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Panic Disorder Paper

Panic Disorder Paper

Which Video # are you doing? Video Title 37

Brief Description Of The Patient

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Explanation Of The Presenting Symptoms

The patient describes a surge of strong mental and bodily symptoms. It appears suddenly and for no apparent cause. The patient recalls feeling as if he were dying of a heart attack, sweating, and having difficulty catching his breath. ‘I was preparing coffee and suddenly WAM, the tightness in my chest returned, and I was sweating and my heart was hammering, the same feeling.’ It was just twelve or fifteen minutes until it vanished.’

Past Medical History And Allergies

In the video, no known allergies to any food or medicine were identified by the patient. As stated by the patient in the video, he experienced identical symptoms the day before. The video does reveal that the illness runs in his family, which is a risk factor for his condition. ‘It was almost like my mum, I remember she would have the same thing, perhaps three to four times a week,’ said the patient. It’s just sheer panic for no apparent cause.’

Psychiatric Diagnosis

According to the DSM-V, Panic Disorder is classified as an anxiety disorder. This specifier refers to a recurring rapid rush of severe terror or pain that peaks within minutes (American Psychiatric Association, 2013). The diagnostic criteria are:

  1. Recurrent panic spells that last only a few minutes and contain four (or more) of the symptoms listed; Palpitations, Feelings of suffocation, experiencing chest pain, feeling faint,  Chills,  Paresthesias,  depersonalization, and  Fear of “losing control.”
  2. At least one of the episodes was accompanied by one or both of the preceding symptoms for one month (or more):
  3. Ongoing anxiety or fear about further panic episodes or their repercussions
  4. A considerable maladaptive shift in behavior as a result of the attacks
  5. The disorder is not the result of substance abuse, physiological effects, or another health condition.
  6. The disorder is not explained by another mental condition.

In this present case, the patient fits all four diagnostic criteria for panic disorder, A, B, C, and D, as listed on pages 208-214 of the DSM-5 (American Psychiatric Association, 2013; Townsend & Morgan, 2018).

Differential Diagnosis

  1. Non-specific anxiety condition or another defined anxiety problem.  If symptom panic episodes have never occurred, the panic disorder should not be diagnosed (American Psychiatric Association., 2013).
  2. Anxiety disorder caused by a medical ailment. Panic disorder is not diagnosed if the panic episodes are confirmed to be a specific physiological effect of another medical ailment. In this example, the patient underwent an EKG. And everything was perfectly normal.
  3. Anxiety condition caused by substances/medication. Panic disorder is not diagnosed if the panic symptoms are proved to be a specific physiological outcome of substance abuse. Usage of nervous system stimulants or marijuana, as well as withdrawals from psychoactive drugs, might cause a panic attack. According to Townsend and Morgan (2018), characteristics commencing after the age of 45 or the involvement of unconventional manifestations throughout a panic attack elevate the possibility that the panic attack manifestations are exacerbated by another medical condition or drug abuse.

Steps for Assessing the Risk of Suicidal Ideation

Suicidal ideation risk assessment identifies how seriously a patient is considering or preparing to commit suicide (Townsend & Morgan, 2018).

  1. The nurse needs to identify risk factors- The risk factors in this scenario include mental health issues and triggering events. There is a history of panic disorder in the family. Triggering events are interpersonal triggers, such as panic attacks.
  2. The nurse should then identify protective factors, including clinical treatment for mental, medical, and chemical health. The patient did go to the emergency department after the first episode he experienced.
  3. Conduct suicide inquiry- The case does not indicate the patient’s plans, ideas, actions, or desire to commit suicide.
  4. Determine the level of risk. The danger level is modest in this scenario.
  5. Determine intervention—the proposed intervention is to send the patient to a therapist and begin therapy.

Panic Disorder Severity Scale

The Panic Disorder Severity Scale (PDSS) is a self-report index that assesses the degree of panic episodes and manifestations of panic disorder. It is suitable for usage with adolescents (13 and above) and adults. A study by Svensson et al. (2019) shows the scale is a good tool for measuring overall panic disorder severity at baseline, and it gives a severity profile for the various panic disorder symptoms.

Because it is quick and sensitive to change, it is an excellent monitoring tool that may be used to follow symptoms over time. The scale comprises seven factors, each of which is scored on a 5-point scale (Svensson et al., 2019). Panic occurrence, distress during panic, panic-focused anticipatory anxiety, phobic aversion to situations, phobic aversion to sensations, impairments in work performance, and impairments in social functioning are all evaluated.

Medications

SSRIs authorized by the FDA for managing panic disorder include fluoxetine, paroxetine, and sertraline. Medications can help alleviate the symptoms of panic attacks (Townsend & Morgan, 2018). For example, fluoxetine at a daily dose of 20 mg is both safe and effective in lowering panic disorder symptoms.

Non-pharmacological Treatments

Psychotherapy is widely accepted as the first-line intervention for panic attacks and panic disorder. Townsend and Morgan (2018) show psychotherapy can help the patient understand panic attacks and how to cope with them. Cognitive-behavioral therapy, a sort of psychotherapy, can assist patients in learning from their history that panic attacks are not dangerous.

Lab Diagnosis

According to American Psychiatric Association (2013), examples of clinical diseases that can trigger panic attacks encompass hyperthyroidism, hyperparathyroidism, pheochromocytoma, vestibular dysfunctions, seizure, and cardiopulmonary conditions, like arrhythmias, tachycardia, asthma, and COPD. Appropriate laboratory testing, such as blood calcium levels for hyperparathyroidism, Holter monitors for arrhythmias, or physical examinations for cardiac disorders, may aid in diagnosing the etiology of another medical disease.

 More Questions To Assist With Diagnosis

Do your fingertips have numbness or pins and needles?

Do you experience apprehension or fear of death?

Do you experience the sensation that you are disconnected from your body?

Further Directives For The Patient

The nurse should investigate the client’s impression of a threat to their bodily integrity or self-concept and assure the patient that they are protected and secure. To aid in the desensitization process, it is critical to understand the client’s perspective of the phobic object or circumstance (Townsend & Morgan, 2018). It is also important to discuss the facts of the problem with the customer to identify what can and cannot be altered.

Before the task of lowering panic can begin, the client must acknowledge the truth of the situation and aspects that cannot be changed. The nurse should include the client in decision-making on alternate coping mechanisms. For example, the client might opt to avoid the phobic stimuli or try to overcome the dread connected with it.

References

American Psychiatric Association. (2013). American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. International Journal of Offender Therapy and Comparative Criminology, 57(12), 1546–1548. International Journal of Offender Therapy and Comparative Criminology, 57(12), 1546–1548. https://doi.org/10.1177/0306624×13511040

Svensson, M., Nilsson, T., Johansson, H., Viborg, G., Perrin, S., & Sandell, R. (2019). Psychometric analysis of the Swedish panic disorder severity scale and its self-report version. Nordic Journal of Psychiatry, 73(1), 58–63. https://doi.org/10.1080/08039488.2018.1554699

Townsend, M., & Morgan, K. (2018). Pocket guide to psychiatric nursing, 10e (10th ed.). F.A. Davis.

Panic Disorder Paper Instructions

 You see a client who has the diagnosis, Panic disorder. The client exhibits the following emotional responses: anxiety, fear, and terror, as well as the following behavioral responses: hypervigilance and avoidance. Describe the various CBT techniques you can employ to address both the client\'s emotional and behavioral responses.

Posts are a minimum of 250 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and a minimum of 2 references (which may include the course textbook).