Panic disorder with or without agoraphobia

Panic disorder with or
Panic disorder with or
without agoraphobia
without agoraphobia
Édouard Auger (m.d., frcpc)
This approach has the advantage of giving them
Alan is 30 years old and a supervisor in a superstore. He is under a lot
This approach has the
practical means to overcome their anxiety. A
of stress at work and is experiencing marital problems at home. At
advantage of giving them
combined form of treatment (medication and
practical means to overcome
work one day, he felt a tightening in the chest, he had difficulty breath-
CBT) could be an effective approach for you. Talk
their anxiety. A combined form
ing and thought he was going to die. He was taken to hospital by ambu-
to your doctor about what is best for you.
of treatment (medication and
lance where, after a thorough examination, he was declared to be in
CBT) could be an effective
perfect health. He left the hospital with little reassurance. Three days
Certain natural products might have a calming
approach for you. Talk to
later, he had a similar attack. Alan thinks that he has a heart condition.
effect that could help reduce the manifesta-
your doctor about what
is best for you.
He often sees his doctor. He is beginning to be less active to prevent his
tions of PDA. However, no study has demonstrat-
heart from working too hard. He is afraid to leave the house. He is
ed their actual efficacy. If you are taking any of
unable to go back to work. He has difficulty taking the car…
these products, it is better to advise your doctor or pharmacist about it,
because some of them may interact with your prescribed medication.
Anxiety and fear are nomal and useful emotions. A feeling of panic can also
be a well-adjusted reaction to extreme situations that can be compared to an
internal alarm system. However, the person suffering from a panic disorder
Conclusion
with agoraphobia (PDA) seems to have lost control of this alarm system. The
Panic disorder is a common and very disabling condition. It affects young
disorder is characterized by sudden and often inexplicable episodes of
adults often when their active life is just beginning. A variety of treatment
anxiety and discomfort (panic attack). These anxiety surges are dreaded by
modalities with proven efficacy are available to treat this illness. We also
the person, and can rapidly lead to fear and avoidance of situations where
know that if the disorder is not treated it can persist and may worsen, and it
these reactions are likely to occur (agoraphobia).
can also cause other health problems in the short or long-term. It is thus
Roughly 1.5 % to 3.5 % of the population will experience PDA during their life-
very important to consult a doctor as soon as possible, if you think that you
time. Women are twice as likely to get the disorder as men. It often appears
are suffering from this condition.
in early adulthood.
The suggested resources may prove useful for the person who wants to
learn more about this illness. However, these references are given on an
Origins of the disorder
indicative basis only and they are surely not complete. Also, we cannot
While a genetic predisposition contributes to the development of this disor-
insure that all the information provided is exact.
der, this factor cannot totally explain its origin. Certain biological and psy-
chological factors seem to make certain individuals more vulnerable than
Dr Édouard Auger, psychiatrist
others.
Hôpital Robert-Giffard,
Québec
This approach has the
Current research indicates that different neuro-
advantage of giving them
transmitters may be involved in the genesis and
practical means to overcome
expression of this illness. The psychological
their anxiety. A combined form
theories focus on the manner in which the per-
of treatment (medication and
son with panic disorder will interpret different
CBT) could be an effective
approach for you.
physical and mental phenomena associated
4
1

---

Panic disorder with or
Panic disorder with or
without agoraphobia
without agoraphobia
with panic attacks and anxiety.
order cannot be based only on the presence of
unexpected panic attacks, but on the fact that
Briefly stated, the diagnostic
of panic disorder cannot be
the person lives with the persistent fear of re-
Symptoms and characteristics
based only on the presence of
experiencing anxiety symptoms that are out of
unexpected panic attacks, but
The beginning of a panic disorder is marked by
control. Also to be considered is the existence of
on the fact that the person
the occurrence of panic attacks without the per-
Certain biological and
a vicious circle between the perceived sensa-
lives with the persistent fear
son being able to identify what could have trig-
psychological factors seem to
tions (e.g., heart palpitations), their interpreta-
of re-experiencing anxiety
make certain individuals more
gered such a reaction.
tion as being dangerous (e.g., having an heart
vulnerable than others.
symptoms that are out
attack), and the resulting anxiety reaction and
A panic attack is characterized by a rapid onset
of control.
intensified sensations (e.g., more palpitations).
(within a few minutes) and a duration of about 30 to 40 minutes. It is accom-
This vicious circle rapidly leads to a full blown panic attack. Agoraphobic
panied by the following symptoms:
avoidance and physical sensations also contribute to the maintenance of
> Chest pain, pressure or discomfort.
the PDA.
> Heart palpitations or increased heart rate.
> Difficulty breathing or increased respiratory rate.
Treatment
> Feeling of being suffocated or of having a lump in the throat.
There are currently two therapeutic approaches proven to be effective for
> Excessive sweating, vertigo, dizziness, numbness.
the treatment of this condition: pharmacotherapy and cognitive-behavioral
> Trembling, chills.
therapy (CBT).
> Feelings of unreality, fear of dying or of going crazy.
Several antidepressant medications have been shown to significantly
reduce the symptoms of PDA, in particular selective serotonin reuptake
Having identified these first panic episodes has being very dangerous for
inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors
their health or life, the sufferers then begin to live with the fear of having
(SNRIs). These medications may take a certain time before having any ben-
another attack. Thus, they interpret every physical sensation that reminds
eficial effects and they often require a dose adjustment to insure an optimal
them of their panic attacks as a source of potential danger. They will then
response. Other antidepressants can also be
start to avoid certain activities (e.g. : exercising, standing up quickly, drink-
used successfully. Benzodiazepines have also
These medications may take a
ing coffee) and certain places or situations in which help might not be
certain time before having any
been shown to be useful in the treatment of the
available if the panic sensations recurred (e.g. : being in a crowd, waiting in
beneficial effects and they
disorder, but they are associated to higher
line, being on a large boulevard).
often require a dose adjustment
relapse and failure rates when the medication is
to insure an optimal response.
Fear and avoidance can lead the individual
discontinued.
A panic attack is characterized
to diminish his participation in more and
by a rapid onset (within a few
In CBT, the therapist helps the sufferers to gradually face the sensations and
more activities and to gradually isolate
minutes) and a duration of
situations associated with anxiety, and he helps them normalize the dys-
himself from his world.
about 30 to 40 minutes.
functional thoughts that they have developed with the presence of a PDA.
Briefly stated, the diagnostic of panic dis-
2
3

