Head Shrinkin'
This therapy is the most effective treatment modality for panic disorder
Cognitive Behavioral Therapy (CBT)
Patients who underwent CBT +/- antidepressants overall had longer lasting and better positive outcomes
If your patient suffers nocturnal panic attacks or has trouble sleeping or eating due to panic, you can consider this PM med
Mirtazepine
SSRI and TCA equally efficacious
True.
It's true.
This ancient Greek philosopher (who has a part of the brain named after him) was the first to recognize panic and anxiety
Hippocrates
Wrote the Hippocratic Corpus where he describes a man named Nicanor, who, whenever intoxicated, was afraid of a girl playing a flute - whenever he saw her, he would have visions of terror and flee the party (?attributed to flutes in battle)
A panic attack is defined as a discrete period of intense fear in which 4 or more symptoms develop abruptly, peak within 10 minutes. Name 4 of the symptoms.
Palpitations/tachycardia
CP
N/V/D/abdominal distress
Dizziness/lightheadedness
Paresthesias
Chills/hot flushes
Fear of going crazy
Fear of dying
Shaking
Shortness of breath/choking
Derealization/depersonalization
Name one TCA that is effective in panic disorder
Clomipramine
Imipramine
TRUE OR FALSE!
Self-help books, workbooks, and videos are a reasonable alternative (from psych sources and licensed therapists) are a reasonable option for patients who cannot do continuous talk therapy
TRUE!
But make sure it's an actual, licensed therapist who wrote it and not some random granola-crunching looney
This Greek philosopher, who also has a mathematical theorum named for him, advised the the best way to cure anxiety was to eat a healthy vegetarian diet, have daily physical and mental exercise, and to have philosophical discussions to try to understand the world around them
Pythagoras
Name 2 common comorbid conditions with panic disorder
Depression
Substance/ETOH use disorders
Phobias/Agoraphobia/Social Phobia
OCD
Trauma/PTSD/Acute Stress
Celexa (citalopram)
Prozac (Fluoxetine)
Luvox (Fluvoxamine)
Paxil (Paroxetine)
Zoloft (Sertaline)
TRUE OR FALSE!
Antidepressants are sufficient monotherapy
False.
This doesn't work for panic.
This Greek philosopher, who shares a name with a salty and moldable kid's toy, felt increased community service and efforts, simple living, an appreciation for life and death, and increased self-acceptance and concern for others was the key to happiness
Plato
What is the difference between derealization and depersonalization?
Derealization - feeling uncertain
Depersonalization - feeling detached from yourself
Benzos are not appropriate long term therapy.
BUT if you must use one, especially while starting therapy or waiting for a maintenance drug to work, name one of the two benzos that is approved and effective for panic disorder
Klonopin (Clonazepam)
Xanax (Alprazolam)
TRUE OR FALSE
Panic disorders have a greater association with alcohol use than drug use
30% ETOH use disorder
17% substance use disorder
The word "phobia" comes from which Greek God?
Phobos
Son of Ares and Aphrodite; associated with the personification of fear and panic
Name and describe 1 grounding technique you can teach your patient
5-4-3-2-1 technique (5 things you can see, 4 you can feel, 3 you can hear, 2 you can smell, 1 you can taste)
3-3-3 technique (move 3 body parts, identify 3 objects around you, identify 3 sounds)
Figure 8 technique/draw around your feet/hands
Breathing square
Chair grounding - sit with heads on head and deep breath
Count your breaths
Benzodiazepines, in addition to having potential for refractory anxiety, addiction, over sedation, abuse, also carry a significant risk of worsening what comorbidity?
Depression
Approximately 20% of people w/ depression and panic will attempt suicide. Benzos make this worse and provide an easy out. Do a good screening.
TRUE OR FALSE!
You can have a panic attack while sleeping
TRUE!
And terrifying.
Patients will describe panic symptoms that will awake them from sleep, resolve within 5-10 minutes. Typically these people either have severe anxiety and panic while awake, or are people with significant life stress but distraction, or have severe depression
The word "panic" comes from which Greek God?
Pan - the Greek God of wilderness, fertility. Thought to have lived in the high hills, watching over flocks/herds, and occasionally causing a stampede in "panic"
(Being visited by this God thought to trigger individual or collective fear, typically unjustified = stampede)