Panic Disorder +/- Agoraphobia (PD or PDA)

Last updated 26.09.12

 

 

Features

-  Anxiety disorder characterised by recurrent, abrupt & unpredictable attacks of fear

-  Reaches peak within minutes

-  Attacks may be spontaneous or cued

-  Patients attempt to escape environemnt

 

Features

-  Lifetime prevelance 4%

-  Women > men

 

Associated S/S

-  90% develop Agoraphobia

-  Phobic avoidance of places escape could be difficult, embarrassing or help hard to find

-  Range of typical somatic & congnitive S/S

-  Autonomic arousal

-  Palpitations, chest pain/discomfort, sweating, trembling

-  Dyspnoea, choking

-  Nausea, abdominal discomfort

-  Dizzy, light headed, faint, numbness, tingling, chills, flushes

-  Depersonalisation, derealisation

-  Fear of losing control, dying or going mad

-  Concern over repeat attacks: anticipatory anxiety

-  Preoccupation w somatic S/S

-  Palpitaions = AMI

-  Dizziness, light headed = brain tumour

-  Commonly associated w

-  Depression (66%+/-)

-  Hyperchondriasis

-  EtOH or BZD abuse

-  Social & Occupational impairment

-  Interpersonal & marital difficulties

-  Suicide: attempts, success

 

Mx

-  Education

-  Hyperventialtion & light headedness..

-  Slow breathing, control techniques

-  CBT

-  Link between autonomic arousal/hyperventilation & S/S

-  In Vivo exposure

-  Medciation

-  Used in severe cases or no improvement from other techniques

-  Antidepressants & high dose BZDs effective 70% pts

-  SSRIs may exacerbate

 

 

 

References