panic disorder - psikiatri
TRANSCRIPT
7/27/2019 Panic Disorder - Psikiatri
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PANIC
DISORDERBy :Madona Clara Yosinta
Faritz Subiyaktoro Aqita Islamiah
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Definition
Panic disorder (PD) is characterized primarily
by the presence of recurrent and
unexpected panic attacks, followed by at
least 1 month of persistent concern about
other attacks, the possible consequences of
attacks and a significant behavioral change
related to the attacks
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Panic attacks are a period of intense fear in
which 4 of 13 defined symptoms develop
abruptly and peak rapidly less than 10
minutes from symptom onset.
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• During the episode, patients have the urge
to flee or escape and have a sense of
impending doom (as though they are dying
from a heart attack or suffocation).
• Other symptoms may include headache,
cold hands, diarrhea, insomnia, fatigue,
intrusive thoughts.
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Neurobiology of Panic Disorder
The neurocircuitry of fear includes two pathways
for processing of sensory information.
The shorter path :
rapid spread of autonomic
and behavioral responses in potentially hazardous
situations.
The major regions :
anterior thalamus and the
central and lateral regions of
the amygdala.
The longer path :the information passes
through several regions,
including the cortex, which
allows for a more refined
analysis of inputs.
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Physical ExaminationNo signs on physical examination are specific
for panic disorder
• If the patient presents in an acute state of panic : – Nonspecific signs:
• Hypertension
• Tachycardia
• Mild tachypnea
•Mild tremors.
• The attack normally lasts 20-30 minutes from onset ,although in rare cases it can go on for more than an hour.
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Physical Examination
•
Appearance : anxious
• Somatic concerns of death from cardiac or respiratory
problems may be a major focus of patients during an
attack. Patients may end up in an emergencydepartment.
• Mental Status Examination
As with the physical examination, no results on theMental Status Examination are specific for panic
disorder.
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Planning Diagnose
No invasive procedures are required to diagnose panic
disorder, although they may be useful in eliminating
other differential diagnoses.
As previously mentioned, history, collateral information,
and physical examination/Mental Status Examination
remain the diagnostic cornerstones for panic disorder
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Laboratory Test
Laboratory studies that can exclude medical disorders other than panic
disorder include the following:
• Serum electrolytes to exclude hypokalemia and acidosis
• Serum glucose to exclude hypoglycemia
• Cardiac enzymes in patients suspected of acute coronary syndromes
• Serum hemoglobin in patients with near-syncope
• Thyroid-stimulating hormone (TSH) in patients suspected of
hyperthyroidism
• Urine toxicology screen for amphetamines, cocaine, and phencyclidine in
patients suspected of intoxication
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General Treatment
• It has a direct impact on disability, resulting inincreased absenteeism, decreasedproductivity and reduced ability to carry outdaily activities.
PanicDisorder
• Improvements in functioning, as well as insymptoms, should be part of evaluatingtreatment effectiveness.
Monitoring
• Panic Disorder patients tend to stoptreatment when they become anxious aboutsomatic sensations from medications.
TreatmentCompliance
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Level of Care
If there is a high risk of danger to
self or others or grave disability,
consider inpatient hospitalization.
Unstable patients may respond to
structured, multi-disciplinarytreatment that emphasizes skills
training, family involvement,
psychoeducation and psychiatric
management
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Medications
SSRIs, SNRIs, tricyclic antidepressants, benzodiazepines
(only appropriate as monotherapy in the absence of a
comorbid mood disorder) and/or cognitive-behavioral
psychotherapy (CBT) have been shown generally to be
equally effective in the acute phase (first 12 weeks) of
treatment
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Psychotherapy
Consider including psychotherapy if there:
• has been a previous positive response to
psychotherapy
• is an incomplete response to an adequate trial of
medication
• are excessive medical risks of medication
• is evidence that coping skills are inadequate to manage
psychosocial stressors
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Prognosis
• Long-term prognosis is usually good, with
almost 65% of patients with panic disorder
achieving remission, typically within 6 months.
• Appropriate pharmacologic therapy and
cognitive-behavioral therapy, individually or in
combination, are effective in more than 85% of
cases.
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Gracias..God Bless You ^_^