Panic Disorder: Symptoms, Prevalence, Treatments, And Current Research

What is panic disorder?

Panic disorder is the anxiety problem in which a person constantly suffers from attacks of fear or panic. Everyone experience feelings of panic and anxiety at various times in his or her life. The patient should have a complete physical exam, blood tests to identify the thyroid and other likely conditions and tests on the heart like ECG (electrocardiogram). They can also go through a psychological evaluation. Some of the self-assessment questionnaires such as DSM 5 can be used to understand the situation.

Symptoms of panic disorder

 Some of the physical symptoms of this mental disorder are increased heartbeat, stomach or chest pain, difficulty in breathing, feeling cold hot or cold chills, sweating, and tingling and numbness of hands (MedlinePlus, 2018). The criteria of the diagnosis of this disorder include having frequent and unpredicted panic attacks. Minimum on of the attacks has been tracked by single month worry related to having next attack; the constant fear of the consequences of the attacks like dropping control, heart attack occurrence or going crazy; or substantial changes in patient’s behavior like escaping condition that they assume may stimulate a panic attack. These attacks are not triggered by drugs or other constituent use, a medical situation or another psychological health condition, like social fear, or obsessive-compulsive disease (Mayoclinic, 2018).

Prevalence rates

An expected 2.7 percent of U.S. youth had a panic disorder in the previous year (Olaya, Moneta, Miret, Ayuso-Mateos, & Haro, 2018). Nearly 4.7 percent of U.S. young people experiences this disorder at least once in a life. The occurrence of this mental condition among the primary care sick people is about twice as elevated as in the overall population with rates of four to eight percent.

The incidence of the panic condition among youth was higher for ladies (3.8%) than for men (1.6%) (Roy-Byrne, 2016). Ladies are twice more probable to be impacted than men, and the sex difference is detected at initial stages of adolescence (Roy-Byrne, 2016). The middle age of start for this disorder in the United States is 20-24 years. The Asian, African, and some Latin American countries have inferior prevalence rates that are ranges from 0.1 to 0.8 per cent (Roy-Byrne, 2016).

Course of disorder

This disorder may initiate at any stage of life, however, most persons develop this condition between puberty and the mid-thirties. A slight number of panic disorder cases begin in babyhood, and onset later the age of 45 is rare (but can occur). The middle age at the beginning is 20-24 years (Roy-Byrne, 2016). The normal course, if not treated, is dangerous or chronic but waning and waxing. Some people have a chronic, occasional course (with irregular occurrences with years of reduction in between). Others have constant severe symptomatology. While agoraphobia may grow at any stage, its onset is commonly within the 1st year of panic disorder (Roy-Byrne, 2016). 

Genetic basis of panic disorder

According to Smoller, Gardner?Schuster, & Covino, (2008), panic disorders are found to be familial and reasonably heritable. The genetic complication has an important influence on panic disorder since it reproduces the preservative or interactive effects of numerous loci with minor individual effects. Some initial studies suggest gene-gene connections. A study defined a nominally important interaction among the functional 5-HTR1A 1019C/G and COMT polymorphisms in panic disorder (Na, Kang, Lee, & Yu, 2011). The twin studies constantly support the theory of genetic influences on the etiology of panic disorder. However, these studies need further research and study (Na, Kang, Lee, & Yu, 2011).

Symptoms of panic disorder

Link to other disorder

PD is associated with various other disorders such as anxiety disorder, depression, PSTD, substance abuse, general phobias and agoraphobia, social phobias and OCD (Obsessive Compulsive Disorder) (Internet Mental Health, 2018). This mental condition somewhat linked to and leads to the PD. A report published in Internet Mental Health (2018), reported that about one-third to one-half of persons identified with PD in community studies also have agoraphobia.

Treatments

Treatment goals

The treatment goal of this disorder aims to recognize the symptoms of the disorder and maintain the recurrences, and complications of the disorder. One of the main treatment goals is to making sure that the vulnerability and exacerbation for panic disorder is reduced and the care should be provided continuously.

Psychotherapy

Psychotherapy, also termed talk therapy, is found to be an effective principal choice management for panic disorder. Psychotherapy can assist the patients to understand the panic disorder and learn how to deal with it (Allen, White, Barlow, Shear, Gorman, & Woods, 2010). A type of psychotherapy named cognitive behavioral therapy (CBT) can help the patient to learn, through their personal experience, that the panic signs are not unsafe. The therapist can help them gradually to cure the symptoms of the panic attack in a harmless and repetitive manner (Allen, White, Barlow, Shear, Gorman, & Woods, 2010).

Medication

Selective serotonin reuptake inhibitors (SSRIs)

Commonly safe with a little risk of severe adverse effects, SSRI antidepressants are naturally suggested as the major choice of drugs to treat the issue. SSRIs approved and permitted by the Food and Drug Administration (FDA) for the management of panic disorder for example, fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil, Pexeva) (Simon et al., 2009).

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

            These drugs are the type of antidepressants. The FDA approved for the management of panic disorder is SNRI venlafaxine (Effexor XR) (Dell’Osso, Buoli, Baldwin, & Altamura, 2010).

Benzodiazepines

These sedative medicines are depressants of the central nervous system. The FDA approved sedative is Benzodiazepines for the management of PD including clonazepam (Klonopin) and alprazolam (Xanax). Benzodiazepines are commonly used only on a temporary basis as they can habit-forming and causing psychological or physical dependency (Otto, McHugh, Simon, Farach, Worthington, & Pollack, 2010).

  These treatments are proven to be very effective in the management or treatment of panic disorder and commonly used across the globe. Combination of antidepressants and cognitive behavioral therapy (CBT) is more effective than using only antidepressants or CBT (Cuijpers, Sijbrandij, Koole, Andersson, Beekman, & Reynolds III, 2014).

