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Cognitive therapists suggest panic disorder to result from 'catastrophic' misinterpretation of bodily sensations. The patient suffering from panic disorder consistently misinterprets normal anxiety responses, such as racing heart, breathlessness or dizziness, as indicating impending disaster. Cognitive therapists, who challenge the traditional view of anxiety as 'free-floating' and irrational, argue that the patient's anxiety is an understandable response to their misinterpretations, and advocate a treatment method based on the patient's specific cognitive make-up and on the principle of collaborative empiricism. The patient is gently guided to identify and challenge idiosyncratic cognitions, and to consider alternative interpretations of danger signs. The article provides an outline of the treatment method and its empirical support.
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PMID:[Cognitive therapy has been shown to be effective in panic disorder]. 983 Mar 10

This article compares panic disorder (PD) medications and discusses long-term therapy. In a review of the literature, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines prove effective in treating PD. MAOIs treat comorbid depression; frequent side effects are dizziness and orthostatic hypotension. SSRIs are better tolerated than MAOIs, producing mild anticholinergic effects, but also producing gastrointestinal side effects and sexual dysfunction. Benzodiazepines are generally well tolerated when titrated gradually; moderate sedation is the most common short-term side effect. Long-term risks are physical dependence and withdrawal reactions. One hundred six PD patients were enrolled in a double-blind, 8-month, placebo-controlled trial of alprazolam and imipramine. In the 8-week short-term phase, daily dosages were titrated up to 10 mg/day of alprazolam and 250 mg/day of imipramine. The greatest number of dropouts occurred during this phase (lack of improvement and/or side effects). Alprazolam patients had a significantly more rapid onset of improvement and lower adverse events and attrition rates. In the 6-month maintenance period, patients continued short-term treatment. Patients receiving either alprazolam or imipramine developed tolerance to some side effects. At maintenance-phase completion, 62% of the alprazolam-group patients and 26% of both the imipramine- and placebo-group patients were panic free (p<0.01). Dosages were tapered to zero over 3 weeks; one third of the alprazolam patients could not discontinue. During the unblinded, 15-month follow-up, patients received open treatment selected by personal physicians on an as-needed basis. At the end of follow-up, all patients were reassessed. Patients who had completed both short-term and maintenance phases were far more likely to be panic-free (85% vs. 55%; p<0.01). PD is chronic and recurrent, and 8 months is an effective treatment period. Maintenance treatment does not lead to tolerance, even with benzodiazepines. Dose tapering must be very gradual. Completion of a long-term maintenance program strongly predicts remission.
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PMID:Panic disorder: long-term pharmacotherapy and discontinuation. 987 8

Panic disorder and agoraphobia have been associated with increased functional disability in individuals who have vestibular problems. The Dizziness Handicap Inventory (DHI), a 25-item self-report questionnaire with three rationally derived subscales, was designed to measure functional, emotional, and physical disability associated with vestibular disturbance. Despite the apparent usefulness of the DHI, there have been few studies of its psychometric properties. The primary purpose of the present study was to assess the factor structure of the DHI. A principal components analysis with oblique rotation was conducted on data collected from 95 patients referred to a tertiary-care vestibular disorders clinic for assessment of vestibular disturbance. Both 2-factor and 3-factor solutions are reported. The 2-factor solution was indicative of General Functional Limitations and Postural Difficulties. In the 3-factor solution, General Functional Limitations was split into factors indicative of Disability in Activities of Daily Living and Phobic Avoidance, while the Postural Difficulties factor remained stable. We also characterized the 3-factor solution by assessing the correlation of factor scores with measures of vestibular symptoms, mood, and anxiety. The general pattern of results does not support the validity of the original subscale structure of the DHI. Implications for revising the DHI to provide a more comprehensive and factorially valid assessment of disability associated with vestibular disturbance are discussed.
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PMID:A factor analytic study of the dizziness handicap inventory: does it assess phobic avoidance in vestibular referrals? 1033 18

