Panic disorder clinical presentation

Coplan JD, Papp LA, Pine DS, et al Clinical improvement with fluoxetine therapy normalizes noradrenergic function in panic disorder. Paper presented at the annual meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, December 1995a... 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

Fitzpatrick, K. K., St Schmidt, N. B. (2000, November). The Discomfort Intolerance Scale (DIS) Psychometric properties and clinical utility in patients with panic disorder. Poster session presented at the annual meeting of the Association for Advancement of Behavior Therapy, New Orleans, LA. 

We do not use benzodiazepines as readily when treating GAD as we do when treating panic disorder. In comparison to those with panic disorder, most patients with GAD can more easily tolerate the delay in treatment response and even any transient exacerbation of anxiety associated with antidepressant therapy. Benzodiazepines are reserved for those who present with especially severe anxiety that necessitates more rapid relief than an antidepressant can afford and for those who do not achieve a satisfactory response to antidepressant or buspirone therapy. Due to the persistent nature of the anxiety experienced by patients with GAD, shortacting benzodiazepines such as alprazolam are not especially helpful unless dosed 3-4 times per day. Instead, we prefer long-acting agents such as clonazepam. When used to treat GAD, clonazepam should be started at a low dose (0.25-0.5 mg/day) and titrated to higher doses (1-4 mg/day) if clinically necessary. 

DSM-IV specifies a total of 12 anxiety disorders, but starts by defining panic attacks. Panic attacks are defined separately but are not considered as a separate diagnostic category because they may occur in many of the other anxiety disorders. Likewise, agoraphobia and panic disorder are not considered as specific anxiety diagnoses but rather their combination. In the following, a description of the clinical presentation will be given ... 

I Full and partial inverse agonists inhibit the action of GABA. They act in the opposite way to a typical BDZ and reduce Cl" influx. There are no clinically useful dmgs in this category at present. However, in patients with panic disorder, flumazenil may act like a partial inverse agonist and cause an increase in anxiety symptoms. 

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