Panic Disorder and Agoraphobia - Literature review Example

Panic disorder and agoraphobia Introduction Panic disorder is a type of the mental illness which can cause distress not only to the individual suffering from it but also to his/her family members. The individual can suffer from this attack anywhere and at any time. Sudden and spontaneous attacks of panic with preoccupation of fear of recurring attack is known as panic disorder. Each episode of panic attack is characterised by abrupt onset of fear which is intense and reaches peak within few minutes and constitutes of atleast four of the following symptoms. The symptoms which can be manifested in a panic attack are the need to escape, a feeling of imminent danger or doom, heart palpitations, trembling, sweating, chest pain or discomfort, shortness of breath, nausea or abdominal discomfort, tingling sensation, dizziness or light-headedness, fear of losing control and chills or heat flush (ADAA, 2009). Many people with panic disorder suffer from agoraphobia. In agoraphobia, the individual avoids going to places or situations where either an attack of panic had previously occurred or the individual may think that the escape route from that place may be difficult. Those suffering from agoraphobia are constantly on guard for the next episode of panic attack. According to DSM-IV-TR, for an individual to be diagnosed as having panic disorder, "panic attacks must be associated with more than 1 month of subsequent persistent worry about (1) having another attack, (2) consequences of the attack, or (3) significant behavioral changes related to the attack" (Daniels, 2006). Agoraphobia causes significant psychological anguish and also many social, medical and occupational consequences like restricted role functioning, increased use of health care and social withdrawal (Daniels, 2006). This essay presents information about panic disorder with agoraphobia derived from literature review. Method Literature search was undertaken using Nova Library and psycINFO. The search terms used were Panic Disorder and Agoraphobia. 5 articles were selected for the literature review. Results Panic disorder is characterised by panic attacks which occur spontaneously and unexpectedly and the frequency of these attacks vary from several attacks a day to only a few per year. Many theories have been put forward to ascertain the pathophysiology of panic disorder. While some researchers favour the serotonergic model wherein the exaggerated response of the post-synaptic receptor to synaptic serotonin is the proposed to be the cause of panic attack, some others postulate increased sensitivity to adrenergic discharge as the cause. Several other models have also been proposed like the the lactate model and the locus cerulus model. The prevalence of panic disorder is estimated to be 1.5- 5%. (Daniels, 2006). Panic disorder is a wide spectrum and other than panic attacks and agoraphobia, it also includes claustrophobia, fear of losing control, claustrophobia, rescue object, loss sensitivity, medical reassurance and reassurance from family members (Rucci, 2009). There is not much empirical support to attribute the role of other factors to constitute the spectrum of panic disorder. Another extension to the spectrum of panic disorders is non-clinical panic attacks. This clinical entity is important because like panic disorder, it is also associated with generalised anxiety disorder (Tulla et al, 2009). Shared relationship of emotion regulation difficulties makes generalised anxiety and panic disorder fall into the same spectrum of clinical symptoms (Tulla et al, 2009). Panic disorder has a bimodal distribution. The highest incidence occurs in late adolescence followed by another peak in the third decade of life (Daniels, 2006). Panic attacks can be either fearful or non-fearful. In the latter group, the attacks occur without the element of subjective fear. Chen et al (2009) conducted a large study to examine the prevalence of non-fearful panic disorder. According to this study, non-fearful panic attacks constitute about 30% of panic disorder. The age of onset and frequency of symptoms are similar to fearful panic disorder. But the symptomatology varies, in the sense, symptoms associated with fear like shortness of breath, depersonalisation, smothering, trembling and anxiety are classicially absent or occur in a reduced form. Also, this form of panic disorder is less associated with agoraphobia or other comorbid mental illnesses. In this study, recall bias and response bias are suspected to have affected the prevalence rates of non-fearful panic disorder. The causes of Panic disorder are not well established. Some attribute hereditary and parenting aspects to the development of the disorder. It is not known whether specific parenting behaviours increases the vulnerability of the condition in the offspring. Leen-Feldner et al (2008) observed the association between sick role behaviour in childhood tuned by parenting-related instrumental and observational learning and reactivity to a panic-relevant biological challenge procedure in individuals who were normal physically and psychologically. The researchers observed that learning experiences which were instrumental and involved arousal-predictive symptoms contributed to increase in post-challenge anxiety, negative affective valence and arousal. This observation supports the potential role of parenting in the development of panic disorder. Panic disorder is associated with many medical comorbid disorders, the most common of which is asthma. Felmana et al (2009) studied the association of panic disorder and asthma and the association of symptoms between the two. According to the authors,emotional disturbance and illness-related poor quality of life contributed to the association between the two. The study showed evidence of greater irritability in patients with asthma-panic disorder than in those with only asthma symptoms. Other medical conditions associated with panic disorder are cardiovascular disorders like hypertension, cardiomyopathy and mitral valve prolapsed, chronic obstructive pulmonary disease, migraine headache and irritable bowel syndrome (Daniels, 2006). No specific laboratory tests or imaging studies are essential to diagnose panic disorder and agoraphobia. The diagnosis is mainly based on clinical symptoms. Most of the times, simple reassurance and social intervention may benefit the patient. Others may require medications ranging from oral benzodiazepines to IV Ativan. Selective serotonin reuptake inhibitors, tricyclic antidepressants and monoamine oxidase inhibitors also can be used to treat symptoms of panic disorder (Daniels, 2006) Conclusion Agoraphobia is one of the manifestations of panic disorder. The diagnosis is mainly based on clinical presentation. A wide spectrum of mental illnesses falls into the category of panic disorder. Many medical, psychological and psychiatric conditions are associated with panic disorder and agoraphobia. Panic disorder can worsen the quality of life especially when associated with other comorbid conditions. In asthma-panic disorder cases, fear may be a good target for improvement in the quality of life. Reassurance, social intervention and medications are the main stay of treatment. References Anxiety Disorders Association of America (ADAA). (2009). Panic Disorder. Retrieved on May 13, 2009 from http://www.adaa.org/gettingHelp/AnxietyDisorders/Panicattack.asp Chen, M., Tsuchiya, N., Kawakami, N., and Furukawa, T. (2009). Non-fearful vs. fearful panic attacks: A general population study from the National Comorbidity Survey. Journal of Affective Disorders, 112(1), 273-278. Daniels, C.Y. (2006). Panic disorder. Emedicine from WebMD. Retrieved on May 13th 2009 from http://emedicine.medscape.com/article/287913-overview Feldmana, J.M., Siddique, M.I., Thompsana, N.S., and lehrer, P.M. (2009). The role of panic-fear in comorbid asthma and panic disorder. Journal of Anxiety Disorders, 23(2), 178-184 Leen-Feldner, E.W., Blumenthal, H., Babson, K., Bunaciu, L., Feldner, M.T. (2008). arenting-related childhood learning history and panic vulnerability: a test using a laboratory-based biological challenge procedure. Behav Res Ther, 46(9), 1009-16. Miniati, M., Oppo, A., Mula, M., Calugi, S., Frank, E., Shear, M.K., Mauri, M., Pini, S., Cassano, G.B. (2009). The structure of lifetime panic-agoraphobic spectrum. J Psychiatr Res., 43(4), 366-79. Tulla, M.T., Stipelmanb, B.A., Pedneaultc, K.S., and Gratza, K.L. (2009). An examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample.Journal of Anxiety Disorders, 23(2), 275-. Read More