Term Paper on "Panic Disorder"

Term Paper 16 pages (4240 words) Sources: 15

[EXCERPT] . . . .

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).

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