Panic Disorder with Agoraphobia

Panic disorder is characterized by the recurrence of unexpected intense discomfort and fear along with various symptoms which include fear of death, chest pain, palpitations, trembling, dizziness, sweating, and shortness of breath. Panic disorder may progress into a chronic state but a good long-term prognosis is possible. Although panic disorder may occur without agoraphobia, the latter is generally linked to the former due to the extreme fear of the patient for embarrassment as he or she experiences panic attack in public places.

Since panic disorder often co-occurs with other psychiatric disorders, patients are required to undergo differential medical assessment which includes diagnosis for neurologic, endocrine, cardiovascular, and respiratory problems. Meanwhile, a long-time treatment is recommended for relapse has a high rate among medication dropouts. Moreover, for more efficient treatment, combined cognitive-behavioral therapy and pharmacotherapy is suggested. Panic Disorder with Agoraphobia Introduction

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Panic disorder is characterized by the recurrence of unexpected intense discomfort and fear along with various symptoms which include fear of death, chest pain, palpitations, trembling, dizziness, sweating, and shortness of breath (American Psychiatric Association, 2000). In some cases, feelings of unreality, gastrointestinal distress, and Paresthesias were also observed. Hence, patients during panic attacks seem to be out of control or crazy and feel that they will likely experience stroke or heart failure.

In addition, 1 to 3% of the affected individuals suffer the affliction of panic disorder throughout their lifetime. Similar to other health problems, panic disorder must be detected and treated in its early stage in order to give primary attention to its comorbidities, particularly depression, for it further aggravates the patient’s conditions. Although panic disorder may occur without agoraphobia, the latter is generally linked to the former due to the extreme fear of the patients for embarrassment as he or she experiences panic attack in public places.

Still, panic disorder patients with agoraphobia share similarities with individuals afflicted with other psychiatric disorders. For examples, obsessive-compulsive disorder or OCD patients also suffer from major depression, psychotic disorder, social phobias, post traumatic stress disorder, and other personality disorder like schizoid, paranoid, dependent, and avoidant (Katon, 1996). However, these mental problems have no features similar to panic attacks.

Rather, the absence of somatic fears and panic attacks in other anxiety disorders such as in generalized anxiety disorder or GAD and OCD basically differentiates them from panic disorder. Nonetheless, even if individuals with social phobias experience bound panic attacks, the unpredicted panic attacks were not observed in significant cases. Etiology and Pathophysiology There are two major theories on panic attacks: biological and cognitive. Panic disorder is etiologically associated with social learning, genetic predisposition, and altered autonomic responsivity (Merikangas, 2005).

In particular, the “panicogens”such as 5 to 35% carbon dioxide inhalation and intravenous sodium lactate spur panic attack among patients which indicated the biological cause of panic disorder (Coryell, Pine, Fyer, and Klein, 2006). This is further elaborated through the physiological pathway of the brain’s stem nuclei called locus coeruleus. The acute panic attacks were closely associated with the locus coeruleus’ noradrenergic secretions.

As such, in about 66. 67% patients, the intravenous sodium lactate infusion as well as carbon dioxide inhalation, and the antagonist action of cholecystokinin tetrapeptide or CCK-4 and yohimbine to alpha 2-adrenergic trigger panic attacks (Coryell, Pine, Fyer, and Klein, 2006). It was postulated that these physiologic activities incite a mechanism that involves noradrenergic and serotonergic neurons in the locus coeruleus and dorsal raphe respectively. Nevertheless, the familial clustering of the different types of anxiety including panic disorder resulted to the notion of genetic predisposition of panic attacks.

The genome-wide screens suggested the familial aggregation of panic disorder. In fact, it was found to be concordant in 30 to 45% of identical twins (Merikangas, 2005). Meanwhile, the cognitive theory describes individuals afflicted with panic disorder as having high inclinations for misperception of physical sensations. This theory suggested that the misinterpretation of simple physical events leads to panic attacks. That is, a mild physical symptom is often perceived as a peril by the patient.

Individuals with panic disorder are sensitive to somatic symptoms which in turn trigger arousal to set off the panic attack. Thus, the cognitive-behavioral psychotherapy emphasizes recognition and correction of thoughts that trigger panic symptoms in order to reduce and prevent panic attacks. If left untreated, panic disorder may aggravate and cause the patient to avoid different places such as market, church, and malls due to the fear embarrassment as he or she experiences panic attack; hence, this often leads to the development of agoraphobia.

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