Quality Management Information for Providers
Clinical Practice Guideline
Panic Disorder
Member Information
The second guideline chosen by Quest Behavioral Health is the American Psychiatric Association's (APA) Practice Guideline for the Treatment of Patients with Panic Disorder. The American Psychiatric Association was founded in 1844 and is a nation-wide professional medical society. Members of the APA include medical professionals who specialize in the diagnosis of mental health and substance use disorders.
Panic disorder is an illness whose symptoms include re-occurring panic attacks and an ongoing concern about having another attack or about the consequences of the attack. Panic attacks are brief periods of intense fear or discomfort and are accompanied by at least four of the thirteen symptoms listed below:
- palpitations, pounding heart or accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feeling of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded or faint
- feelings of unreality or being detached from oneself
- fear of losing control or going crazy
- fear of dying
- numbness or tingling sensation
- chills or hot flashes
An attack comes on quickly and reaches a peak usually within ten minutes. During the attack, one often feels a sense of approaching danger and an urge to escape. The panic attack may be followed by a frequent concern about having additional attacks, worry about the consequences of the attack or about the change in behavior related to the attack.
Panic disorder is a serious condition, but current treatments are very effective. A comprehensive physical should be completed prior to starting treatment to eliminate the possibility that a medical condition may be causing the panic symptoms. Psychotherapy (also known as talk therapy) and medications have both been shown to be effective treatment for panic disorder. Two types of therapy approaches are discussed (Cognitive Behavioral Therapy and Psychodynamic Therapy) as well as information on the helpfulness of medication. The choice between therapy and / or medication depends upon an individual assessment from a provider, examining the benefits and risks involved, as well as the patient's personal preference.
Cognitive Behavioral Therapy (CBT)
CBT is a type of therapy treatment for panic disorder that focuses on the symptoms of a panic attack (listed above). Treatment always begins with patient education and identifying panic symptoms. Then an outline for treatment is established. Patients are encouraged to monitor their panic attacks, using techniques such as keeping a diary. Next, the therapist introduces a technique to manage anxiety, such as deep breathing. The technique is used to control the body's physical responses to the anxiety. Patients are asked to practice the technique daily. The goal is to identify and counter fear of bodily sensations. The final phase of CBT involves actual exposure to increasing levels of anxiety evoking situations until the anxiety has diminished. Cognitive behavioral therapy (CBT) has been shown to be effective.
Psychodynamic Psychotherapy
Psychodynamic psychotherapy is another type of therapy based on the concept that symptoms result from mental processes that may be outside of the patient's conscious awareness and be part of the patient's unconscious. More awareness of these mental processes may lead to a remission of symptoms. In order to lessen panic symptoms, the therapist considers it necessary to identify and change these unconscious mental processes. This approach may produce optimal long-term outcomes for some patients.
Medication
Medications have been shown to be effective in the treatment of panic disorder. Some have the ability to stop or reduce the frequency of panic attacks. Many also decrease the fear of panic attacks, phobias, and associated depression and may increase overall functioning. The physician will consider the patient's symptoms, potential side affects, research results, cost, individual preference and previous response of the individual or family when choosing a medication.
Patient Support Groups
Patient support groups are very helpful for some patients suffering from panic disorder. Patients have the opportunity to learn that they are not alone in experiencing panic attacks. Group members also share ways of coping with the illness. Support groups can be helpful in encouraging patients to confront frightening situations. Finally, family members of patients with panic disorder may benefit from the educational aspects of patient support groups. Support groups are not a substitute for effective treatment. They should be complimentary.
The initial phase of treatment with either therapy or medication generally lasts 12 weeks. At the end of this period, individuals should have significantly fewer and less intense panic attacks than before treatment. If no improvement occurs in the first 6-8 weeks with a particular treatment, the patient may need reevaluation of diagnosis, type of treatment or may need to consider combined treatment. Ideally, panic attacks should be eliminated entirely. Some, but not all, studies indicate that long-term remission is possible. Studies vary in the rate of panic symptoms returning when discontinuing medication, but most show that the reoccurrence of symptoms is common. Regardless of the method of treatment, it is often helpful to involve family members and significant others when appropriate and possible. Educating family members and enlisting their support can be very helpful.
We would welcome your comments regarding the panic disorder guidelines chosen by Quest. Please contact the Quality Management Department of Quest at 1-800-364-6352 with your comments.
