Epidemiology
Lifetime prevalence of panic disorder is 1 to 4 percent. Median age of onset is 20 – 24 years. Rates are similar among hispanics, blacks and whites.Women are two to three times more likely than men to be affected. Morbidity and impairment of quality of life in PD is comparable to that of depression (5, 23)
Clinical features
A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: Palpitations/ Sweating/ tremors / sensation of choking/ shortness of breath/ chest pain/ nausea or abdominal distress/ light-headedness/ chills or heat/ paresthesias/ derealization or depersonalization / Fear of losing …show more content…
The term agoraphobia includes fears not only of open spaces but also situations like crowded stores, closed spaces, busy streets and wherever there is a difficulty of immediate or easy escape to a safe place. It is one of the most incapacitating of phobic disorders. Two groups of symptoms are described in agoraphobics, panic attacks and anxious cognitions about fainting and going crazy. Severely affected individuals become completely house-bound, especially women. Most patients are less anxious when accompanied by a trusted person or a family member. Depressive symptoms, depersonalization and obsessional thoughts may also be present …show more content…
The basal ganglia, the limbic system, the occipital lobe and the frontal cortex have been implicated. Genetic factors have also been implicated. Psychodynamic theory hypothesizes that anxiety is a symptoms of unconscious, unresolved conflicts. According to cognitive behavioral school, persons with GAD respond to incorrectly perceived dangers (23).
Differential diagnosis
GAD needs to be differentiated from anxiety disorder due to a medical condition such as pheochromocytoma or hyperthyroidism. Substance or medication induced anxiety disorder, social anxiety disorder, obsessive compulsive disorder, post traumatic stress disorder, adjustment disorder, depression, bipolar disorder and psychotic disorders need to be ruled out (5).
Management
Among the medication, SSRIs are the first line agents and among SSRIs, sertraline is preferred. If Sertraline is ineffective then a switch to another SSRI/SNRI can be made. Buspirone, which is a 5 HT 1A receptor partial agonist has been found to be effective with GAD, especially in reducing the cognitive symptoms. Drugs with short half -lives such as venlafaxine and paroxetine should be avoided because they can cause withdrawal syndromes. Benzodiazepines may be used with caution on a short - term basis, due to their addiction potential. The effectiveness and side effects of the drugs must be reviewed every 2–4 weeks during the first 3 months of treatment and