Foundation URI : http://id.who.int/icd/entity/1383708356 ICD-11 Criteria For Panic Attacks in Mood Episodes  6A80.1 Description In the context of a current mood episode (manic, depressive, mixed, or hypomanic), there have been recurrent panic attacks (i.e., at least two) during the past month that occur specifically in response to anxiety-provoking cognitions that are features of the mood episode. If panic attacks occur exclusively in response to such thoughts, panic attacks should be recorded using this qualifier rather than assigning an additional co-occurring diagnosis of panic disorder. If some panic attacks over the course of the depressive or mixed episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts, a separate diagnosis of panic disorder should be assigned. Exclusions Panic disorder (6B01) Diagnostic Requirements This specifier can be applied if, in the context of a current Episode, there have been panic attacks during the pas

Psychotherapy      Reassurance Self-help and psychoeducation à Pure self-help, guided self-help, group psychoeducation Relaxation therapy à applied relaxation, progressive muscle relaxation, deep breathing exercises Cognitive behavior therapy Exercise Pharmacotherapies Indications of pharmacotherapy While on psychotherapy, short-term Psychotherapy ineffective, Psychotherapies not available First-line         Selective Serotonin Reuptake Inhibitors à These and SNRIs may initially exacerbate symptoms; a lower starting dose is often required.   Fluoxetine and sertraline are preferred options.   Sertraline is the most tolerable and cost effective, recommended as first choice by NICE. Fluoxetine is most effective choice. Effexor (venlafaxine) SR up to 225 mg/day Dulan/Duron (duloxetine) up to 60 mg/day pregabalin 150–600 mg/day Second-line choices             Agoviz (agomelatine) 25 mg                2 x nocte Agoviz (agomelatine) 25 mg    

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 

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