Psychiatric disorders panic disorder

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

Most of the Axis 1 conditions are organized in a more complex fashion than personality disorders. Panic disorder is used as an example. Panic disorder is defined by the DSM-1V-TR (American Psychiatric Association, 2000, p. 402) as follows ... 

Avery DH, Osgood TB, Ishiki DM, Wilson LG, Kenny M, Dunner DL. (1985). The DST in psychiatric outpatients with generalized anxiety disorder, panic disorder, or primary affective disorder. Am J Psychiatry. 142(7) 844-48. 

Other psychiatric illnesses, particularly the anxiety disorder, are also risk factors for development of major depressive disorder. Persons with anxiety disorders (panic disorder, obsessive compulsive cUsorder, social phobia, generalized anxiety disorder, and posttrauma tic stress disorder) go on to develop major depressive cUsorder over the course of 5-20 years in over 50% of cases. 

Antidepressants are small heterocyclic molecules entering the circulation after oral administration and passing the blood-brain barrier to bind at numerous specific sites in the brain. They are used for treatment of depression, panic disorders, generalized anxiety disorder, social phobia, obsessive compulsive disorder, and other psychiatric disorders and nonpsychiatric states. 

Otto MW, Pollack MH, Sachs GS, et al Alcohol dependence in panic disorder patients. J Psychiatr Res 26 29-38, 1992... 

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. 

Data from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. Washington, DC American Psychiatric Association, 2000 429-484 Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders Recommendations from the British Society for Psychopharmacology. J Psychopharmacology 2005 19 567-596 and Katon WJ. Panic disorder. N EnglJ Med 20062554 2560-2567. 

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... 

Amering, M., Katschnig, H. (1990). Panic attacks and panic disorder in cross-cultural perspective. Psychiatric Annals, 20, 511-516. 

Panic disorder is characterized by the occurrence of panic attacks that occur spontaneously and lead to persistent worry about subsequent attacks and/or behavioral changes intended to minimize the likelihood of further attacks. Sporadic panic attacks are not limited, however, to those with syndromal panic disorder as they do occur occasionally in normal individuals and in those with other syndromal psychiatric disorders. The hallmark of panic disorder is that the panic attacks occur without warning in an unpredictable variety of settings, whereas panic attacks associated with other disorders typically occur in response to a predictable stimulus. For example, a person with acrophobia might experience a panic attack when on a glass elevator. A patient with obsessive-compulsive disorder (OCD) with contamination fears may have a panic attack when confronted with the sight of refuse, and a combat veteran with post-traumatic stress disorder (PTSD) may experience a panic attack when a helicopter flies overhead or an automobile backfires. 

Although the delineation of panic disorder as a unique diagnostic entity is a relatively recent development, references to what would today be known as panic attacks commonly appeared in the annals of medical and psychiatric literature. For example, cardiologists, who frequently encounter patients with panic disorder due to the dramatic presentation of cardiac symptoms in association with panic, have numerous terms for panic including cardiac neurosis, DaCosta s syndrome, soldier s heart, and neurocirculatory asthenia. 

The symptoms of a panic attack are so frightening that an unusually large number of those with panic disorder (in comparison to other psychiatric illnesses) seek treatment on their own accord. However, easily half of those who seek treatment do so in general medical settings such as hospital emergency rooms and the offices of primary care physicians. Easily mistaken for severe and even life-threatening medical conditions such as asthma attacks and heart attacks, panic disorder results in disproportionately higher health care utilization than other anxiety disorders. 

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. 

In contrast to panic disorder, the somewhat more subtle and persistent symptoms of GAD do not always command immediate attention. Although patients with GAD may present with a primary complaint of anxiety, they are more likely to complain of a physical ailment or another psychiatric condition or symptoms, for example, depression or insomnia. As such, many patients with GAD will seek treatment from a primary care physician long before recognizing the need for mental health care despite readily acknowledging that they have been anxious virtually all of their lives. 

Psychiatric patients Flumazenil may provoke panic attacks in patients with a history of panic disorder. 

In this chapter, we consider categorical anxiety disorders as defined by the standardized diagnostic criteria of American Psychiatric Association s Diagnostic and Statistical Manual for Psychiatric Disorders [i.e., DSM-III (1980), DSM-III-R (1987), DSM-IV (1994)]. The subtypes of anxiety states included are panic disorder, agoraphobia, specific phobia, social phobia, generahzed anxiety/overanxious disorder, separation anxiety, and obsessive-compulsive disorder. 

Mendlewicz J, Papdimitriou G, Wilmotte J (1993) Family study of panic disorder comparison with generalized anxiety disorder, major depression and normal subjects. Psychiatr Genet 3 73-78... 

Schmidt SM, Zoega T, Crowe RR (1993) Excluding linkage between panic disorder and the gamma-aminobutyric acid beta 1 receptor locus in five Icelandic pedigrees. Acta Psychiatr Scand 88 225-228... 

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