Panic attack body s adaptive alarm response fight or flight but it s a false alarm no genuine danger present Panic disorder recurrent unexpected panic attacks false alarms lasting one month or longer Prevalence of panic disorder 2 3 of adult population Gender ratio F M 2 1 Co morbid diagnoses a Depression b Alcohol abuse dependence Hypothesized causes of panic disorder A Medical model Respiratory control center suffocation reflex Lactate infusion challenge Genetic contribution B Cognitive behavioral model Revised lactate infusion challenge cognition matters panic results from faulty learning maladaptive thoughts David Barlow s theory 1 Patients misinterpret body sensations interoceptive cues 2 Catastrophic thoughts lead to panic 3 Modify thoughts reduce panic 4 Exposure to interoceptive cues extinction of conditioned alarms Treatments for Panic Disorder A Drug Treatments 1 SSRI selective serotonin reuptake inhibitor e g Prozac Paxil Zoloft Celexa Lexapro 2 Imipramine a tricyclic antidepressant SSRI imipramine 60 acute efficacy 40 for placebo high rate of relapse 30 recovered at 1 yr 3 Benzodiazepine Xanax Ativan Klonopin Tranquilizers immediate relief but addictive very high relapse B Psychological Treatments CBT appears to be treatment of choice 12 outcome studies Exposure habituation to feared stimuli extinction of conditioned alarms Modify irrational catastrophic thoughts 75 acute efficacy 50 recovered at 2 year followup
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