Anxiety disorder is characterized by a feeling that something bad is about to happen, a desire to avoid certain situations and sudden occurrence of 10-15 minutes of escalating anxiety that usually disappears in less than a half hour. Symptoms include sudden shortness of breath, a feeling of choking, fainting, rapid heart beat, sweating, shakiness, hot flushes, chills or nausea. Sometimes it is very difficult to find the trigger, but episodes can be caused by closed spaces, heights, certain situations such as a whistle or noise or exposure to certain types of places or people. Rarely, they are caused by unpleasant experiences in childhood.
Anxiety disorder can be caused by medical conditions such as thyroid, cortisone or adrenal hormonal abnormalities, heart or lung disease, tumors, diseases that damage nerves, certain infections, drug abuse or drug reactions. Episodes are sometimes misdiagnosed as heart (1), lung (2) or gastrointestinal (3) diseases. If doctors cannot find a medical cause, they often prescribe exposure or relaxation therapy and drugs to treat anxiety and depression, such as monoamine oxidase inhibitors, benzodiazepines and serotonin reuptake inhibitors (Imipramine, Paxil, Prozac, Paxil, Xanax, etc.). Calming drugs such as beta blockers including Inderal are notoriously ineffective. People with panic disorder are advised to avoid caffeine, nicotine and alcohol.
1) RE Carr. Panic disorder and asthma: Causes, effects and research implications. Journal of Psychosomatic Research 44: 1 (JAN 1998):43-52. The presence of asthma is a risk factor for the development of panic disorder.
2) RP Fleet, G Dupuis, A Marchand, J Kaczorowski, D Burelle, A Arsenault, BD Beitman. Panic disorder in coronary artery disease patients with noncardiac chest pain. Journal of Psychosomatic Research 44: 1 (JAN 1998):81-90. Psychological distress in these patients appears to be related to the panic syndrome and not to the presence of the cardiac condition.
3) RG Maunder. Panic disorder associated with gastrointestinal disease: Review and hypotheses. Journal of Psychosomatic Research 44: 1 (JAN 1998):91-105. An association between panic disorder and functional gastrointestinal disease has emerged. 3) MK Shear, D Clark, U Feske. The road to recovery in panic disorder: Response, remission, and relapse. Journal of Clinical Psychiatry 59: Suppl. 8 (1998):4-10.
4) JRT Davidson. The long-term treatment of panic disorder. Journal of Clinical Psychiatry 59: Suppl. 8 (1998):17-23.
5) DJ Nutt. Antidepressants in panic disorder: Clinical and preclinical mechanisms. Journal of Clinical Psychiatry 59: Suppl. 8 (1998):24-29.
6) JA Denboer. Pharmacotherapy of panic disorder: Differential efficacy from a clinical viewpoint. Journal of Clinical Psychiatry 59: Suppl. 8 (1998):30-38. antidepressants are more effective than the benzodiazepines in reducing associated depressive symptomatology.
7)DS Baldwin, J Birtwistle. The side effect burden associated with drug treatment of panic disorder. Journal of Clinical Psychiatry 59: Suppl. 8 (1998):39-46.
8) JC Ballenger, JRT Davidson, Y Lecrubier, DJ Nutt, DS Baldwin, JA Denboer, S Kasper, MK Shear. Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59: Suppl. 8 (1998):47-54. Serotonin selective reuptake inhibitors are recommended as drugs of first choice with a treatment period of 12 to 24 months. Pharmacotherapy should be discontinued slowly over a period of 4 to 6 months.
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