Panic attacks management

In two studies in which benzodia2epines were gradually tapered, concurrent cognitive-behavioral therapy (CBT) did not increase the proportion of patients who were able to successfully discontinue their use of these agents (Oude Voshaar et al. 2003 Vorma et al. 2003). On the other hand, other studies of patients with panic disorder found that CBT facilitated the discontinuation of benzodiazepine use (Otto et al. 1993). Similarly, CBT may be superior to supportive medical management in preventing the reoccurrence of panic attacks in panic disorder patients in whom alprazolam has been tapered (Bruce etal. 1999). 

Unlabeled Uses Augmenting medication for antidepressants management of aggression in mental retardation and secondary mental disorders, major depression, panic attack... 

Long-Term Efficacy Clonazepam has been shown to be effective for long-term use to manage PD or agoraphobia with panic attacks. In a 1-year follow-up study of clonazepam for PD or agoraphobia with panic attacks. Pollack et al. (42) reported that 18 of 20 (90%) patients, many of whom had failed to respond to or tolerate other BZDs or antidepressants, maintained a good response. One patient was in complete remission at 44 weeks and remained well even off medication at 56 weeks. Tolerance to therapeutic efficacy did not appear to develop, although 40% required a dose increase (from 0.25 to 4.5 mg) to maintain initial improvement. 

PD and its related symptoms can be quite disabling. The recognition that specific drug therapies can effectively block the panic episodes has brought new found hope for thousands of patients. Optimal outcome, however, often requires the addition of various behavioral techniques to manage all related components of the disorder (e.g., panic attack, anticipatory anxiety, phobic avoidance). 

Indications Anxiety disorders (especially A and C for panic and phobic disorders) sedation seizure disorders muscle relaxants (D) management of alcohol withdrawal Depression, anxiety disorders (OCD, panic attacks, social phobias, etc.) Generalized anxiety disorders (GAD)... 

Other clinical uses Tricyclic drugs are also used in the treatment of bipolar affective disorders, acute panic attacks, phobic disorders (compare with alprazolam Chapter 22), enuresis, and chronic pain states. Clomipramine and the selective serotonin reuptake inhibitors, including fiuvoxamine, are effective in obsessive-compulsive disorders. SSRls are also effective in patients who suffer from panic attacks, social phobias, bulimia, and premenstrual syndrome (PMS) and may also be useful in the treatment of alcohol dependence. Bupropion is used for management of patients attempting to withdraw from nicotine dependence. 

A patient with atypical bipolar disorder and panic attacks, given alprazolam 7.5 mg daily, had a reduction of more than 50% in plasma alprazolam levels, from 43 to 19.3 nanograms/mL when given carbamazepine. This was accompanied by a deterioration in his clinical condition, which was managed with haloperidol. ... 

A major event involving the use of chemical weapons would potentially result in chaos and panic, widespread social disruption, and significant morbidity and mortality. Nurses need to have an awareness of the challenges that would be encountered in caring for victims of a chemical attack, and where to locate guidelines for patient care and event management. 

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