---

Panic disorder with or
Panic disorder with or
without agoraphobia
without agoraphobia
with panic attacks and anxiety.
order cannot be based only on the presence of
unexpected panic attacks, but on the fact that
Briefly stated, the diagnostic
of panic disorder cannot be
the person lives with the persistent fear of re-
Symptoms and characteristics
based only on the presence of
experiencing anxiety symptoms that are out of
unexpected panic attacks, but
The beginning of a panic disorder is marked by
control. Also to be considered is the existence of
on the fact that the person
the occurrence of panic attacks without the per-
Certain biological and
a vicious circle between the perceived sensa-
lives with the persistent fear
son being able to identify what could have trig-
psychological factors seem to
tions (e.g., heart palpitations), their interpreta-
of re-experiencing anxiety
make certain individuals more
gered such a reaction.
tion as being dangerous (e.g., having an heart
vulnerable than others.
symptoms that are out
attack), and the resulting anxiety reaction and
A panic attack is characterized by a rapid onset
of control.
intensified sensations (e.g., more palpitations).
(within a few minutes) and a duration of about 30 to 40 minutes. It is accom-
This vicious circle rapidly leads to a full blown panic attack. Agoraphobic
panied by the following symptoms:
avoidance and physical sensations also contribute to the maintenance of
> Chest pain, pressure or discomfort.
the PDA.
> Heart palpitations or increased heart rate.
> Difficulty breathing or increased respiratory rate.
Treatment
> Feeling of being suffocated or of having a lump in the throat.
There are currently two therapeutic approaches proven to be effective for
> Excessive sweating, vertigo, dizziness, numbness.
the treatment of this condition: pharmacotherapy and cognitive-behavioral
> Trembling, chills.
therapy (CBT).
> Feelings of unreality, fear of dying or of going crazy.
Several antidepressant medications have been shown to significantly
reduce the symptoms of PDA, in particular selective serotonin reuptake
Having identified these first panic episodes has being very dangerous for
inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors
their health or life, the sufferers then begin to live with the fear of having
(SNRIs). These medications may take a certain time before having any ben-
another attack. Thus, they interpret every physical sensation that reminds
eficial effects and they often require a dose adjustment to insure an optimal
them of their panic attacks as a source of potential danger. They will then
response. Other antidepressants can also be
start to avoid certain activities (e.g. : exercising, standing up quickly, drink-
used successfully. Benzodiazepines have also
These medications may take a
ing coffee) and certain places or situations in which help might not be
certain time before having any
been shown to be useful in the treatment of the
available if the panic sensations recurred (e.g. : being in a crowd, waiting in
beneficial effects and they
disorder, but they are associated to higher
line, being on a large boulevard).
often require a dose adjustment
relapse and failure rates when the medication is
to insure an optimal response.
Fear and avoidance can lead the individual
discontinued.
A panic attack is characterized
to diminish his participation in more and
by a rapid onset (within a few
In CBT, the therapist helps the sufferers to gradually face the sensations and
more activities and to gradually isolate
minutes) and a duration of
situations associated with anxiety, and he helps them normalize the dys-
himself from his world.
about 30 to 40 minutes.
functional thoughts that they have developed with the presence of a PDA.
Briefly stated, the diagnostic of panic dis-
2
3

