Panic Disorder Counseling Panic Disorder

Panic Disorder

Counseling

Panic disorder is a comparatively heterogeneous disorder, with its center characteristic, the knowledge of frequent unanticipated panic attacks, surrounding a diversity of somatic, physiological, and cognitive indications that can vary from patient to patient. There are three basic kinds of panic attacks portrayed in the DSM-IV: situationally bound, unexpected and situationally predisposed. Panic disorder with or without agoraphobia is rather ordinary. Even though all socio-demographic groups are affected, panic disorder is most common in women, individuals under the age of fifty years, individuals who are divorced or separated and those who live in an urban area. Treatment for panic disorder can range from psychotherapy to anti-depressant medications to Internet based therapy.

Introduction

As defined in DSM-IV-TR, panic disorder is a comparatively heterogeneous disorder, with its center characteristic, the knowledge of frequent unanticipated panic attacks, surrounding a diversity of somatic, physiological, and cognitive indications that can vary from patient to patient (Kircanski, Craske, Epstein and Wittchen, 2009). Panic Attacks (PA's) presently are defined as a short stage of powerful fear or uneasiness in which four or more of a list of thirteen symptoms grow abruptly and reach a crest inside ten minutes. PA's are ordinary to anxiety disorders, and are a major indicator of risk for the advance and demonstration of psychopathology more generally. As such, PA's may be used as a specifier or as a measurement across all DSM diagnoses (Craske, Kircanski, Phil, Epstein, Wittchen, Hans-Ulrich, Pine, Lewis-Fernandez and Hinton, 2010).

Case Study

Personality traits have been looked at in relation to the diagnosis and treatment of panic disorder (PD). It has normally been determined that personality trouble in that disorder is connected with definite symptomatology, poor reaction to both pharmacological and psychological treatments, and bad prediction. Panic disorder does not typically occur by itself, but as it has been reported in epidemiological studies about a third to one-half of the people with PD also have agoraphobia. This pace is considerably higher in clinical examples, where the agoraphobia is at hand in up to seventy five percent of these people, who are reported to be sicker than people with only PD. Dissimilar personality outlines have been found in PD people with or without agoraphobia, but the links between usual personality traits and agoraphobia have not been looked at. Furthermore, prior studies include PD patients in dissimilar evaluative stages of the disarray and poor predictive or difficult treatment cases could be over characterized. To conquer these boundaries, it is significant to study personality qualities in a sample of an initial phase (Carrera, Herran, Ramirez, Ayestaran, Sierra-Biddle, Hoyuela, Rodriguez-Cabo and Vazquez-Barquero, 2006).

In a study done by Carrera, Herran, Ramirez, Ayestaran, Sierra-Biddle, Hoyuela, Rodriguez-Cabo and Vazquez-Barquero, 2006, the Big Five model of personality in people with panic disorder was looked at and contrasted to consequences established in healthy subjects. The authors examined personality traits as propositions in panic harshness, in the expansion of agoraphobia, and in the short-range treatment reaction of the disorder. For the intention of this study, they incorporated PD patients in their first phases of the illness, and contrasted them with a vigorous model removed from the general populace.

Participants along with healthy people were examined at intake. Patients entered in a flexible-dose Selective Serotonin Reuptake Inhibitors (SSRI's) treatment. After the eight-week follow-up period on SSRI's, people were looked at again to evaluate development and treatment reaction. Socio-demographic and clinical variables were looked at with a particularly created questionnaire. A comprehensive interview was done along the first appointments to look at the date of the first panic attack, and then the commencement of PD. DSM-IV current diagnoses of PD with or without agoraphobia and other Axis-I disorders were recognized utilizing the Mini International Neuropsychiatric Interview (MINI). Control subjects were looked at for present diagnoses with the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD; PHQ) in order to rule out those with PD. Personality magnitudes were evaluated with the Neuroticism-Extraversion-Openness Five Factor Inventory of Personality (NEO-FFI), a shorter edition of the Revised NEO Personality Inventory. This is sixty item self-administered questionnaires gauging the five domains of the Five-Factor Model of personality (Carrera, Herran, Ramirez, Ayestaran, Sierra-Biddle, Hoyuela, Rodriguez-Cabo and Vazquez-Barquero, 2006).

The chief findings of this study were: PD patients in the first stages of the sickness show more neuroticism than healthy people irrespectively of the presence of agoraphobia, extraversion only fluctuates from healthy population in panic patients with agoraphobia, other higher-order personality magnitudes of Costa & McRae's Big Five model of personality do not seem to play a pertinent role in PD, and neither clinical strictness nor short-term treatment reaction emerges to be inclined by personality proportions (Carrera, Herran, Ramirez, Ayestaran, Sierra-Biddle, Hoyuela, Rodriguez-Cabo and Vazquez-Barquero, 2006).

DSM-IV-TR

There are three basic types of panic attacks portrayed in the DSM-IV: situationally bound, unexpected and situationally predisposed. If one knows that they are frightened of high places or of driving over long bridges, one might have a panic attack in these circumstances but not someplace else, this is a situationally bound or cued panic attack. On the other hand, one might experience unanticipated or uncued panic attacks if they don't have any clue when or where the next attack will take place. The third kind of panic attack, the situationally predisposed, is amid these two kinds. One is additionally likely, but will not inescapably, have an attack where they have had one prior. If one doesn't know whether it will take place and it does, the attack is situationally predisposed. Unforeseen and situationally predisposed attacks are significant in panic disorder (Durand and Barlow, 2010).

Criteria

Panic disorder is defined as recurring unanticipated panic attacks in which at least one of the attacks has been followed by one month or more and one or more of the following: constant apprehension about having other attacks, is anxious about the implications of the attack or its penalties, an important alteration in behavior connected to the attacks. The panic attacks are not due to the express physiological results of a substance like drug of abuse or a medication or a common medical condition. The panic attacks are not better explained by an additional mental disorder, such as Social Phobia, Specific Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder or Separation Anxiety Disorder (Craske, Kircanski, Phil., Epstein, Wittchen, Pine, Lewis-Fernandez and Hinton, 2010).

Prevalence

Panic disorder with or without agoraphobia is rather ordinary. Roughly three and a half percent of the populations meet the criterion for panic disorder at some point throughout their lives, two-thirds of them are women, and another two to five percent meet the criteria for agoraphobia. These rates drop a little if one counts only those looking for treatment or who are noticeably impaired. In addition, the rates of agoraphobia may be to some extent overrated as a consequence of procedural complexities, but most individuals with panic disorder do not have agoraphobic evasion (Durand and Barlow, 2010).

Even though all socio-demographic groups are affected, panic disorder is most common in women, individuals under the age of fifty years, individuals who are divorced or separated and those who live in an urban area. Aetiological factors comprise familial and genetic parts, and developmental variables, such as parental loss and separation in childhood, demanding life proceedings and social environmental troubles. The occurrence of panic disorder is roughly one and a half to four percent of the general population. It takes place most often in the late twenties to thirties age bracket. With the presence of agoraphobia, panic attacks are two times as common in women as in men. In the absence of agoraphobia, males and females are affected evenly (Rouillon, 1997).

Relations to case study

In the case that was looked at earlier the DSM-IV current diagnoses of PD with or without agoraphobia and other Axis-I disorders were recognized using the Mini International Neuropsychiatric Interview (MINI). This helped the researchers to analyze personality characters as insinuations in panic severity, in the expansion of agoraphobia, and in the short-term treatment response of panic disorder. This study found that personality dimensions play a huge role in the beginning of panic disorder and are something that should be looked at when treatment is sought.

Causation

Biological

Serotonin, norepinephrine and dopamine are chemicals that act as neurotransmitters or messengers in the human brain. They send communication between dissimilar areas of the brain and are believed to affect a person's mood and anxiety level. One theory of panic disorder is that indications are caused by an unevenness of one or more of these chemicals. Support for this theory is the decrease of panic indications that a lot of patients experience when antidepressants, which modify brain chemicals, are used. It is thought that gamma aminobutyric acid (GABA) is a chemical in the brain that adjusts anxiety. GABA offsets enthusiasm in the brain by inducing relation and repressing anxiety. Research has shown that it may play a role in a lot of mental health issues comprising anxiety and mood disorders (Garakani, Matthew and Charney, 2006).

Health awareness is defined as assessments, appraisals or understanding of a person's health. Apparent health can be generally positive or negative; in spite of how it links with the real health; it may be significant to comprehend its function in certain kinds of psychopathology. Negatively apparent health has been anticipated to symbolize a cognitive risk factor for panic disorder (PD), detached from elevated anxiety feeling. As a result, PD may be more likely to take place on a background of negative perceptions of one's health. A negatively perceived health may also have predictive implications for PD patients, bearing in mind that negatively perceived health has been found to be a considerable predictor of mortality in general and that individuals with panic-like anxiety indications, panic attacks, and PD have elevated mortality rates, mostly due to cardiovascular and cerebrovascular illnesses (Starcevick, Berle, Fenech, Milicevic, Lamplugh and Hannan, 2009).

Psychological

Studies have suggested that panic attacks (PA) are widespread and connected with an augmented occurrence of mental disorders and inferior quality of life, and may be an indicator of severe psychopathology. These studies have suggested that individuals with panic disorder have an overstated, perhaps genetically founded, neurobiological reaction to demanding life events. A person's normal alarm system, its fight or flight reaction, tends to go off as if the body is in serious danger even when it isn't. An original panic attack may turn out to be linked with the upsetting feelings that accompanied it, leading to chronic panic disorder, or recurrent fear of having future panic attacks. The majority of people with panic disorder are found to have experienced troubles with anxiety or panic even as kids (Kinley, Cox, Clara, Goodwin and Sareen, 2009).

Social

Panic disorder is more widespread in people with low educational attainment. For instance, people with less than twelve years of education are five times more probable to have a panic attack and more than ten times more likely to have panic disorder than individuals with more than sixteen years of education. Nevertheless, the power of this finding concerning education contrasts noticeably with another variable connected to general socio-economic standing: earnings. Large dissimilarities in earnings, such as making less than $20,000 compared with more than $70-000 per year, were linked with only small, non-important differences in occurrence rates (Eaton, Kessler, Wittchen and Magee, 1994).

Stressful life dealings activate a person's biological and psychological vulnerabilities to anxiety. The majority are interpersonal in nature, like marriage, divorce, troubles at work or death of a loved one. A few might be physical, such as an injury or illness. Social pressures, possibly to do extremely well in school, might also supply adequate stress to produce anxiety. The same stressors can cause physical responses such as headaches or hypertension and emotional reactions such as panic attacks. The exacting manner that one responds to stress seems to run in families (Durand and Barlow, 2010).

Cultural

Culture comes into play by affecting the feelings that are the center of concern and by influencing the types of disastrous appraisals probable to take place. Panic disorder patients experience fear following the disastrous misunderstanding of certain bodily feelings, particularly orthostatic dizziness. Yet, the foundation for their misunderstanding often lies in folk makeup. This process is the same across cultures, disastrous misinterpretation of certain bodily sensations, but the substance varies (McNally, 2008).

Panic disorder is known to exist worldwide, even though its expression may differ from place to place. Somatic indications of anxiety may be highlighted in Third World cultures. Subjective approaches of fear or anguish may not be part of the cultural idiom; that is, people do not attend to these feelings and do not account them, centering mainly on bodily feelings. There are a lot of cultures that conceptualize their bodies as having vessels that carry blood and wind, and the most significant of these vessels are positioned in the limbs and neck. Stress and disease might partly block these vessels, resulting in augmented bodily wind, which in turn gives rise to a diversity of bodily indications. If the stress becomes to harsh, according to these cultures, the blood vessels in the neck may rupture as wind tries to move upward toward the head, which may then result in death (Durand and Barlow, 2010).