Current researches

According to Riske, Thomas, Baker, & Dursun, (2017), MCTs, HCAR1s, and breakdown of lactate should be measured as potential markers when developing novel medications for treating the Panic disorder and possibly preventing extrapyramidal adverse effects resulting caused by the use of antipsychotics.

Another recent study conducted by Graeff, (2017) found that Panic patients may not have sufficient opioid buffering; results heightened feeling to suffocation and separation anxiety. They also found that the exogenous opioids can also be used as a substitute or adjunctive drug in the treatment of PD in drug-resistant panic patients. A recent study conducted by Kemp (2018) found that exercise has a positive effect on decreasing anxiety indications in panic disorder patients. However, the workout can be more effective as the adjunctive therapy joined with the present first line treatment of cognitive behavioral therapy.

Recommendations

• Longer studies should be done on mental interventions centered on CBT for the patients with the Panic disorder, to assess the long-term effectiveness of treatment and the impacts of disturbance of the treatment (Cisler, Olatunji, Feldner, & Forsyth, 2010).
• Also, as outcome variables, the occurrence of panic attacks, including other variables like proactive anxiety should also be comprised, in addition to standards for every aspect of the disease (behavioral, cognitive, and “arousal” or activation state).
• The efficiency of psychodynamic psychotherapy on the patients with Panic disorder needs to be better assessed, standardizing the study design and constantly using randomized organized studies whenever conceivable (Mohr, Burns, Schueller, Clarke, & Klinkman, 2013).
• The efficacy of other treatments such as counseling and brief family therapy for people with PD needs to be assessed.
• The effectiveness of the psychological assistance presently accessible in primary care must be studied with controlled randomized trials that are methodologically appropriate, also assessing the influence on the consumption of psychoactive drugs in people with PD (Cisler, Olatunji, Feldner, & Forsyth, 2010).
• The presence of probable long-term adverse effects of the mixture of CBT and medical treatment should be examined.
• Strategies must be industrialized and examined to treat a diseased person with refractory Panic disorder or patients who respond only partially to the therapies (Livermore, Sharpe, & McKenzie, 2010).

References

Allen, L. B., White, K. S., Barlow, D. H., Shear, M. K., Gorman, J. M., & Woods, S. W. (2010). Cognitive-behavior therapy (CBT) for panic disorder: Relationship of anxiety and depression comorbidity with treatment outcome. Journal of Psychopathology and Behavioral Assessment, 32(2), 185-192.

Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of psychopathology and behavioral assessment, 32(1), 68-82.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta?analysis. World Psychiatry, 13(1), 56-67.

Dell’Osso, B., Buoli, M., Baldwin, D. S., & Altamura, A. C. (2010). Serotonin-norepinephrine reuptake inhibitors (SNRIs) in anxiety disorders: a comprehensive review of their clinical efficacy. Human Psychopharmacology: Clinical and Experimental, 25(1), 17-29.

Graeff, F. G. (2017). A translational approach to the pathophysiology of panic disorder: Focus on serotonin and endogenous opioids. Neuroscience & Biobehavioral Reviews, 76, 48-55.

Internet Mental Health (2018). Panic disorder. Retrieved from: https://www.mentalhealth.com/home/dx/panic.html

Kemp, D. (2018). Is Exercise an Effective Treatment for Reducing Anxiety in Patients with Panic Disorder?. Retrieved from: https://digitalcommons.pcom.edu/pa_systematic_reviews/367/

Livermore, N., Sharpe, L., & McKenzie, D. (2010). Panic attacks and panic disorder in chronic obstructive pulmonary disease: a cognitive behavioral perspective. Respiratory Medicine, 104(9), 1246-1253.

Mayoclinic (2018). Panic attacks and Panic disorder. Retrieved from: https://www.mayoclinic.org/diseases-conditions/panic-attacks/diagnosis-treatment/drc-20376027

medlinePlus (2018). Panic disorder. Retrieved from: https://medlineplus.gov/panicdisorder.html

Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: evidence review and recommendations for future research in mental health. General hospital psychiatry, 35(4), 332-338.

Na, H. R., Kang, E. H., Lee, J. H., & Yu, B. H. (2011). The genetic basis of the panic disorder. Journal of Korean medical science, 26(6), 701-710.

Olaya, B., Moneta, M. V., Miret, M., Ayuso-Mateos, J. L., & Haro, J. M. (2018). Epidemiology of panic attacks, panic disorder and the moderating role of age: Results from a population-based study. Journal of affective disorders, 241, 627-633.

Otto, M. W., McHugh, R. K., Simon, N. M., Farach, F. J., Worthington, J. J., & Pollack, M. H. (2010). Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: further evaluation. Behavior research and therapy, 48(8), 720-727.

Riske, L., Thomas, R. K., Baker, G. B., & Dursun, S. M. (2017). Lactate in the brain: an update on its relevance to brain energy, neurons, glia, and panic disorder. Therapeutic advances in psychopharmacology, 7(2), 85-89.

Roy-Byrne, P. P. (2016). Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. Retrieved from: https://www.uptodate.com/contents/panic-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis

Simon, N. M., Otto, M. W., Worthington, J. J., Hoge, E. A., Thompson, E. H., LeBeau, R. T., … & Pollack, M. H. (2009). Next-step strategies for panic disorder refractory to initial pharmacotherapy. The Journal of clinical psychiatry, 70(11), 1563.

Smoller, J. W., Gardner?Schuster, E., & Covino, J. (2008, May). The genetic basis of panic and phobic anxiety disorders. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 148(2), 118-126.