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KMID : 0377819910110050550
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Diagnosis and Treatment
1991 Volume.11 No. 5 p.550 ~ p.551
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PANIC DISORDER
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임태식/Lim, Tae Shik
김광수/유태열/Kim, Kwang Soo/Lew, Tae Yul
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Abstract
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Panic disorder is a dramatic syndrome characterized by discrete spontaneous panic attacks --crescendos of fear and apprehension-associated with multiple physical symptoms. Attacks resemble the body´s normal physiologic response to a life-threatening situation or extreme´physicai exertion but, in-, panic disorder; attacks come on suddenly and unpredictably without provocation.
Panic attacks are characterized by feelings of fear, extreme tension, and a sense of impending doom. -Various physical symptoms accompany these feelings, most commonly ; shortness of breath, palpitation, chest pain or discomfort, choking or smothering sensations, dizziness, vertigo, unsteady feelings, paresthesias and faintness.
Because the symptoms of panic attacks mimic many organic disorders, patient often consult internists for these symptoms and may have extensive medical workups and numerous consultations before the idea of a panic disorder is considered. The disorder is common : it occurs in an estimated 1 to 2 percent of the general populaton, although it frequently goes .unrecognized. It is diagnosed more often among women than men, and typically begins in late adolescence or early adulthood. Panic disorder tends to run in families, and an accumulating body of evidence suggests both that biochemical factors play a crucial role in- the etiology of this condition and that there may be a genetic vulnerability to it.
Panic disorder may be limited to one brief period of illness lasting several weeks or months, it may recur several times, or it may become chronic. Patients usually develop nervokusness and apprehension between at-tacks ; when this is severe, agoraphobia ensues.
Treatment must be aimed at each of three aspects of this syndrome ; panic atta.;ks, antcipatory anxiety, and agoraphobia. It begins with a careful history, physical examination. And laloratory studies to rule out underlying organic illness. Panic attacks can be blocked ef. fectively by maintaining patients on a tricyclic antidepressant .(e. g.,´Imipramine) or a mono-amine oxidase(MAO) inhibitors. Anticipatoory anxietyand free floating: anxiety can be treated with selective intermittent use of a benzodiaze pine (e. g., Diazepam).
Recently some clinicians have advocated the use of the benzodiazepine alprazolam(xanax) alone, since it is thought to have properties that both reduce anticipatory anxiety and block panic attacks.
Agoraphobia may be treated with behavior therapy designed to expose patiens gradually to feared experiences, so that they can slowly master their fear of recurrent attacks in specific.situations (e. g., in supermarket, at parties). Dynamically oriented psychotherapy may be necessary when anxiety is due to conflicts or to reactions to the environment that be explored before syndromes will resolve.
We experienced a case of a patient with anti-depressant and benzodiazepine, and also individual psychotherapecstic appoaches, and reort it with the review of literatures.
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