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Panic Disorder01:27

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Panic disorder is an anxiety disorder characterized by recurrent and sudden minutes-long episodes of intense fear, known as panic attacks. These attacks may feel like heart attacks and often happen without warning or a specific cause. They can include symptoms such as rapid heart rate, shortness of breath, chest pain, trembling, sweating, dizziness, and a sense of helplessness. During a panic attack, individuals may feel as though they are experiencing a heart attack or are in a...
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Behavior Therapy01:22

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Behavior therapy incorporates diverse techniques rooted in classical conditioning principles to address maladaptive behaviors and anxiety disorders. These methods aim to reduce avoidance behaviors, foster adaptive coping mechanisms, and alter associations between stimuli and responses, making them effective in a wide range of therapeutic contexts.
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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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Treatment Strategies for Psychological Disorders01:24

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Treatment approaches for psychological disorders fall into three main categories: psychological, biological, and sociocultural. Each approach targets different aspects of mental health, requiring varying levels of education and training.
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Anxiolytic drugs are vital in managing anxiety disorders by effectively alleviating symptoms such as excessive fear, tachycardia, and tremors. There are several classes of anxiolytic medications, each with unique mechanisms of action and potential side effects.
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Treatment-resistant panic disorder: a systematic review.

Rafael C Freire1, Morena M Zugliani1, Rafael F Garcia1

  • 1a Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro and National Institute for Translational Medicine (INCT-TM) , Rio de Janeiro , Brazil.

Expert Opinion on Pharmacotherapy
|December 5, 2015
PubMed
Summary

Treatment-resistant panic disorder (PD) remains a challenge, with cognitive-behavioral therapy augmentation showing short-term benefits. Preliminary evidence also supports specific medications for persistent PD symptoms.

Keywords:
Agoraphobiaanxietyclinical trialcognitive-behavioral therapypanic attack

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Panic disorder (PD) affects a significant population, leading to work impairment and frequent healthcare utilization.
  • A notable proportion of PD patients experience persistent symptoms despite available treatments.

Purpose of the Study:

  • To review clinical trials on treatment-resistant panic disorder.
  • To identify effective interventions for patients with persistent PD symptoms.

Main Methods:

  • Searched MEDLINE/Pubmed, CENTRAL, PsycINFO, and Web of Science for clinical trials (1980-2015).
  • Included prospective experimental studies on adult subjects with treatment-resistant PD (DSM-III to DSM5).
  • Excluded case studies, case series, retrospective studies, and studies with fewer than 10 subjects.

Main Results:

  • Only 11 articles met the inclusion criteria, with limited high-quality studies (two randomized, controlled, double-blind).
  • Cognitive-behavioral therapy augmentation showed short-term efficacy in treatment-resistant PD.
  • Preliminary evidence suggested efficacy for reboxetine and olanzapine monotherapy, and augmentation with pindolol, divalproex sodium, aripiprazole, and olanzapine.

Conclusions:

  • Few quality studies exist for treatment-resistant PD.
  • Augmenting pharmacological treatment with CBT offers short-term benefits.
  • Several pharmacological options show preliminary short-term efficacy for treatment-resistant PD.