PSYC-4430 Spring 2010

Panic Disorder

Group 9: Jarrett Cole, Andrea Fletcher, La-Toya Gray, Jon Johnson, and Christine McCauley

History and Statistics

History:

According to Ronald L. Hoffman, MD, CNS (2009) Panic Disorders roots lie in Greek mythology most notably the Greek demi-god pan. The Greek demi-god “Pan was a mischievous forest sprite inhabiting he lonely stretches of wilderness that separated the Greek city-states.”Pan would lie and wait in the buses for his victims mostly distant travelers walking at night then he would rustle some buses. Basically scaring them so bad that they would never come the same way without experiencing a wave of apprehension. Thus did the term panic originate Ronald L. Hoffman, MD, CNS (2009)

ANGST J. (1998) explains panic disorders are not only an psychological condition there is possibly something more to the puzzle. There for more research needs to be conducted to determine the cause. “Females are almost twice as likely as males to suffer panic disorder, and about seven times as likely to suffer repeated panic attacks. Overall, panic disorder or panic attacks occur in up to one in ten of the general population.” ANGST J. (1998)

Good (2002) explains that in the early 1980's, Panic Disorder was just becoming a diagnosable disorder. Prior to the 1980's, symptoms of Panic Disorder may have been diagnosed as stress, severe anxiety, or depression. Freud was the first to describe a syndrome very similar to what is now called "panic disorder." However, Freud's description was labeled "anxiety neurosis."

According to Croft (2008) throughout history, treatment for anxiety and extreme stress were not effective but included soaking in very cold water, blood letting, or various herbs and balms.

Barlow and Durand (2009) state that Agoraphobia is a Greek word meaning busy shopping area and was first used by Karl Westphal in the in 1870's. This explains why Panic Disorder with Agoraphobia (PDA) involves the person's fear of being in a place where a panic attack could occur or has occurred.

Statistics:

• Prevalence: 1.7% of Adults in the U.S. (ages 18-54) (NIMH, 2002).
  
• Gender: Women:Men ratio - 2:1
• Age of Onset: Late teen years or early adulthood. 50% diagnosed develop it before the age of 24 (NIIMH, 2002).
  
• Cultural Differences: Similar prevalence rates exist worldwide as well as among various ethnic groups within the United States (Barlow & Durand, 2009).
  
• Other Statistics: 30% of patients suffer from alcohol abuse and 17% abuse drugs (NIMH, 2002).
• World Wide Prevalence
  

Symptoms and Specifiers

Symptoms:

List of symptoms for a panic attack according to the DSM-IV-TR. Must have four or more of the symptoms listed (American Psychiatric Association, 2000).

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or Shaking
• Shortness of Breath
• Feeling of Choking
• Chest Pain or Discomfort
• Nausea or Abdominal Pain
• Feeling Dizzy, Lightheaded, or Faint
• Feelings of Unreality or Detached from Oneself
• Fear of Losing Control or Going Crazy
• Fear of Dying
• Numbness of Tingling Sensations
• Chills or Hot Flushes

Diagnosis Criteria for Panic Disorder (PD) according to the DSM-IV-TR (American Psychiatric Association, 2000).

• A) Both 1 and 2 below

1- Recurrent unepected panic attacks
2- Panic attacks have been followed by at least 1 month of one (or more) of the
following:
*Persistent concern about having additional attacks
*Worry about the implications of the attack or its consequences
* Significant change in behavior related to the attacks

• B) Panic attacks are not due to direct physiological effects of substance abuse of a general medical condition
• C) Panic attacks are not better accounted for by another mental disorder, such as Social Phobia, Specific Phobias, OCD, PTSD, or Separation Anxiety Disorder.
  

Diagnosis Criteria for Panic Disorder with Agoraphobia (PDA) according to the DSM-IV-TR (American Psychiatric Association, 2000).

• A) Anxiety about being in places or situations where escape might be difficult or help may not be available in the event of having a panic attack or symptoms of a panic attack. Fears typically involve characteristic clusters of situations that include being outside the home, in a crowd, standing in line, being on a bridge, or traveling in a vehicle.
  
• B) Situations are avoided or endured with increased distress about having a panic attack or panic-like symptoms; require the presence of a companion.
• C) Panic attacks are not better accounted for by another mental disorder, such as Social Phobia, Specific Phobias, OCD, PTSD, or Separation Anxiety Disorder.

Specifiers:

Two types of Panic Disorder:
1) Panic Disorder without Agoraphobia (PD)
2) Panic Disorder with Agoraphobia (PDA)

• About one in three people with panic disorder develops agoraphobia (The Anxiety Disorders Association of America).

Comorbidity:

Often, panic disorders will occurs along with depression, alcoholism, and/or substance abuse. (WebMD).

Causes:

According to WebMD, certain factors are taken into consideration when explaining the cause of Panic Disorder. These factors consist of, family history (genetics), abnormalities in the brain, substance abuse, and major life stress.

Prognosis and Treatments

Prognosis:

Panic disorder may cause severe depression and phobias but with proper treatment, symptoms can be drastically reduced or even eliminated in 70 - 90% of patients (NIMH, 2002).

Not seeking treatment can cause issues in many aspects of the person's life such as job, family, relationships, friends, etc. and cause the person to not perform everyday tasks such as driving, shopping, etc. (NIMH, 2002).

Treatment:

Common treatment includes Cognitive-Behavioral therapy (CBT) in addition to breahting exercises, behavioral therapy, psychodynamic therapy, and real-life exposure (NIMH, 2002).

Additionally, antidepressants such as SSRIs can be prescribed as well as Benzodiazepines (NIMH, 2002).

Video: Case Study Example

URL: Panic Disorder Case Study

Panic Disorder Media

Listed below are links to articles or news stories related to various aspects of Panic Disorder.

Reducing Anxiety

Depression and Panic Disorder Medicine Advice

Anxiety Disorders and the Media

Dealing With Panic Attacks

Panic Disorder Treatment Through the Internet

Q&A: Panic Disorders

Differences Among Various Anxiety Disorders

Lead in the Blood and Panic Disorders

Panic Disorder Mis-Diagnosis

Sweat Causes Stress

Youth and Anxiety

Women and Stress

Can Anxiety Be Good For You?

Managing Stress

Video: Panic Disorder PSA

Understanding Panic Attacks

Anxiety and Panic Disorder Health Care Guide

References

References

American Psychiatric Association. (2000). Diagnositic and statistical manual of mental disorders (4th ed.). Washington, D.C.: Author

ANGST J. (1998). Panic disorder: history and epidemiology. culture & revolver, Retrieved from:http://cat.inist.fr/?aModele=afficheN&cpsidt=2266945

Anxiety Disorders Association of America. (2010). Panic Disorder and Agoraphobia. Retrieved from: http://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia

Barlow, D. H. & Durand, V. M. (2009). Abnormal psychology: An integrative approach (5th ed.). Belmont, CA : Wadsworth Cengage Learning.

Croft, H. (2008). History of anxiety disorders. Healthy Place. Retrieved from http://www.healthyplace.com/anxiety-panic/insights-into-anxiety/history-of-anxiety-disorders/menu-id-1236/

Good, B. J. (2002). Culture and panic disorder: How far have we come? Culture Medicine and Psychiatry 26, 133-136. Retrieved April 24, 2010 from EBSCOhost.

NIMH. (2002). Facts about panic disorder. Wrong Diagnosis. Retrieved from http://www.wrongdiagnosis.com/artic/facts_about_panic_disorder_nimh.htm

Chalraburtty, Amal. (2009). Anxiety and Panic Disorder. Retrieved from: http://www.webmd.com/anxiety-

panic/guide/mental-health-panic-disorder

Ronald L. Hoffman, MD, CNS (2009). The Origin of "panic". Disorder panic disorder. Retrieved from:http://www.mental-health-matters.com/index.php?option=com_content&view=article&id=240