic avoidance, which together impair the patient's professional, social, and familial functioning. Patients with panic disorder have medically unexplained symptoms that lead to overutilization of healthcare services. Panic disorder is often comorbid with agoraphobia and major depression, and patients may be at increased risk of cardiovascular disease and, possibly, suicide. Research into the optimal treatment of this disorder has been undertaken in the past 2 decades, and numerous randomized, controlled trials have been published. Selective serotonin reuptake inhibitors have emerged as the most favorable treatment, as they have a beneficial side-effect profile, are relatively safe (even if taken in overdose), and do not produce physical dependency. High-potency benzodiazepines, reversible monoamine oxidase inhibitors, and tricyclic antidepressants, have also shown antipardc efficacy. In addition, cognitive-behavioral therapy has demonstrated efficacy in the acute and long-term treatment of panic disorder. A n integrated treatment approach that combines pharmacotherapy with cognitive-behavioral therapy may provide the best treatment. Long-term efficacy and ease of use are important considerations in treatment selection, as maintenance treatment is recommended for at least 12–24 months, and in some cases, indefinitely.

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