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Treatment Guidelines for Panic Disorder

Treatment Guidelines for Panic Disorder Drug of choice SSRIs Sertraline is recommended first-line per NICE Stepped Care Model Second-line MAOIs, Mirtazapine, Imipramine, Clomipramine, Venlafaxine Experimental Gabapentin, Inositol, Pindolol as augmentation Psychotherapy      CBT, Anxiety management

Psychodynamic Themes in Panic Disorder

Difficulty tolerating anger. Physical or emotional separation from a significant person both in childhood and in adult life  Situations of increased work responsibilities may trigger it  Perception of parents as controlling, shocking, cynical, and demanding  Internal representations of relationships involving sexual or physical abuse  A chronic sense of feeling trapped  A vicious cycle of anger at parental rejecting behavior followed by anxiety that the fantasy will destroy the tie to parents. Failure of signal anxiety function in ego related to self fragmentation and self-other boundary confusion 

Neurobiology of Panic Disorder

Neurobiology of Panic Disorder "There is most evidence for changes in Gamma-aminobutyric acid , with lowered cortical Gamma-aminobutyric acid type  levels measured by magnetic resonance spectroscopy, and diminished benzodiazepine -receptor binding in the parietotemporal regions in unmedicated patients with panic disorder (Hasler et al., 2008)." This happens in panic disorder. Gamma-aminobutyric acid is the major  inhibitory  neurotransmitter in the brain. Benzodiazepine also binds to Gamma-aminobutyric acid type A receptors and increases its firing rate, thus resulting in hyperpolarisation of the cell because of increased chloride influx. So, specific regions in the brain are hyperexcitable in patients with panic disorder. Summary of Hasler et al.  Context Studies have implicated the benzodiazepine receptor system in the pathophysiologic mechanism of panic disorder  by indirect evidence from pharmacological challenge studies and by direct evidence from single-photon emission

Hypochondriacal Disorder

Hypochondriacal Disorder A 34-year-old operating room assistant has presented you in the outpatient department; his physician— to whom he reported ninth time in last three months with a dread that he has human immune virus infection—sent him to you for psychiatric assessment and management. The physician notes he requested him to examine and re-test him for AIDS. He explained that his roommate in the mess recently confessed to having homosexual relationships with multiple partners. The patient never had a homosexual contact nor carries a factor for human immune virus infection. He had anankastic traits; remains worried about his health, however, he has no depression or disturbed biological functions. What will be the differential diagnosis in this case? What is the most likely diagnosis? Justify. How would you manage this case? Differential Diagnosis Hypochondriasis/Illness Anxiety Disorder Obsessive-compulsive disorder, these could be intrusive thoughts, but this is less likely. Monos

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety A 30-year-old man presented with episodes of sudden anxiety, palpitations, chest tightness, and a feeling of impending doom. These episodes occur about 4-5 times per month for the last 7 months and last about 10 minutes on average. They have carried his physical examination and laboratory evaluation out, which is inconclusive about biological causation for his condition.  What would be the most effective treatment option? Cognitive therapy  Fluoxetine Imipramine Amitriptyline  Cognitive Behavior Therapy Controlled studies have shown that cognitive therapy is at least as effective as antidepressant medication in the treatment of the panic disorder (Mitte, 2005). Combined treatment with medication and psychotherapy may cause a better response in the acute phase than either treatment modality given alone, but probably not in the longer term. In the longer-term medication alone may have a less good outcome th