what did Skapinakis et al 2010 find about the prevalence of
1.7% presented with panic disorder (with/without agoraphobia)
2.73% present with subthreshold panic symptoms
4.4% prevalence of panic attacks within last month
5.1% in women, 3.74% in men
what did Bandelow and Michaelis 2015 find about prevalence of panic disorder
meta analysis
lifetime prevalence of panic disorder 1.6-5.2%
what did de Ligster et al 2017 find about the average age of onset for panic disorder
average age of onset is 30.3 years for panic disorder and 21.1 years for agoraphobia with panic disorder
average age of is 10.6 years for social anxiety disorder and 11.1 years for specific phobia
studies find a role of genetics in development of panic disorder and agoraphobia, whereas specific phobia does not
what are the neurochemical theory of panic disorder
imbalance of neurotransmitters
dysregulated functioning causing a deficiency/excess serotonin
evidenced by effectiveness of pharmacological treatments, using anti-depressants (ie SSRIs) or anxiolytics like benzodiazepines
benzodiazepines work on GABA receptors but are highly addictive
what is the hormonal theory of panic disorder
gonadal hormones play a role in frequency/intensity of panic attacks
panic disorder is more common in women than men
women with panic disorder can experience a reduction in symptoms in the perinatal period
what is the genetic theory of panic disorder
3x more likely to develop panic disorder
more common in identical twins than non-identical
what is Clarks 1986 cognitive model of panic disorder
development of panic disorder begins following a panic attack
based on the idea of catastrophic misinterpretation
intense physical symptoms and feeling like “losing control” leads to fright - misinterpreted as dangerous
TRIGGER (internal and external) leads to INITIAL THREAT APPRAISAL leads to ANXIETY which leads to PHYSICAL SENSATIONS to THOUGHTS to ANXIETY again to PHYSICAL… etc etc (those three in a loop)
what is casey et al (2004)’s model?
integrative cognitive model for panic disorder
based off clark’s model (catastrophic misinterpretation) and bandura and beck’s work
“panic self-efficacy” = how much an individual believes they can cope with panic symptoms
if someone has low self efficacy, they’re more likely to interpret their panic as threatening
increases arousal, to increase hypersensitivity to triggers
is panic disorder often misdiagnosed?
yes!
Vermani, Marcus and Katzman (2011) found a non-detection rate of 85.8% - semi-structured interview
based on DSM-IV and ICD-10 still only gave a detection rate of 41.5%
clinicals can use screening questions to explore potential panic disorder, such as the panic disorder severity scale, a seven item questionnaire (Shear et al, 1997)
what is the NICE guidance 2004 for panic disorder
people with mild to moderate panic disorder should be offered low intensity interventions:
self help/guided self help/support groups/exercise
moderate to severe panic disorder (with/without agoraphobia) should offer:
CBT (1-2 hour sessions, 7-14 hours within 4 months) OR antidepressant medication (SSRIs, SNRIs, TCAs, if the disorder is chronic or talking therapy is declined/found to be unhelpful)
pharmacological intervention: avoid benzodiazepines (risk of addiction), sedating antihistamines or antipsychotics - INSTEAD, use SSRIs, SNRIs or tricyclic antidepressants, which are the only medication recommended for long-term use for panic disorder - selection of SSRIs are licensed for use within panic disorder (ie citalopram, sertraline and venlafaxine)
some GPs prescribe beta-blockers, ie propranolol, to be taken “as required” to reduce physical symptoms associated with panic disorder - NOT recommended by NICE, insufficient evidence to suggest this is an effective way of treating panic disorder(Steenen et al 2016)
what is CBT for panic disorder
in NHS UK, its often treated with low-intensity CBT delivered by a psychological wellbeing practitioner in guided self-help form
1:1, 30 mins, remotely
focus on between session tasks
guided self-help for panic disorder is superior to treatment as usual (assessment only, and info/minimal contact/medication) and comparable to group or 1:1 face-to-face therapy
how to formulate the problem in CBT
UNDERSTAND development using 5 areas formulation:
situation leads to physical sensations which lead to behaviours and thoughts, which interact together and also interact with emotions in a vicious cycle
explore what maintains the cycle and what changes can be made to break it
ask patient to keep a panic diary
what is psychoeducation
cognitive models of panic disorder suggest that the condition is maintained by catastrophic misinterpretation so if we can help people understand their sensations correctly, we can minimise panic symptoms
treatment therefore often begins by providing psychoeducation, helping the patient to make appropriate sense of their experience
keep a psychoeducation diary (same as panic diary but with alternative explanation for symptoms)
what is cognitive restructuring for panic disorder
panic diary helps us identify “hot thoughts” ie “im about to have a heart attack”
give evidence for and against the “hot thought”
revise the thought
