Panic Disorder

Learning Objectives

  1. Describe the epidemiology, natural history, and course of panic disorder with and without agoraphobia.
  2. Describe the methodology used in the diagnosis of panic disorder.
  3. Discuss various current treatments.
  4. Identify short-term and long-term effects of acute an extended treatment of this disorder.
  5. Identify the short-term and long-term adverse effects of these treatments.
  6. Describe the best means of managing these adverse effects.
  7. Discuss various considerations for treatment planning.
  8. Identify the significant areas for future research in panic disorder.
  9. Identify 13 symptoms of panic attack.
  10. Describe the historical background of panic disorder and explain various terms used to describe panic disorder by the medical profession over the last two centuries.
  11. Describe the epidemiology of panic disorder.
  12. List the prevalence of panic disorder in various population groups. Chapter 4: Etiology of Panic Disorder.
  13. Describe the etiology of panic disorder in terms of genetic, environmental and stressful life event factors.
  14. List four components of panic disorder.
  15. Explain panic disorder associated with irritable bowel syndrome, chest pain and other somatic complaints.
  16. Describe three types of somatization.
  17. Describe diagnostic criteria for somatization disorder and list 35 symptoms that make the diagnosis of somatization disorder.
  18. List characteristics that help distinguish patients with somatization disorder from those with panic disorder.
  19. Provide a differential diagnosis between major depression and panic disorder.
  20. List overlapping symptoms of panic disorder and alcohol with¬drawal.
  21. Describe diagnostic criteria for psychoactive substance dependents.
  22. Describe maladaptive patterns with alcohol abuse.
  23. Describe diagnostic criteria for generalized anxiety disorder.
  24. Describe social phobia and differentiate with panic disorder or major depression.
  25. Describe diagnostic criteria for posttraumatic stress disorder and discuss the relationship of PTSD to panic disorder and major depression.
  26. Describe how panic disorder affects the course of chronic medical disorders affecting the patient.
  27. Discuss if panic disorder predisposes the patient to specific medical disorders.
  28. Describe how the autonomic nervous system controls the occur¬rence of panic disorder.
  29. Discuss the association of panic disorder with angina pectoris and labile hypertension.
  30. Explain the occurrence of panic disorder with mitral valve prolapse.
  31. List 26 medical disorders and substances that can mimic panic symptoms.
  32. Discuss the association of hyperfhyroidism with panic disorder.
  33. Discuss hypoglycemia as a possible cause of panic disorder.
  34. Discuss similarities and differences in symptoms between temporal lobe epilepsy and panic disorder.
  35. Describe in physiological terms how illicit drugs can cause anxiety attacks.
  36. Describe circumstances under which a physician should order a medical workup prior to making a definitive diagnosis of panic disorder.
  37. Describe general cognitive model of anxiety.
  38. Describe septohippocampal theory of the neurobiology of anxiety.
  39. Discuss the role played by the sympathetic nervous system in responding to stimuli that threaten the well-being of an organism.
  40. Discuss five key principles of panic disorder treatment.
  41. Formulate eight questions to elicit patient’s beliefs about his or her illness.
  42. Discuss psychopharmacologic treatment using three classes of medications.
  43. Describe five useful treatment strategies to increase medication compliance.
  44. Discuss the target patient population, the effectiveness and side effects of tricyclic antidepressants, benzodiazepines and monoamine oxidase inhibitors.
  45. Describe three major disadvantages of benzodiazepines.
  46. List four types of patients who should not be treated with benzodiazepines,
  47. List dietary restrictions for patients taking monoamine oxidase inhibitors.
  48. Describe three goals of psychotherapy.
  49. Describe three techniques of behavioral therapy that are helpful in convincing the patient of the diagnosis.
  50. Describe six categories of patients who would benefit from psychiatric consultation or referral.

Course Contents

Learning Objectives

Introduction: Mental Illness in the Medical Setting

  1. Panic Disorder: Three Stages of Development
  2. Historical Background
    • Military Historical Reports
    • Nonmilitary Historical Reports
  3. Epidemiology of Panic Disorder
  4. Etiology of Panic Disorder
    • Stressful Life Events
    • Genetics
    • Developmental Antecedents
  5. Difficulty in Diagnosis Somatization
    • Specific Somatic Complaints
    • Amplification of Somatic Symptoms
  6. Differential Diagnosis of Panic Disorder and Other Psychiatric Illnesses
    • Affective Illness and Panic Disorder
    • Alcohol Abuse and Panic Disorder
    • Generalized Anxiety Disorder
    • Social Phobia
    • Simple Phobia
    • Posttraumatic Stress Disorder
  7. Comorbidity With Medical Disorders
    • Cardiovascular Morbidity and Mortality
    • Panic Disorder and Mitral Valve Prolapse
  8. Self-Destructive Behavior
    • Thyroid Disease and Panic Disorder
    • Hypoglycemia
    • Pheochromocytoma
    • Temporal Lobe Epilepsy and Panic Disorder
    • Illicit Drug Use
    • Suggested Medical Workup
  9. Psychobiology of Panic Disorder
    • General Cognitive Model of Anxiety
    • Septohippocampal Theory
    • The Sympathetic Nervous System
    • Gamma-Aminobutyric Acid-Benzodiazepine Hypothesis
    • Provocative Studies
    • Summary of Psychobiologic Studies
  10. Treatment of Panic Disorder
    • Psychopharmacologic Treatment
    • Psychotherapy
    • Behavioral Therapy
  11. Indications for Psychiatric Consultation or Referral
  12. Suggested Readings
  13. Bibliography
  14. Post Test