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American Family Physician May 2015Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's... (Review)
Review
Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.
Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents; Anxiety Disorders; Comorbidity; Diagnosis, Differential; Dietary Supplements; Humans; Life Style; Panic Disorder; Patient Education as Topic; Phytotherapy; Prevalence; Psychiatric Status Rating Scales; Psychotherapy; Referral and Consultation; Relaxation Therapy; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index
PubMed: 25955736
DOI: No ID Found -
Journal of Affective Disorders Dec 2016There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
BACKGROUND
There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
GOAL
This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.
METHOD
Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.
RESULTS
Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.
CONCLUSIONS
These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.
Topics: Adolescent; Adult; Anxiety Disorders; Comorbidity; Female; Humans; Male; Panic Disorder; Parenting; Phobia, Social; Phobic Disorders; Risk Factors; Young Adult
PubMed: 27466747
DOI: 10.1016/j.jad.2016.07.008 -
American Family Physician Nov 2005Chest pain presents a diagnostic challenge in outpatient family medicine. Noncardiac causes are common, but it is important not to overlook serious conditions such as an... (Review)
Review
Chest pain presents a diagnostic challenge in outpatient family medicine. Noncardiac causes are common, but it is important not to overlook serious conditions such as an acute coronary syndrome, pulmonary embolism, or pneumonia. In addition to a thorough history and physical examination, most patients should have a chest radiograph and an electrocardiogram. Patients with chest pain that is predictably exertional, with electrocardiogram abnormalities, or with cardiac risk factors should be evaluated further with measurement of troponin levels and cardiac stress testing. Risk of pulmonary embolism can be determined with a simple prediction rule, and a D-dimer assay can help determine whether further evaluation with helical computed tomography or venous ultrasound is needed. Fever, egophony, and dullness to percussion suggest pneumonia, which can be confirmed with chest radiograph. Although some patients with chest pain have heart failure, this is unlikely in the absence of dyspnea; a brain natriuretic peptide level measurement can clarify the diagnosis. Pain reproducible by palpation is more likely to be musculoskeletal than ischemic. Chest pain also may be associated with panic disorder, for which patients can be screened with a two-item questionnaire. Clinical prediction rules can help clarify many of these diagnoses.
Topics: Adult; Algorithms; Ambulatory Care; Cardiovascular Diseases; Chest Pain; Female; Humans; Male; Middle Aged; Musculoskeletal Diseases; Panic Disorder; Physical Examination; Primary Health Care
PubMed: 16342831
DOI: No ID Found -
Comprehensive Psychiatry 1999The differentiation of three types of panic attacks is proposed to be significant for understanding the course and etiology of panic and other psychiatric disorders and... (Comparative Study)
Comparative Study
The differentiation of three types of panic attacks is proposed to be significant for understanding the course and etiology of panic and other psychiatric disorders and physical illnesses. The present investigation is based on longitudinal data from the Epidemiologic Catchment Area (ECA) Study of 1980 to 1981 and its 1994 to 1996 follow-up. Multidimensional scaling (MDS) of panic symptoms identified three types of panic which were consistent over time and for which reliable scales were constructed to measure derealization, cardiac panic, and respiratory panic. Unlike panic disorder, none of the three types of panic attacks predicted the incidence of depression. Derealization was associated with a broader variety of psychiatric disorders than the other two types of panic, including simple phobias, but was not associated with physical diseases. Cardiac panic attacks were associated with a history of heart disease and predicted the incidence of agoraphobia but were not comorbid with depression, unlike the other two forms of panic. Respiratory panic attacks were consistently symptomatic of dysthymia and predicted a higher risk of hospitalization for breast cancer and myocardial infarction (MI).
Topics: Adult; Breast Neoplasms; Catchment Area, Health; Cross-Sectional Studies; Depressive Disorder; Female; Follow-Up Studies; Humans; Male; Myocardial Infarction; Panic Disorder; Psychiatric Status Rating Scales; Respiration Disorders; Retrospective Studies; Severity of Illness Index
PubMed: 10579380
DOI: 10.1016/s0010-440x(99)90092-5 -
BMJ Clinical Evidence Dec 2008Panic disorder occurs in up to 3% of the adult population at some time, and is associated with other psychiatric and personality disorders, and with drug and alcohol... (Review)
Review
INTRODUCTION
Panic disorder occurs in up to 3% of the adult population at some time, and is associated with other psychiatric and personality disorders, and with drug and alcohol abuse. The risk of suicide and attempted suicide has been found to be higher in people with panic disorder than in people with other psychiatric illness, including depression.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug treatments for panic disorder? What are the effects of drug treatments for panic disorder? What are the effects of combined drug and psychological treatments for panic disorder? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 36 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: applied relaxation, benzodiazepines, breathing retraining, brief dynamic psychotherapy, buspirone, client-centred therapy, cognitive behavioural therapy (CBT) (alone or plus drug treatments), cognitive restructuring, couple therapy, exposure (external or interoceptive), insight-orientated therapy, monoamine oxidase inhibitors (MAOIs), psychoeducation, selective serotonin reuptake inhibitors (SSRIs), self-help, and tricyclic antidepressants (imipramine).
