Panic Disorder

很久沒有如此用心的去思考一篇article
願友人學懂面對過去的事
就如近視一樣
習慣相處

Extracted from
The New England Journal of Medicine
Volume 354(22), 1 June 2006, pp 2360-2367


The frightening physical symptoms of panic disorder often lead to extensive use of medical services.Patients with medically unexplained syndromes ... have been shown to have higher rates of coexisting panic disorder than do control subjects with documented medical syndromes.

Education of Patients

An essential step after the clinical diagnosis is made is to review with the patient her or his fears of medical illness and expectations of medical testing and treatment. More than 80 percent of patients with panic disorder present with a medical symptom, and most are fearful of having a serious condition, such as a heart attack. Clinical experience suggests that patients benefit from education about panic disorder as the cause of their symptoms and the mechanism by which a brain disorder may provoke physical symptoms. Educational materials for patients may be obtained from the Anxiety Disorders Association of America (http://www.adaa.org ) and the National Institute of Mental Health (http://www.nimh.nih.gov/healthinformation/anxietymenu.cfm
).
Nonpharmacologic Management

Cognitive behavioral treatment is provided in 12 to 16 sessions over a period of three to four months and is focused on recreating the feared symptoms and then modifying the patient's usual responses to the symptoms.The mental health professional or physician helps the patient correct cognitive distortions such as exaggerating the threat to health (e.g., having thoughts
such as "I am going to die") that precipitate more anxiety... Finally, the mental health professional or physician helps the patient modify the associated behaviors, such as seeking escape and avoidance. The clinical practice guidelines for the treatment of panic disorder recommend that the severity of symptoms, patients' preferences, the response to treatment during prior episodes, and the availability of a clinician with experience with cognitive behavioral treatment should influence the treatment recommendations, since medications and cognitive behavioral
treatment are equally effective. When medications are used, both of the guidelines recommend initiating SSRIs as the first line of treatment on the basis of their better side-effect profile and safety than tricyclic antidepressants and benzodiazepines and given the more limited data on the efficacy of SNRIs.