Coping with panic disorder
For our classical ancestors Pan was a deity calling for respect. He
was supposed to be the son of Hermes, but there is no agreement over
the name of his mother. His name means “guardian of flocks”. Half man,
half goat, he lurked in forests and on the hills, making an occasional
appearance that scared humans taken unawares — hence the name panic given
to sudden and unanticipated fits of acute anxiety.
Panic disorder is an
extreme manifestation of the anxiety state. It involves recurrent attacks
of intense fear and discomfort, lasting usually only a few minutes but
on rare occasions for hours. Their onset is unexpected and may be associated
with a phobia such as discomfort in a supermarket or in a crowd of any
kind. Once a sufferer associates certain situations with severe discomfort
further attacks of panic may be foreseen thus rendering the mental state
worse.
Symptoms that may arise include shortness of breath, palpitations
with accelerated heart rate, chest pain, choking or smothering sensations,
dizziness and faintness. The patient may express a fear of dying, going
crazy or of launching into uncontrollable actions.
Panic
disorder is the
subject of a clinical discussion by a Washington psychiatrist in the
1 June issue of the New England Journal of Medicine. He states
that the disorder is twice as common among women as among men and may
show one peak in late adolescence and another in the mid-30s. Diagnostic
criteria require current attacks of anxiety building to a peak within
seconds or minutes and changes of behaviour such as avoiding social activities
and concern about subsequent attacks or fits of unawareness.
Panic has
both biological and environmental causes. Some 80 per cent of patients
report major life stresses during the previous 12 months. A history of
sexual or physical abuse in childhood and smoking by teenagers increase
the risk. As many as 90 per cent will suffer at least one other psychiatric
disorder during their lifetime. Education about the disorder is helpful.
Randomised
trials have shown that five types of medication are effective in patients
with panic disorder. Selective serotonin-reuptake inhibitors, serotonin-nonadrenaline-reuptake
inhibitors, benzodiazepines, tricyclic antidepressants, and monoamine
oxidase inhibitors have been used. Vanlafaxine in doses of 75 to 225
mg per day has reduced panic, anticipatory anxiety and fear and avoidance
of social activities. For safety reasons, the first option has been given
to selective serotonin-reuptake inhibitors, although these tend to produce
side effects early in treatment, before therapeutic effects are seen.
A
disadvantage of benzodiazepines is that possibly 40 to 80 per cent of
patients treated with them for longer than four months may experience
a withdrawal
syndrome characterised by anxiety, irritability, headache, muscle tension,
perceptual abnormalities, insomnia, decreased power of concentration
and cardiorespiratory symptoms when they stop medication. Cognitive behavioural
treatment over three to four months has effects comparable to those of
antidepressants.
Some improvement is expected within two to four weeks
with medication and four to eight weeks with cognitive behavioural therapy,
though a full response to either method may take eight to 12 weeks to
appear. Close follow-up is recommended since up to one third of patients
will have a relapse within two years of the completion of treatment.
Back to Top
|
The
Pharmaceutical Journal
The rather spirited arguments over the celebrated dwarfs who left their
fossilised remains in the island of Flores in Indonesia show no signs
of settling
down into an agreed pattern.