I. Overview.
Panic disorder (PD), also known as acute anxiety disorder, is characterized by recurrent, sudden, unpredictable and intense panic experiences, usually lasting 5-20 minutes, accompanied by a sense of near death or loss of control, where the patient often experiences fear and dread of a near catastrophic end. The attack is accompanied by very specific and intense cardiac and neurological symptoms that are very worrisome for the patient. And the persistent anxiety and concern about re-occurrence for a period of 1 month can produce certain behavioral changes in the patient, with some people unable to work or study normally, some avoiding certain places where escape or help is not easy, not wanting to be alone, etc.
Panic disorder is a chronic recurrent disorder accompanied by significant functional impairment. It has a prevalence of about 3% and is a disabling disorder with a high co-morbidity rate with alcohol abuse, somatic disorders and other psychiatric disorders, and a 30% co-morbidity rate with depressive disorders, which is more detrimental to the prognosis. The risk of suicidal ideation and suicide attempts among patients with this disorder is twice that of patients with attempted mental illness and almost 20 times that of those without mental illness.
Clinical manifestations: Panic disorder is characterized by the unpredictability and suddenness of the attack, the intensity of the reaction, patients often experience the fear and dread of the imminent catastrophic end, and the termination is also rapid. The clinical manifestations are characterized as follows.
(1) Panic attack: sudden panic experience with a sense of near death or loss of control, accompanied by severe autonomic dysfunction symptoms, such as chest tightness, tachycardia, irregular heartbeat, dyspnea or hyperventilation, headache, dizziness, numbness and abnormal sensation in the extremities, sweating, flesh jumping, general shaking or general weakness. The person is always conscious and highly alert during the seizure. The onset and termination are usually rapid, usually peaking within 10 minutes and rarely exceeding 1 hour.
(2) Anticipatory anxiety: the interval between attacks is still palpitating, fear of another attack, anxiety, or there can often be panic, chest tightness, muscle tension, etc.
(3) Help-seeking and avoidance: 60% of patients are afraid to go out alone, to go to crowded places, to take the bus, to go to the highway, etc. because of the fear of not getting help when they have an attack, otherwise they are anxious and uncomfortable.
(4) Many patients develop depressive symptoms after repeatedly seeking medical help or after poor self-adjustment, and 7% of patients have a history of suicide attempts.
(5) Some patients form alcohol or Valium drug abuse to relieve symptoms.
Treatment: 1.
1, treatment goals: reduce the frequency and severity of panic attacks, alleviate anticipatory anxiety, fearful avoidance, treatment-related depressive symptoms, so that patients achieve clinical recovery; minimize the co-morbidity rate, reduce the disability rate and suicide rate; restore the patient’s function and improve their quality of life.
2.Treatment principles: comprehensive treatment (assessment-based medication, psychotherapy, family social intervention and physical therapy, etc.); full treatment (acute phase, consolidation phase, maintenance phase); individualized treatment.
3.Treatment strategies.
(1) Early diagnosis and early treatment: there may be 2 ways for patients with panic disorder to seek medical attention, one is to consult a comprehensive department, such as respiratory medicine (suspected asthma), cardiovascular medicine (suspected heart disease), endocrinology, neurology, etc.; the other is to consult an emergency room. Patients often arrive at the hospital with symptoms already partially or completely relieved, and are referred to the mental health department for diagnosis and early treatment after detailed examination by physicians to exclude cardiac and other disorders.
(2) Selecting the appropriate treatment site: Patients are often combined with depressive symptoms and have a high risk of suicide, so families should pay high attention to this and be hospitalized if necessary, and standardized detoxification treatment is needed if substance dependence is combined.
(3) Treatment course: Acute treatment is usually 4-12 weeks, and after basically reaching clinical recovery, enter consolidation treatment for at least 9-12 months. If the disease does not reignite, enter the maintenance period, start to closely observe the changes in the condition based on the gradual reduction of drugs, if the relapse should immediately restart drug therapy.
IV. Precautions.
(1) Although panic disorder is not a serious mental illness at present and the standardized comprehensive treatment is more effective, patients generally have poor treatment compliance, sensitivity to adverse reactions, long-term recurrent episodes resulting in abnormal brain function and brain structure, serious impairment of social life, repeated medical visits consume a lot of medical resources and increase the economic burden of the family. Therefore, patients and their families need to pay special attention to: take medication on time every day; some drugs may take several weeks to take effect (non-benzodiazepines); continue to take medication after symptoms improve; do not reduce and stop medication on your own; seek timely medical guidance on how to deal with adverse reactions and other related problems; make timely and reasonable arrangements for daily activities or sports you like; and live, study and work as normally as possible.
(2) Prohibit or cautiously use alcohol and weight-loss drugs, other psychoactive substances, and reduce smoking during medication administration.
(3) If there are co-morbidities that require the combination of multiple drugs, please be sure to use them under medical supervision.
(4) Benzodiazepines (Valium) have a faster onset of action than antidepressants (which have anxiolytic effects), and their early application can help patients improve sleep and reduce intolerance in the early stages of antidepressant use. However, long-term use of this class of drugs is not recommended.
(5) Panic disorder is associated with psychosocial factors, abnormal brain structure and function, genetics, growth environment, repeated experience of negative life events and catastrophic cognition, etc. Therefore, comprehensive treatment is needed, such as assessment-based medication, cognitive-behavioral psychotherapy, physical therapy, family social intervention, and cultural and physical activities, etc. Many patients cannot be “eradicated” by medication alone. “Many patients cannot be treated with medication alone.