---

Panic disorder with or
Panic disorder with or
without agoraphobia
without agoraphobia
Édouard Auger (m.d., frcpc)
This approach has the advantage of giving them
Alan is 30 years old and a supervisor in a superstore. He is under a lot
This approach has the
practical means to overcome their anxiety. A
of stress at work and is experiencing marital problems at home. At
advantage of giving them
combined form of treatment (medication and
practical means to overcome
work one day, he felt a tightening in the chest, he had difficulty breath-
CBT) could be an effective approach for you. Talk
their anxiety. A combined form
ing and thought he was going to die. He was taken to hospital by ambu-
to your doctor about what is best for you.
of treatment (medication and
lance where, after a thorough examination, he was declared to be in
CBT) could be an effective
perfect health. He left the hospital with little reassurance. Three days
Certain natural products might have a calming
approach for you. Talk to
later, he had a similar attack. Alan thinks that he has a heart condition.
effect that could help reduce the manifesta-
your doctor about what
is best for you.
He often sees his doctor. He is beginning to be less active to prevent his
tions of PDA. However, no study has demonstrat-
heart from working too hard. He is afraid to leave the house. He is
ed their actual efficacy. If you are taking any of
unable to go back to work. He has difficulty taking the car…
these products, it is better to advise your doctor or pharmacist about it,
because some of them may interact with your prescribed medication.
Anxiety and fear are nomal and useful emotions. A feeling of panic can also
be a well-adjusted reaction to extreme situations that can be compared to an
internal alarm system. However, the person suffering from a panic disorder
Conclusion
with agoraphobia (PDA) seems to have lost control of this alarm system. The
Panic disorder is a common and very disabling condition. It affects young
disorder is characterized by sudden and often inexplicable episodes of
adults often when their active life is just beginning. A variety of treatment
anxiety and discomfort (panic attack). These anxiety surges are dreaded by
modalities with proven efficacy are available to treat this illness. We also
the person, and can rapidly lead to fear and avoidance of situations where
know that if the disorder is not treated it can persist and may worsen, and it
these reactions are likely to occur (agoraphobia).
can also cause other health problems in the short or long-term. It is thus
Roughly 1.5 % to 3.5 % of the population will experience PDA during their life-
very important to consult a doctor as soon as possible, if you think that you
time. Women are twice as likely to get the disorder as men. It often appears
are suffering from this condition.
in early adulthood.
The suggested resources may prove useful for the person who wants to
learn more about this illness. However, these references are given on an
Origins of the disorder
indicative basis only and they are surely not complete. Also, we cannot
While a genetic predisposition contributes to the development of this disor-
insure that all the information provided is exact.
der, this factor cannot totally explain its origin. Certain biological and psy-
chological factors seem to make certain individuals more vulnerable than
Dr Édouard Auger, psychiatrist
others.
Hôpital Robert-Giffard,
Québec
This approach has the
Current research indicates that different neuro-
advantage of giving them
transmitters may be involved in the genesis and
practical means to overcome
expression of this illness. The psychological
their anxiety. A combined form
theories focus on the manner in which the per-
of treatment (medication and
son with panic disorder will interpret different
CBT) could be an effective
approach for you.
physical and mental phenomena associated
4
1

---

Panic disorder with or
without agoraphobia
Useful books
Mastering your anxiety and panic, Barlow & Craske
La peur d’avoir peur, 3e édition, Marchand, A. & Letarte, A., Éditions Alain
Editorial
Stanké, 2005.
committee :
Surmontez vos peurs : vaincre le trouble panique et l’agoraphobie, Emery,
Denis Audet ,
Jean-Luc, Éditions Odile Jacob, Paris 2000.
Family Physician
Louis Blanchette,
ADAC/ACTA
Stéphane Bouchard,
Psychologist
Jean-Claude Cusson,
ATAQ
Martin Katzman,
Psychiatrist
Acknowledgement:
We would like to thank our
two FOUNDING PARTNERS :
Helpful Websites
ADAC/ACTA :
www.anxietycanada.ca/
Association/Troubles Anxieux
du Québec (ATAQ) :
www.ataq.org/
Anxiety Disorder Assiociation
for their unrestricted
of America :
www.adaa.org/
educational grant to
financially support this
publication.
May 2005
5
Cette brochure est aussi disponible en français

---

Panic disorder with or
without agoraphobia
Useful books
Mastering your anxiety and panic, Barlow & Craske
La peur d’avoir peur, 3e édition, Marchand, A. & Letarte, A., Éditions Alain
Editorial
Stanké, 2005.
committee :
Surmontez vos peurs : vaincre le trouble panique et l’agoraphobie, Emery,
Denis Audet ,
Jean-Luc, Éditions Odile Jacob, Paris 2000.
Family Physician
Louis Blanchette,
ADAC/ACTA
Stéphane Bouchard,
Psychologist
Jean-Claude Cusson,
ATAQ
Martin Katzman,
Psychiatrist
Acknowledgement:
We would like to thank our
two FOUNDING PARTNERS :
Helpful Websites
ADAC/ACTA :
www.anxietycanada.ca/
Association/Troubles Anxieux
du Québec (ATAQ) :
www.ataq.org/
Anxiety Disorder Assiociation
for their unrestricted
of America :
www.adaa.org/
educational grant to
financially support this
publication.
May 2005
5
Cette brochure est aussi disponible en français

---