The primary objectives of this multicenter study were to determine the efficacy and safety of moclobemide, a selective reversible inhibitor of monoamino oxidase A, as drug treatment in DSM-III-R panic disorder with and without agoraphobia. In a comparative double-blind, randomized parallel-group design with fixed-flexible dose moclobemide 450 mg per day was compared to clomipramine 150 mg per day, as that drug was considered standard treatment of panic disorder in Europe. 135 patients were randomized and treated for a period of eight weeks. No other treatment was given. By the end of week 8, 49% of the patients treated with moclobemide and 53% of those treated with clomipramine were seen as treatment responders since they were without panic attacks. 78% of the patients in the moclobemide and 88% in the clomipramine group were considered responders according to clinical global impression of change. No significant differences were found between the two treatments at week 8. Adverse events were observed with significantly higher frequency among patients treated with clomipramine, particularly due to anticholinergic side effects. Close to 20% of those treated with moclobemide experienced headache, dizziness, nausea, insomnia, or dry mouth, but other adverse effects were infrequent. In conclusion, moclobemide in a dose of 450 mg per day seems to be a good drug alternative for treatment of panic disorder with and without agoraphobia.
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PMID:The efficacy and safety of moclobemide compared to clomipramine in the treatment of panic disorder. 1036 62

Panic disorder is a prevalent psychiatric condition that often is chronic and rarely resolves without medical intervention. Many patients with panic disorder initially present with a variety of somatic symptoms, including chest pain, nausea, or dizziness, and patients frequently seek care in ambulatory care settings. Although panic disorder is classified as a single entity, it can have many dimensions and may be associated with significant morbidity. During the past 2 decades, there have been significant advances in the treatment of panic disorder, and a range of therapeutic choices is now available. Four classes of medications, including the selective serotonin reuptake inhibitors (SSRIs), high-potency benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors, may be considered for the management of patients with panic disorder. Emerging clinical data favor the SSRIs as first-line treatment for patients with panic disorder, and paroxetine and sertraline have been approved by the U.S. Food and Drug Administration for use in panic disorder. This article reviews the efficacy and safety of these treatments, as well as their relative merits and disadvantages, and assists the practicing clinician in choosing among the various pharmacotherapies to tailor therapy to each patient's individual needs.
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PMID:Current concepts in the treatment of panic disorder. 1048 51

A randomized, double-blind, placebo-controlled, parallel-group study was conducted to evaluate the efficacy and safety of gabapentin in relieving the symptoms of panic disorder. One hundred three patients were randomly assigned to receive double-blind treatment with either gabapentin (dosed flexibly between 600 and 3,600 mg/day) or placebo for 8 weeks. No overall drug/placebo difference was observed in scores on the Panic and Agoraphobia Scale (PAS) (p = 0.606). A post hoc analysis was used to evaluate the more severely ill patients as defined by the primary outcome measure (PAS score > or = 20). In this population, the gabapentin-treated patients showed significant improvement in the PAS change score (p = 0.04). In patients with a PAS score of 20 or greater, women showed a greater response than men regardless of treatment. Adverse events were consistent with the known side effect profile of gabapentin and included somnolence, headache, and dizziness. One patient experienced a serious adverse event during the study. No deaths were reported. The results of this study suggest that gabapentin may have anxiolytic effects in more severely ill patients with panic disorder.
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PMID:Placebo-controlled study of gabapentin treatment of panic disorder. 1091 8

This study surveys Khmer refugees attending two psychiatric clinics to determine both the prevalence of panic disorder as well as panic attack subtypes in those suffering panic disorder. A culturally valid adaptation of the SCID-panic module, the Cambodian Panic Disorder Survey (CPDS), was administered to 89 consecutive Cambodian refugees attending these psychiatric clinics. Utilizing culturally sensitive panic probes, the CPDS provides information regarding both the presence of panic disorder and panic-attack subtypes during the month prior to interview. Of 89 patients surveyed at two psychiatric clinics, 53 (60%) currently suffered panic disorder. Among the 53 patients suffering panic disorder, the most common panic attack subtypes during the previous month were the following: "sore neck" [51% of the 53 panic disorder patients (PDPs)], orthostatic dizziness (49% of PDPs), gastrointestinal distress (26% of PDPs), effort induced (21% of PDPs), olfactory induced (21% of PDPs), and "while-sitting dizziness" (16% of PDPs).
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PMID:Panic disorder among Cambodian refugees attending a psychiatric clinic. Prevalence and subtypes. 1107 60

