Panic Disorder F41.0 - ICD10 Description, World Health Organization
Panic Disorder - Diagnostic Criteria, American Psychiatric Association
Effective TherapiesCognitive behavioral therapy (CBT), benzodiazepines and antidepressants (SSRI + SNRI) are very effective as treatments for this disorder.
Ineffective therapiesVitamins and dietary supplements are ineffective for this disorder.
ComplicationsIndividuals with Panic Disorder often anticipate a catastrophic outcome from a mild physical symptom or medication side effect. Such individuals are also much less tolerant of medication side effects and generally need continued reassurance in order to take medication. The belief that they have an undetected life-threatening illness may lead to both chronic debilitating anxiety and excessive visits to health care facilities. Demoralization is a common consequence, with many individuals becoming discouraged, ashamed, and unhappy about the difficulties of carrying out their normal routines. These individuals may frequently be absent from work or school for doctor and emergency-room visits, which can lead to unemployment or dropping out of school.
Psychological ComorbidityFrom 10% to 65% of individuals with panic disorder also have major depressive disorder. Often individuals may treat their panic disorder with alcohol or medications, and thus may develop alcoholism or drug addiction as a consequence. Social anxiety disorder (social phobia) and generalized anxiety disorder have been reported in 15%-30% of individuals with panic disorder, specific phobia in 2%-20%, obsessive-compulsive disorder in up to 10%, and posttraumatic stress disorder in 2%-10%. Separation anxiety disorder in childhood has been associated with this disorder. Hypochondriasis commonly occurs in panic disorder.
Medical ComorbidityIndividuals with panic disorder often have dizziness, cardiac arrhythmias, asthma, chronic obstructive pulmonary disease, and irritable bowel syndrome. The nature of these associations (e.g., cause-and-effect) remains unclear. The association between panic disorder and mitral valve prolapse or thyroid disease is controversial.
Associated Laboratory FindingsNo laboratory test has been found to be diagnostic of this disorder. Some individuals with panic disorder show signs of compensated respiratory alkalosis. Sodium lactate infusion or carbon dioxide inhalation will more commonly trigger panic attacks in individuals with panic disorder than in control subjects or individuals with generalized anxiety disorder.
PrevalenceThe lifetime prevalence rate for this disorder in the general population is 1% to 2%. The 1-year prevalence rate is 0.5% to 1.5%. Panic disorder is diagnosed in approximately 10% of individuals referred for mental health consultation, and in approximately 60% of individuals in cardiology clinics. Approximately one-third to one-half of individuals diagnosed with panic disorder in community samples also have agoraphobia (i.e., fear leaving home alone). Women are 2 to 3 times more likely to develop panic disorder than men.
CourseThis disorder may begin at any age, but most individuals develop this disorder between adolescence and the mid-30s. A small number of cases begin in childhood, and onset after age 45 is unusual (but can occur). The usual course is chronic. Some individuals have a chronic, episodic course (with episodic outbreaks with years of remission in between). Others have continuous severe symptomatology. Although agoraphobia may develop at any point, its onset is usually within the first year of panic disorder.
OutcomeThe agoraphobia accompanying panic disorder may become chronic regardless of the continued presence or absence of panic attacks. Anxiety Disorder Clinics report that, at 6-10 years posttreatment, about 30% of their patients are well, 40%-50% are improved but symptomatic, and the remaining 20%-30% have symptoms that are the same or worse.
Familial PatternTwin studies indicate a genetic contribution to the development of panic disorder. If the age at onset of the panic disorder is before 20, first-degree relatives have been found to be up to 20 times more likely to have Panic Disorder. However, as many as one-half to three-quarters of individuals with Panic Disorder do not have an affected first-degree biological relative.
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