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Journal of Emergency Nursing May 2021Mental health disorders are common in the United States and may cause significant disturbances in all aspects of a person's life. Individuals with mental health...
Mental health disorders are common in the United States and may cause significant disturbances in all aspects of a person's life. Individuals with mental health disorders often present to emergency departments for health care. Recognizing and managing common psychiatric emergencies may be challenging for non-mental health providers. The Diagnostic Statistical Manual-5 diagnostic criteria will be discussed and reviewed for panic attack and panic disorder. Both pharmacologic and nonpharmacologic treatment strategies will also be addressed. Adverse drug reactions associated with antipsychotics and selective serotonin reuptake inhibitors are another common psychiatric emergency that will be examined, offering potential management strategies. The objective of this clinical manuscript is to educate emergency health care providers about specific psychiatric emergencies, including panic attack, panic disorder, and adverse drug reactions associated with mental health treatment medications.
Topics: Drug-Related Side Effects and Adverse Reactions; Emergencies; Emergency Service, Hospital; Health Personnel; Humans; Panic Disorder
PubMed: 33714565
DOI: 10.1016/j.jen.2021.01.004 -
Behaviour Research and Therapy Sep 2014Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of... (Meta-Analysis)
Meta-Analysis Review
Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.
Topics: Adaptation, Psychological; Cognitive Behavioral Therapy; Humans; Panic; Panic Disorder; Self Efficacy
PubMed: 25036540
DOI: 10.1016/j.brat.2014.06.003 -
Systematic Reviews Mar 2015The clinical presentation of panic disorder and panic attack overlaps many symptoms typically experienced in coronary heart disease (CHD). Etiological links between... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The clinical presentation of panic disorder and panic attack overlaps many symptoms typically experienced in coronary heart disease (CHD). Etiological links between panic disorder and CHD are controversial and remain largely tenuous. This systematic review aims to pool together data regarding panic disorder with respect to incident CHD or myocardial infarction.
METHODS/DESIGN
Electronic databases (MEDLINE, EMBASE, PsycINFO and SCOPUS) will be searched using a search strategy exploding the topics for CHD and panic disorder. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows:
POPULATION
persons without CHD who meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; Comparison: persons without CHD who do not meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms;
OUTCOME
verified fatal and non-fatal CHD at follow-up; including coronary revascularization procedure, coronary artery disease, and myocardial infarction. Studies adopting self-report CHD will be ineligible. Screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, risk ratios, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the CHD outcomes with Cochrane Review Manager 5.3.
DISCUSSION
This systematic review aims to clarify whether panic disorder is associated with elevated risk for subsequent CHD. An evaluation of the etiological links between panic disorder with incident CHD might inform evidence-based clinical practice and policy concerning triaging chest pain patients, diagnostic assessment, and psychiatric intervention with panic disorder patients.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42014014891 .
Topics: Clinical Protocols; Coronary Artery Disease; Humans; Myocardial Infarction; Panic; Panic Disorder; Research Design; Systematic Reviews as Topic
PubMed: 25875199
DOI: 10.1186/s13643-015-0026-2 -
La Revue Du Praticien Nov 2019EPIDEMIOLOGY OF ANXIETY DISORDERS - The prevalence of anxiety disorders is higher in high-income countries than in middle- and low-income countries. In France, their...
EPIDEMIOLOGY OF ANXIETY DISORDERS - The prevalence of anxiety disorders is higher in high-income countries than in middle- and low-income countries. In France, their lifetime prevalence ranges from 2.1% for panic disorder to 10.7% for specific phobias. They are more frequent among young, female subjects, with low levels of education, unemployed, with low income and not living with a partner. Phobic disorders, separation anxiety and social anxiety have an early onset, most often in childhood; other anxiety disorders have a later and more variable onset age. Apart from separation anxiety, anxiety disorders have a chronic course in more than half of cases and are frequently associated with a substantial functional impairment. The most common comorbid psychiatric disorders are other anxiety disorders, followed by mood disorders, particularly depression, substance use disorders and impulse control disorders. In France, less than a third of people with anxiety disorders receive treatment and less than 15% receive potentially adequate treatment. Of those who perceive a need for care, less than half receive adequate treatment.
Topics: Anxiety Disorders; Child; Comorbidity; Female; France; Humans; Panic Disorder; Phobic Disorders; Prevalence; Prognosis; Substance-Related Disorders
PubMed: 32237615
DOI: No ID Found -
Journal of Psychiatric Research Jul 2019It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities.
METHODS
In a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), symptomatic comorbidities of agoraphobia, MDD, GAD, and social anxiety disorder (SAD) were assessed pre-to-post treatment with the Anxiety Disorders Interview Schedule (ADIS). Comparative efficacy of CBT versus PFPP for treating comorbid disorders was tested at termination and 1 year's follow-up. Covariance between panic and comorbidity improvements was also analyzed.
RESULTS
Most treatment completers (n = 120) evidenced diagnostic remission of their comorbidity (range = 54-69%), which typically reflected a subclinical score on the ADIS (mean range = 1.3 to 1.8). These improvements were generally retained at follow-up. However, patients with MDD dropped out significantly more often (HR = 2.79). No significant symptom change or remission differences emerged between CBT and PFPP for any comorbidity at termination or at follow-up. Panic change was strongly related to improvements in agoraphobia (r = 0.70) and MDD (r = 0.53), moderately related for GAD (r = 0.31), and not significantly related for SAD (r = 0.20).
DISCUSSION
Patients completing panic-focused psychotherapies often experience meaningful remission for diagnoses of agoraphobia, MDD, GAD, and SAD, with no detectable differences between treatments, although sample sizes for the MDD and SAD comparisons were small. In addition, additional efforts may be needed to keep MDD-comorbid patients in treatment.
Topics: Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Female; Humans; Male; Mood Disorders; Panic Disorder; Psychiatric Status Rating Scales; Psychotherapy, Psychodynamic
PubMed: 31015099
DOI: 10.1016/j.jpsychires.2019.04.009 -
Psychophysiology Mar 2016In the current review, we reconceptualize a categorical diagnosis-panic disorder and agoraphobia-in terms of two constructs within the domain "negative valence systems"... (Review)
Review
In the current review, we reconceptualize a categorical diagnosis-panic disorder and agoraphobia-in terms of two constructs within the domain "negative valence systems" suggested by the Research Domain Criteria initiative. Panic attacks are considered as abrupt and intense fear responses to acute threat arising from inside the body, while anxious apprehension refers to anxiety responses to potential harm and more distant or uncertain threat. Taking a dimensional view, panic disorder with agoraphobia is defined with the threat-imminence model stating that defensive responses are dynamically organized along the dimension of the proximity of the threat. We tested this model within a large group of patients with panic disorder and agoraphobia (N = 369 and N = 124 in a replication sample) and found evidence that panic attacks are indeed instances of circa strike defense. This component of the defensive reactivity was related to genetic modulators within the serotonergic system. In contrast, anxious apprehension-characterized by attentive freezing during postencounter defense-was related to general distress and depressive mood, as well as to genetic modulations within the hypothalamic-pituitary-adrenal (HPA) axis. Patients with a strong behavioral tendency for active and passive avoidance responded better to exposure treatment if the therapist guides the patient through the exposure exercises.
Topics: Agoraphobia; Animals; Avoidance Learning; Clinical Trials as Topic; Defense Mechanisms; Female; Humans; Male; Models, Neurological; Multicenter Studies as Topic; Neurosciences; Panic Disorder; Reflex, Startle; Risk Factors
PubMed: 26877119
DOI: 10.1111/psyp.12553 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2021The aim of the study was to investigate the course of agoraphobia with panic disorder combined with the major depressive disorder to establish positive and negative...
OBJECTIVE
The aim of the study was to investigate the course of agoraphobia with panic disorder combined with the major depressive disorder to establish positive and negative prevalence predictors.
MATERIAL AND METHODS
The sample consisted of 49 women. The average age was 41.5±9.9 years. All patients (=49; 100%) had symptoms of agoraphobia with panic disorder (F40.01) (=49; 100%) and recurrent depressive disorder with mild (F33.01) (=33; 67.3%) or moderate (F33.11) (=16; 32.7%) severity. The duration of the disease by the time of inclusion in the study was from 2 to 5 years. Clinical-psychopathological, clinical-follow-up, clinical-dynamic, and statistical methods were used.
RESULTS AND CONCLUSION
Two types of agoraphobia prevalence with panic disorder were identified. Type I is a relatively favorable one with complete remissions of phobic anxiety and affective disorders (=29; 59.2%). Type II is an unfavorable one with constant phobic anxiety symptoms (=20; 40.8%). The predictive factors of the unfavorable type of agoraphobia with panic disorder (APD) combined with depression were psychogenic situations, astheno-vegetative disorders at the onset of APD, gastrointestinal symptoms, senestopathy, fear of going crazy, or loss of control in the structure of a panic attack (PA), morning PA, vertebral artery syndrome, diseases of the gastrointestinal tract, panic attacks with provocation, depression with hysteroform symptoms in pre-manifest period APD, the age at the time of the debut APD, professional status, occupational psychogenic, family microclimate, health problems, endocrine system diseases, severe agoraphobia.
Topics: Adult; Agoraphobia; Anxiety Disorders; Depression; Depressive Disorder, Major; Female; Humans; Middle Aged; Panic Disorder
PubMed: 34405657
DOI: 10.17116/jnevro20211210549 -
Journal of Dual Diagnosis 2022Rates of lifetime substance use disorder (SUD) are high among people with lifetime posttraumatic stress disorder (PTSD). Panic attacks are also prevalent among trauma...