If individuals in these cultures undergo anxiety and panic attacks with associated dizziness and feelings of faintness, their concentration rapidly turns to their neck and troubles with too much wind and any repetition of these symptoms can produce panic attacks. Therefore, individuals from these cultures come to clinics complaining of sore neck or dizziness when standing up, which is a good sign that they have typical cases of panic disorder that they are describing according to the viewpoints and expressions of their cultures. If mental health professionals are not aware of these things, these people might be misdiagnosed and improperly treated (Durand and Barlow, 2010).

Panic Attack Disorder with Agoraphobia

Panic attack disorder with agoraphobia is a disorder in which people experience harsh unforeseen panic attacks. They often believe they are dying or otherwise losing control. For the reason that they never know when an attack might take place, they develop agoraphobia, or fear and evasion of circumstances in which they would feel insecure in the event of a panic attack or indications (Durand and Barlow, 2010). Panic Disorder with Agoraphobia according to the DSM-IV-TR is anxiety about being in places or circumstances from which flight might be hard or awkward or in which aid may not be obtainable in the event of having an unforeseen or situationally predisposed panic attack or panic-like indications. Agoraphobic worries characteristically entail distinguishing bunches of circumstances that comprise being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or fcar. These circumstances are evaded or else are suffered with marked anguish or with anxiety about having a panic attack or panic-like indications, or necessitate the attendance of a friend (Wittchen, Gloster, Beesdo-Baum, Fava and Craske (2010).

Panic Attack Disorder without Agoraphobia

The main trait of Panic Disorder without Agoraphobia is unforeseen and recurring panic attacks, without agoraphobia. The occurrence and harshness of these unforeseen and recurrent attacks differ extensively from individual to individual. At times attacks occur ever day, then for a time once ever few months. Some attacks may be lengthy and some may be short one never knows. These attacks come whenever they want to, giving a person immense uneasiness about the next attack. In order for Panic Disorder without Agoraphobia to be diagnosed, a person must have recurring panic attacks in irregular situations, combined with either unending concern about the attacks, fear of their implications or a serious alteration in behavior as a consequence of the attacks. it's also significant that the attacks take place in situations in which they are inconsistent to the situation at hand (Kikuchi, Komuro, Oka, Kidani, Hanaoka and Koshino, 2005).

Treatment

Just like with most psychiatric illnesses, panic disorder is best treated with both psychotherapy and anti-anxiety medications. There are quantities of kinds of psychotherapy appropriate for the treatment of panic disorder. These comprise relaxation therapy, behavior therapy and cognitive behavioral therapy. Medications are utilized to assist psychotherapy as a main kind of treatment. Medications such as sedatives and antidepressants are utilized in this setting to decrease the incidence and harshness of panic attacks. The most frequently utilized sedatives are the benzodiazepines such as diazepam; but their use beyond four to six weeks is disheartened with the appearance of dependence beyond this period. The most frequently utilized antidepressant for this condition is the SSRI's such as flluoxetine and sertraline. Antidepressant medications will typically necessitate three months of therapy to attain sufficient effect, but have the benefit that they do not bring on patient dependence. Another class of drugs frequently utilized for panic disorder is the beta-blockers. These drugs block the body's reaction to anxiety, stopping the incidence of palpitations, sweating and tremor in the event of a panic attack. They can also be taken in expectancy of stressful circumstances to lessen the effect of anxiety on the body (Panic Disorder, with or Without Agoraphobia, 2006).

Antidepressants have a few drawbacks in that they typically take several weeks to work, and they may get rid of panic attacks without influencing the even more disabling and demoralizing conditioned terror of panic attacks. About a third of people cannot endure the side effects of the tricyclics; particularly dry mouth, augmented heart rate, and dizziness. These indications are particularly troublesome for a person who links extraordinary physical feelings with the beginning of panic. SSRI's have an advantage here, for the reason that their side effects are less and milder. Benzodiazepines also have a small number of side effects, and not like antidepressants, they start to work right away, but a lot of people find it hard to stop taking them because of dependence and removal indications. Benzodiazepines are also utilized to treat generalized anxiety, and they may offer relief from conditioned fear more than from panic itself (Panic attacks and panic disorder -- part II, 1996).