Topics: Cognitive Behavioral Therapy; Depression; Depressive Disorder; Humans; Panic Disorder; Treatment Outcome
PubMed: 19445787
DOI: No ID Found -
The Primary Care Companion For CNS... Feb 2021
Topics: Anxiety; COVID-19; Humans; Panic; Panic Disorder; SARS-CoV-2
PubMed: 34000140
DOI: 10.4088/PCC.20l02826 -
Endocrinology and Metabolism Clinics of... Dec 2019Pseudopheochromocytoma manifests as severe, symptomatic paroxysmal hypertension without significant elevation in catecholamine and metanephrine levels and lack of... (Review)
Review
Pseudopheochromocytoma manifests as severe, symptomatic paroxysmal hypertension without significant elevation in catecholamine and metanephrine levels and lack of evidence of tumor in the adrenal gland. The clinical manifestations are similar but not identical to those in excess circulating catecholamines. The underlying symptomatic mechanism includes augmented cardiovascular responsiveness to catecholamines alongside heightened sympathetic nervous stimulation. The psychological characteristics are probably attributed to the component of repressed emotions related to a past traumatic episode or repressive coping style. Successful management can be achieved by strong collaboration between a hypertension specialist and a psychiatrist or psychologist with expertise in cognitive-behavioral panic management.
Topics: Adrenal Gland Neoplasms; Humans; Hypertension; Panic Disorder; Pheochromocytoma; Somatoform Disorders
PubMed: 31655774
DOI: 10.1016/j.ecl.2019.08.004 -
BMC Psychiatry Jun 2022The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale - Self-Report (PDSS-SR) and to examine psychometric properties of...
BACKGROUND
The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale - Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version.
METHODS
A sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial.
RESULTS
The French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach's alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change.
CONCLUSIONS
The French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.
Topics: Adult; Canada; Humans; Panic Disorder; Reproducibility of Results; Self Report; Severity of Illness Index
PubMed: 35761266
DOI: 10.1186/s12888-022-03989-x -
Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis.Evidence-based Mental Health May 2018Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid... (Meta-Analysis)
Meta-Analysis Review
QUESTION
Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid with BD has been systematically reviewed and subject to meta-analysis.
STUDY SELECTION AND ANALYSIS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were thoroughly followed for literature search, selection and reporting of available evidence. The variance-stabilising Freeman-Tukey double arcsine transformation was used in the meta-analysis of prevalence estimates. Both fixed-effect and random-effects models with inverse variance method were applied to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I statistics.
FINDINGS
Overall, 15 studies (n=3391) on cross-sectional prevalence and 25 independent lifetime studies (n=8226) were used to calculate pooled estimates. The overall random-effects point prevalence of PD in patients with BD, after exclusion of one potential outlier study, was 13.0% (95% CI 7.0% to 20.3%), and the overall random-effects lifetime estimate, after exclusion of one potential outlier study, was 15.5% (95% CI 11.6% to 19.9%). There were no differences in rates between BD-I and BD-II. Significant heterogeneity (I >95%) was found in both estimates.
CONCLUSIONS
Estimates that can be drawn from published studies indicate that the prevalence of PD in patients with BD is higher than the prevalence in the general population. Comorbid PD is reportedly associated with increased risk of suicidal acts and a more severe course. There is no clear indication on how to treat comorbid PD in BD. Findings from the current meta-analysis confirm the highly prevalent comorbidity of PD with BD, implicating that in patients with BD, PD might run a more chronic course.
Topics: Bipolar Disorder; Comorbidity; Humans; Panic Disorder
PubMed: 29636354
DOI: 10.1136/eb-2017-102858 -
Translational Psychiatry May 2015Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with... (Review)
Review
Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with significant morbidity and an increased risk of suicide attempts and completed suicide. Recently however, neuroimaging and panic provocation challenge studies have provided insights into the pathoetiology of panic phenomena and have begun to elucidate potential neural mechanisms that may underlie panic attacks. In this regard, accumulating evidence suggests that acidosis may be a contributing factor in induction of panic. Challenge studies in patients with PD reveal that panic attacks may be reliably provoked by agents that lead to acid-base dysbalance such as CO2 inhalation and sodium lactate infusion. Chemosensory mechanisms that translate pH into panic-relevant fear, autonomic, and respiratory responses are therefore of high relevance to the understanding of panic pathophysiology. Herein, we provide a current update on clinical and preclinical studies supporting how acid-base imbalance and diverse chemosensory mechanisms may be associated with PD and discuss future implications of these findings.
Topics: Acid-Base Imbalance; Acidosis; Autonomic Nervous System; Chemoreceptor Cells; Humans; Hydrogen-Ion Concentration; Hyperventilation; Panic Disorder
PubMed: 26080089
DOI: 10.1038/tp.2015.67