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Source: Melton ST, Kirkwood CK. Anxiety disorders: generalized anxiety, panic, and social anxiety disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146065193.
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Associated with activation of brainstem and basal ganglia regions.
May be abnormal activation of parahippocampal region and prefrontal cortex.
5-HT may have role in development of anticipatory anxiety.
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Affects 6 million Americans over age of 18
One-year prevalence rate: 3.1%
Twice as common in women as in men.
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CLINICAL PRESENTATION
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Psychological symptoms:
Excessive anxiety.
Worries that are difficult to control.
Feeling keyed up or on edge.
Trouble concentrating or mind going blank.
Depersonalization.
Derealization.
Fear of losing control, going crazy, or dying.
Physical symptoms:
Symptoms of panic attack peak within 10 min and usually last 20–30 min.
Many patients eventually develop agoraphobia, which is avoidance of specific situations (eg, being in crowded places) where they fear attack might occur.
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MEANS OF CONFIRMATION AND DIAGNOSIS
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History of recurrent, unexpected panic attacks followed by:
At least 1 month of concern about having another attack.
Worry about consequences of attacks.
Behavioral changes because of attacks.
During attack, there must be at least four physical symptoms in addition to psychological symptoms.
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TREATMENT: NONPHARMACOLOGIC THERAPY
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Cognitive behavioral therapy (CBT) may be used alone for patients who cannot or will not take medications.
Aerobic exercise may be beneficial.
Educate patients to avoid:
Caffeine.
Stimulants.
Drugs of abuse.
Smoking.
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TREATMENT: PHARMACOLOGIC THERAPY
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Selective serotonin reuptake inhibitor (SSRIs) are first-line agents due to tolerability and efficacy.
Imipramine is second line due to cardiovascular and anticholinergic effects.
Benzodiazepines are second line due to ...