Rates of lifetime substance use disorder (SUD) are high among people with lifetime posttraumatic stress disorder (PTSD). Panic attacks are also prevalent among trauma survivors and people with SUD, yet studies on PTSD/SUD have rarely examined comorbid panic. This potentially creates additional barriers to effective treatment for people with PTSD/SUD, in that panic may be under-diagnosed among people with PTSD/SUD and consequently attenuate treatment outcome. Additionally, research on PTSD/SUD often combines people with alcohol use disorder (AUD) and people with drug use disorders (DUDs) into a single group despite evidence that these two PTSD/SUD subgroups differ along important sociodemographic and clinical variables. This study tested the hypothesis that among adults with lifetime PTSD, panic attacks would be associated with greater lifetime risk for both AUD and DUD. We also explored whether panic attacks were associated with specific DUDs that frequently co-occur with PTSD (cannabis, sedatives/tranquilizers, heroin/opioids, and cocaine). Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a cross-sectional national study. Adults with lifetime PTSD ( = 2,230) were classified into one of three groups based on diagnostic interview data: adults with PTSD/AUD (i.e., met criteria for PTSD and AUD but not DUD; = 656), adults with PTSD/DUD (i.e., met criteria for PTSD and DUD, regardless of AUD diagnostic status; = 643), or adults with PTSD-only (i.e., met criteria for PTSD but not AUD or DUD; = 1,031). Weighted logistic regression analyses showed that lifetime risk of PTSD/AUD and PTSD/DUD, each relative to PTSD-only, was greater for adults who were younger at the time of data collection, were male, and had a history of panic attacks. Panic attacks did not predict DUD diagnoses comorbid with PTSD in exploratory analyses adjusting for sociodemographic and clinical covariates. Findings highlight the importance of assessing and targeting panic in PTSD/SUD clinics, but suggest panic may not discriminate between specific DUDs that commonly co-occur with PTSD. Study limitations and future directions are discussed.
Topics: Adult; Alcohol-Related Disorders; Alcoholism; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Panic Disorder; Stress Disorders, Post-Traumatic; Substance-Related Disorders
PubMed: 34965200
DOI: 10.1080/15504263.2021.2013096 -
Nordic Journal of Psychiatry Aug 2016Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it...
Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it has been problematic to use very comprehensive anxiety questionnaires in epilepsy patients, as panic attacks and epileptic seizures, although two distinct clinical entities from a diagnostic point of view, show a significant overlap of symptoms. Aims We have focused on single items for anxiety and depression as screening candidates in adolescent epilepsy. Methods The individual panic attack item in the Screen for Children Anxiety Related Emotional Disorders Scale (SCARED) and the single depression item in the Kellner Symptom Questionnaire were tested. Our samples consisted of adolescent patients with epilepsy and a matched control group with healthy participants, as well as two numerical groups acting as controls. Results The single panic attack item identified panic anxiety in 24.1% in the group of patients with epilepsy and 0.0% in the matched control group (p = 0.01). The single depression item identified 52.2% with depression in the epilepsy group and 6.2% in the matched control group (p = 0.001). Conclusion As screening instruments, single items of panic attack and depression are sufficient to screen for these affective states in adolescent epilepsy. The clinical implications are that it is important to be quite specific when screening for depression and panic attacks in adolescent patients with epilepsy.
Topics: Adolescent; Adolescent Behavior; Anxiety; Child; Emotions; Epilepsy; Female; Humans; Male; Panic Disorder; Psychometrics; Surveys and Questionnaires
PubMed: 26906494
DOI: 10.3109/08039488.2016.1143029 -
Depression and Anxiety Nov 2020Panic disorder is a common anxiety disorder affecting up to 5% of the population. Although its pathogenesis is unclear, evidence about its association with ambient...
BACKGROUND
Panic disorder is a common anxiety disorder affecting up to 5% of the population. Although its pathogenesis is unclear, evidence about its association with ambient temperature is limited. We aimed to investigate the association between short-term exposure to increased ambient temperature and exacerbation of panic attacks requiring emergency department visits.
METHODS
From the national emergency database of South Korea, we identified 1,926 patients who presented with panic attacks at the emergency department in Seoul from 2008 to 2014. Using a time-stratified case-crossover design and conditional logistic regression analysis, we compared ambient temperature levels on emergency department visits and correspondingly matched-control days.
RESULTS
Increased ambient temperature levels were significantly associated with panic attacks. The risk of a panic attack increased by 2.2% (95% confidence interval, 0.7-3.8%) per every 1°C increase in temperature. This association was significant after adjusting for air pollutants.
CONCLUSIONS
Our results provide new evidence that short-term exposure to increased ambient temperature may increase the risk of exacerbation of panic attacks. These findings may provide a basis for further research to establish the association between panic attacks and ambient temperature, thus establishing preventive measures for panic attacks.
Topics: Air Pollutants; Cross-Over Studies; Emergency Service, Hospital; Humans; Panic Disorder; Republic of Korea; Temperature
PubMed: 32301576
DOI: 10.1002/da.23019