Panic disorder (PD) is one of the most common psychiatric illnesses in Thailand but the picture of PD in Thailand is not clear. Therefore, the objective of this research was to review, summarize, and analyse data from research reports concerning the clinical aspects of PD in Thailand. Relevant papers were searched comprehensively. Four groups of data including prevalence and incidence rates, sex differences, clinical symptoms during panic attacks, and scores of the Hamilton anxiety scale (HAM-A) were extracted where available. Data thus obtained were then grouped and compared. It was found that 2.1 per cent to 12.4 per cent of patients who visited the psychiatric outpatient clinic for the first time were diagnosed as having PD. Males were affected at a similar rate to females with a ranging ratio of female:male from 1.3:1 to 0.67:1. The most common symptoms during panic attacks were palpitations, chest pain or discomfort, and dizziness or vertigo, similar to South American studies. Regarding scores of original HAM-A, mean somatic anxiety scores of PD patients who attended the cardiology clinic were significantly higher than generalized anxiety disorder patients (15.0 vs 9.8, p < 0.05). PD patients who attended the psychiatric clinic had higher mean scores of HAM-A when compared to PD patients who visited the cardiology clinic, but it was not statistically significant (27.7 vs 26.6, p > 0.05). However, the fear item of PD patients at the psychiatric clinic had significantly higher scores (2.1) than the other one (0.7). The difference between these findings and those of Western studies may be caused by cultural factors. Thai men tend to react more promptly to panic attacks and seek medical attention while women mostly attributed their symptoms to "Air Disease". However, incidence rates from other rural areas are lacking. Before conclusions can be drawn, research on epidemiologic data in the community should be further investigated.
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PMID:Panic disorder in Thailand: a report on the secondary data analysis. 1114 81

We used structural equation modeling (SEM) to test the hypothesis that childhood instrumental and vicarious learning experiences influence frequency of panic attacks in young adulthood both directly, and indirectly through their effects on anxiety sensitivity (AS). A total of 478 university students participated in a retrospective assessment of their childhood learning experiences for arousal-reactive sensations (e.g., nausea, racing heart, shortness of breath, dizziness) and arousal-non-reactive sensations (i.e., colds, aches and pains, and rashes). SEM revealed that learning history for arousal-reactive somatic symptoms directly influenced both AS levels and panic frequency; AS directly influenced panic frequency; and learning history for arousal-non-reactive symptoms directly influenced AS but did not directly influence panic frequency. These results are consistent with the findings of previous retrospective studies on the learning history origins of AS and panic attacks, and provide the first empirical evidence of a partial mediation effect of AS in explaining the relation between childhood learning experiences and panic attacks in young adulthood. Implications for understanding the etiology of panic disorder are discussed.
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PMID:Causal modeling of relations among learning history, anxiety sensitivity, and panic attacks. 1128 Mar 42

The aim of this study was to assess the prevalence of symptoms of panic disorder in a representative community sample of people with dizziness and to compare the profile of those whose panic was consistently linked to attacks of dizziness with those in whom dizziness was just one of many, variable somatic symptoms of panic. Validated questionnaires assessing physical and psychological symptoms, occupational disability, and handicap were administered to 128 people reporting dizziness in an epidemiological survey. Nearly two thirds of the sample reported having panic attacks, and one in four met key criteria for panic disorder. People whose panic symptoms were consistently associated with dizziness reported higher rates of vertigo than those with panic unrelated to dizziness, and higher rates of fainting, agoraphobic behavior, and occupational disability than either comparison group. Explanation of perceptual-motor triggers for disorientation may increase the predictability of attacks, thus reducing vulnerability to dizziness-provoked panic.
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PMID:Panic disorder with agoraphobia associated with dizziness: characteristic symptoms and psychosocial sequelae. 1137 77


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