Psychotherapy, medication, support recommended for panic disorder

Clinicians should consider patient preferences, medical and treatment history and the coexistence of psychiatric or physical disorders in treating patients with panic disorder, according to the American Psychiatric Association’s guideline for Treatment of Patients with Panic Disorder.

Moreover, clinicians should set realistic treatment goals with the patient and provide patient education on adherence and expectations, according to the guideline.

When evaluating a patient with panic disorder, a psychiatrist should obtain detailed information about the patient’s medical and psychiatric history, as well as any history of substance abuse. The clinician also should review the patient’s medication history and current mental and physical health, and conduct any appropriate tests to rule out physical causes of panic disorder symptoms. Conditions associated with an increased risk for panic disorder include:

thyroid disease
cancer
chronic pain
cardiac disease
irritable bowel syndrome
migraine
mitral valve prolapse
vestibular disorders
allergies
respiratory disease

After determining a patient’s safety and degree of impairment caused by the panic disorder, the clinician should choose an appropriate treatment setting. In some cases, suicide risk or substance abuse issues may necessitate hospitalization. For agoraphobic patients who are afraid to leave their homes, home visits may be an option.

There are several types of psychotherapy that may be beneficial to patients with panic disorder. Panic-focused psychodynamic psychotherapy yielded positive results in a clinical trial and may be a viable initial treatment. Cognitive behavioral therapy has been effective in multiple randomized studies, and exposure therapy has been studied extensively and is another treatment option.

Regarding pharmacodynamic treatment for this condition, selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitor antidepressants are currently the first-line option. Tricyclic antidepressants also may be effective, but are associated with more side effects and toxicities. While monoamine oxidase inhibitors have demonstrated efficacy in treating panic disorder, the safety profile of this class of drugs has led the APA to restrict usage to cases where several first-line therapies have failed.

While treating a patient with panic disorder, psychiatrists should work with the patient to set reasonable treatment goals, ensure adherence to treatment, and offer education and support. Encourage healthy habits, such as regular sleep and exercise, and recommend decreased use of caffeine, tobacco, alcohol, and other potentially aggravating substances.

Source: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf