Anxious Patient in the Emergency Ward
R. Thara, Lakshmi Vijayakumar in Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Social anxiety disorder, also known as social phobia, is one of the most common psychiatric disorders. Its onset is usually during childhood or adolescence. The typical feature of social phobia is a marked and persistent fear of one or more social or performance-related situations, in which the person is exposed to unfamiliar people or to possible scrutiny by others (American Psychiatric Association 2013). The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. The person recognizes that the fear is excessive or unreasonable. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a panic attack. The person avoids the feared social or performance-related situations or endures them with intense anxiety or distress. Social phobia is of two subtypes – generalized and non-generalized/circumscribed. In the generalized type, the person experiences anxiety during most social situations or avoids these situations. In the circumscribed type, anxiety occurs only in specific social situations (e.g. public speaking) (American Psychiatric Association 2013; Schneier 2006). Social anxiety disorder differs from shyness and performance anxiety in that its severity, pervasiveness, and the resultant distress and impairment are greater. Persons with social anxiety disorder may avoid important activities, such as attending classes and meetings, or attend them but avoid active participation. Anticipatory anxiety is common.
Anxiolytics: Predicting Response/Maximizing Efficacy
Mark S. Gold, R. Bruce Lydiard, John S. Carman in Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Histories from many panic disorder patients reveal that full-fledged spontaneous attacks are only the tip of the iceberg of endogenous anxiety which these patients experience. Commonly, they also experience partial spontaneous panic attacks, and these may also reinforce secondary apprehension and avoidance. The “minor endogenous anxiety” attacks consist of one or two symptoms of a complete panic attack, such as tachycardia, shortness of breath, hyperventilation, paresthesias, hot flashes, nausea, tremor, depersonalization, sweating, alterations of sensory perception of sound, light, apprehension, etc. These minor attacks can be confused with cardiac, respiratory, gastrointestinal, or other neuroendocrine diseases as well as exogenous anticipatory anxiety which panic patients also experience. Proper identification of them as endogenous anxiety attacks can be assured by noting that they occur spontaneously and have an instantaneous onset. The patient is surprised by the event. If patients have only minor attacks, three in 3 months, Sheehan classifies this as Minor Endogenous Anxiety.24 If patients have three major attacks in 3 months, and have minor attacks also, the patients have Major Endogenous Anxiety. It is important to note that panic disorder often presents with minor endogenous attacks years before major attacks or phobic avoidance occurs.
Treatment of Chronic Fatigue Syndrome
Jay A. Goldstein in Chronic Fatigue Syndromes, 2020
A view which I favor is that panic attacks are primarily a limbic, and not a brain stem, phenomenon, since alprazolam may block even lactate-induced panic. In some studies the CFS panic disorder, particularly in those patients with no premorbid mood disorders, seems to be somewhat different. The anticipatory anxiety seems to be much more autonomous, as if it were being generated by a neurotransmitter disorder, as one might see in a post-viral syndrome. Once again, most CFS symptoms do not usually resolve when panic attacks and anxiety are reduced or even eliminated. This clinical observation supports the hypothesis that a limbic encephalopathy is involved with most cases of CFS, and that one aspect of this process would be panic disorder.
Relapse prevention in panic disorder with pharmacotherapy: where are we now?
Published in Expert Opinion on Pharmacotherapy, 2020
Daniela Caldirola, Alessandra Alciati, Silvia Daccò, Wilma Micieli, Giampaolo Perna
Panic disorder (PD) is among the most common mental disorders, presenting 12-month and lifetime prevalences of approximately 2.4 and 3.8%, respectively, in the general population in the US and high-income European countries [1,2]. PD is characterized by recurrent, unexpected panic attacks (PAs) (i.e., sudden, intense fear/discomfort episodes with a surge of somatic symptoms, such as palpitations, chest pain, breathlessness, and dizziness) associated with anticipatory anxiety and/or maladaptive changes in behavior related to Pas [3]. Most individuals with PD fear or avoid multiple situations in which PAs might occur, developing co-morbid full-blown agoraphobia (AG) [3]. Among individuals with PD, psychiatric and medical co-morbidity is common, and healthcare service utilization is high; further, PD is associated with functional impairment of multiple aspects of daily life, including work, and decreased quality of life [4]. Consequently, the economic burden of PD, including direct medical costs, indirect non-medical costs, and productivity loss, is substantial. The burden is increased by concurrent AG or other psychiatric/medical co-morbidities, and it is even higher than that of other common mental disorders [5–89]. An analogous picture in terms of co-morbidity, functional limitation, and social costs is observed in subthreshold PD (STHPD), a condition with a similar or even higher prevalence than PD that is characterized by clinically relevant panic symptoms that do not meet the diagnostic threshold for full-blown disorder [4,6–78].
Misophonia and comorbid psychiatric symptoms: a preliminary study of clinical findings
Published in Nordic Journal of Psychiatry, 2019
Mercede Erfanian, Christiana Kartsonaki, Azita Keshavarz
The similarity between misophonia and agoraphobia may relate to the anticipatory anxiety. In both conditions, the anticipatory anxiety is followed by physiological reactivity. With continued neurophysiological discomfort as such, an individual with misophonia may become isolated [42]. However, there are two remarkable differences. While agoraphobics avoid the public places and crowded area for fear of scrutiny and humiliation by others in case of panic attacks in public [43], misophonia sufferers seem to avoid these situations only if ‘the disturbing triggers’ are present. The dominant negative emotion in agoraphobia is anxiety and intense fear (DSM-5).
Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines
Published in Expert Opinion on Drug Safety, 2018
Laiana A. Quagliato, Rafael C. Freire, Antonio E. Nardi
PD is a chronic condition with relevant effects on patients’ quality of life, and requires long-term management. For the individual patient, the goal of therapy is complete cessation of panic attacks and associated anticipatory anxiety, along with the treatment of any comorbidity and reduction in functional disability. The review of the benefits and the risks associated with a drug is basically an evaluation of two dimensions. The dimension of benefits is measured primarily in terms of the successful treatment of the condition for which the drug is indicated. The dimension of risks includes the safety profile observed in the form of the sum of all adverse drug reactions. The current review showed strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD. Few studies to date have performed head-to-head comparisons of these two drug classes. When looking at the comparison between individual benzodiazepines, the available evidence, suggests that there is no significant difference between individual benzodiazepines in terms of response rate and dropout due to any reason [60]. Furthermore, no evidence suggests a differential efficacy within the SSRIs class [60]. Therefore, the main question of whether there are differences between antidepressants and benzodiazepines, and between individual antidepressants and individual benzodiazepines, remains unanswered. Future studies on the pharmacological treatment of PD should include direct comparison of risks and benefits of these medications. This could help improve the evidence-based pharmacotherapy of PD. Although extremely important, evidence-based medicine is population-based medicine, whereas clinical medicine is practiced one patient at a time. What is right for the average patient is not always right for the individual patient. Therefore, knowing the risks and benefits of the most widely prescribed medications in PD is not only crucial for evolving guidelines, but is also highly important for individual physicians to choose the most adequate drug for each patient and thus achieve the most successful treatment.
Related Knowledge Centers
- Amygdala
- Anxiety
- Anxiety Disorder
- Bullying
- Chest Pain
- Insular Cortex
- Hyperventilation
- Fear
- Panic Attack
- Social Anxiety Disorder