Panic disorder diagnosis

It is less clear how one should handle the requirement of unexpected and recurrent panic attacks. This is an inclusion criterion in form, while it is an exclusion criterion in function. This requirement can be operationalized either as a selection filter or as a component of the syndrome. We think it useful to break up unexpected and recurrent into two components and consider them separately. The unexpectedness of the panic attack is such a fundamental requirement in the DSM definition that it makes sense to operationalize it as a selection criterion. According to the DSM, individuals who have only experienced situationally bound panic attacks cannot have a panic disorder diagnosis, which can happen if this criterion is used as an indicator in CCK analyses. An individual can become a taxon member by being elevated on some, but not necessarily all, indicators. Moreover, unexpectedness of a panic attack cannot be easily coded as a continuous variable, which can present computational difficulties, especially for MAXCOV. 

Treating a condition is usually cheaper than not treating it (the offset effect). A Spanish study of panic disorder patients reported an offset effect of 14% following 12 months of drug treatment (Salvador-Carulla et al, 1995). Thus, the total direct costs of health-care use during the previous year and the year following diagnosis were US 29 000 and US 46 000 respectively, but the estimated... 

It is not unusual for nosologic systems to adopt a mixed approach that contains both monothetic and polythetic elements. This type of system, which is used in the DSM, may require that certain diagnostic criteria are present. Other criteria for the disorder may be definitive but not necessary so that any combination of these latter criteria may be sufficient for the diagnosis. For example, panic attacks and some form of panic-related worry are both definitive and necessary criteria for panic disorder. However, any combination of 4 of the 13 symptoms constituting a panic attack is sufficient for this particular element in the diagnosis. 

In the case of panic disorder, the exclusion criteria specify that only certain types of panic attacks are relevant to this diagnosis (i.e., panic attacks resulting from drugs, other anxiety disorders do not count). One could sim-... 

Bipolar I Disorder, Single Episode (296.0x) is one of many DSM-1V diagnoses for which the taxonic status cannot be directly tested (American Psychiatric Association, 1994). The problem lies with the structure of the 296.0x diagnosis. Unlike the definition of panic disorder, 296.0x lacks a unique... 

As you might expect, the diagnostic criteria for panic disorder requires the presence of recurrent panic attacks, but panic attacks alone are not sufficient for the diagnosis of panic disorder. Those with other anxiety disorders, for example, can experience panic attacks when confronted by the situation or object that they fear. 

The differential diagnosis of panic disorder includes other psychiatric illnesses, medical illnesses, and substances that can cause panic attacks. Also included are medical illnesses that cause symptoms resembling panic attacks. It should be mentioned that these other conditions, which are described below, and panic disorder are not necessarily mutually exclusive. In fact, there is a high rate of comorbidity between panic disorder, other anxiety disorders, and mood disorders. Because panic disorder is frequently accompanied by agoraphobia, the differential diagnosis also includes illnesses that are associated with symptoms resembling the avoidance of the agoraphobic patient. 

Panic Disorder. As previously noted, panic disorder and GAD should in theory at least be fairly easy to distinguish. Yet, patients commonly confuse the two when describing their symptoms. It is common that a patient with GAD will describe an anxiety attack or panic attack that comes on gradually and lasts several hours (or even days). This does not represent a true panic attack but a periodic fluctuation in the severity of their generalized anxiety. It should be noted, however, that patients with a principal diagnosis of GAD might occasionally experience panic attacks. In... 

Panic disorder. Sixty-six panic disorder patients were included in a study. All of whom met the DSM-IV diagnosis of panic disorder (n = 45) or panic disorder with agoraphobia ([PDA] n = 21). Twenty-four patients experienced their first panic attack within 48 hours of cannabis use and then went on to develop panic disorder. All the patients were treated with paroxetine (gradually increased up to 40 mg/day). The two groups responded equally well to paroxetine treatment as measured at the 8 weeks and 12 months follow-up visits. There were no significant effects of age, sex, and duration of illness as covariates with response rates between the two groups. In addition, panic disorder or panic disorder... 

The diagnosis generalized anxiety disorder, not otherwise specified refers to a free-floating state of anxiety that is not firmly bounded. For example, a person with a diagnosis of generalized anxiety would be differentiated from someone who suffers specifically from panic disorders or from another particular phobia. 

Note. BROF = brofaromine CIT = citalopram CLO = clomipramine CT = cognitive therapy Dx = diagnosis EXP = exposure in vivo FLU = fluvoxamine FLUOX = fluoxetine GAD = generalized anxiety disorder 5-HTP = 5-hydrox3rtryptophan IMl = imipramine MAP = maprotiline OCD = obsessive-compulsive disorder PAR = paroxetine PD = panic disorder PLA = placebo PPM = psychological panic management RIT = ritanserin ... 

Unanswered questions remain about the role of the CCK system in anxiety and panic. It is still unknown whether CCK plays a role in panic disorder exclusively or whether it is involved in the pathogenesis of other anxiety disorders. Additional provocation studies will help answer this question and might be useful not only for the understanding of the neurobiology of anxiety and panic but possibly in their diagnosis. 

Bakish D, Saxena BM, Bowen R, et al Reversible monoamine oxidase-A inhibitors in panic disorder. Clin Neuropharmacol 16 (suppl 2 S77-S82, 1993a Bakish D, Lapierre Y, Weinstein R, et al Ritanserin, imipramine and placebo in the treatment of dysthymic disorder. J Chn Psychopharmacol 13 409-414, 1993b Bakish D, Ravindran A, Hooper C, et al Psychopharmacological treatment response of patients with a DSM-111 diagnosis of dysthymic disorder. Psychopharmacol Bull 30 53-59, 1994... 

Goisman RM, Warshaw MG, Steketee GS, et al. DSM-IV and the disappearance of agoraphobia without a history of panic disorder new data on a controversial diagnosis. Am J Psychiatry 1995 152 1438-1443. 

Worthington JJ III, Pollack MH, Otto MW, et al. Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull 1998 34 199-205. 

Perugi G, Frare F, Toni C Diagnosis and treatment of agoraphobia with panic disorder. CNS Drugs 2007 21(9) 741. 

It is common to confuse panic attacks with panic disorder. Many psychiatric disorders can have panic attacks associated with them (Table 9—7). However, to qualify for the diagnosis of panic disorder itself, patients must have some panic attacks that are entirely unexpected (Table 9—7). Panic attacks can also be reproducibly triggered by certain specific situations for various individuals, and therefore can be... 

Panic attacks are the common symptom for many of the anxiety disorders. A panic attack is a brief and intense experience of fear or distress accompanied by some of the symptoms listed in Table 4.4 (DSM-IV-TR requires four or more symptoms for this diagnosis but acknowledges that patients can be severely anxious with fewer than four different symptoms). A panic attack—or even several panic attacks—is not by itself a disorder. Many people have a panic attack at some point in their lives. However, about 4% of individuals develop recurrent panic attacks, and 3.5% actually meet DSM-IV-TR criteria for panic disorder. 

Cluster C patients may indeed present for psychotherapy and may improve with that treatment modality alone. However, the therapist should carefully consider the differential diagnosis between avoidant personality disorder and panic disorder or social anxiety disorder, for example, which responds well to SSRI therapy. And the therapist should particularly evaluate the Cluster C patient for obsessional signs and symptoms that may respond well to antiobsessional medication. 

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