PHARMACOTHERAPY VERSUS PSYCHOTHERAPY IN PANIC DISORDER. REVIEW

  • Alexandra BOLOS “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ilinca UNTU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Adela BARZU .“Socola” Institute of Psychiatry, Iasi
  • Ana-Caterina CRISTOFOR “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Magdalena BIRSAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

PHARMACOTHERAPY VERSUS PSYCHOTHERAPY IN PANIC DISORDER.REVIEW (Abstract) Panic disorder is one of the most frequent psychiatric conditions and the incidence is increasing. More worrying than the number of patients is the major negative impact over personal, social and economic functioning. Due to the increasing risk of death, whether by suicide or by cardiovascular disease, in patients suffering of panic disorder a prompt, adequate intervention is essential. This condition has a chronic evolution, with low rates of remission and a significant negative impact over quality of life and over social and economic aspects. In this article we presented different aspects related to the therapeutic management of panic disorder, with special reference to pharmacotherapy and its specific classes and psychotherapy, particularly Cognitive-Behavioral Therapy. These two therapeutic categories proved to be the most efficient in both acute and long-term symptomatology, with improvement of anxiogenic rumination, avoidance behavior or agoraphobia. Pharmacotherapy, whether with antidepressants or benzodiazepines, is recommended to be followed by psychotherapy. SSRIs and SSNRs are recommended as first-line medication, while benzodiazepines are necessary only in acute phases or until the therapeutic effect of the above-mentioned medicines is obtained. In treatment-resistant patients at patients who do not respond sufficiently to any first-line treatments it is necessary to use other classes of medicines, such as atypical antipsychotics. 

Author Biographies

Alexandra BOLOS, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (III)

Ilinca UNTU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (III)

Ana-Caterina CRISTOFOR, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (III)

Magdalena BIRSAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Pharmacy
Department of Pharmaceutical Sciences (II)

References

1. Nepon J. et al. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depression and anxiety 2010; 27(9): 791-798.
2. Mihai C., Chiriță R., Robu V., Untu I., Szalontay AS. Predicting suicide risk among male offenders: the role of severe personality disorders. Revista de Cercetare și Intervenție Socială 2017. 57: 28 50.
3. Jordanova V., Maric NP., Alikaj V., Bajs M., Cavic T., Iosub D., Mihai A., Szalontay A., Sartorius N. Prescribing practices in psychiatric hospitals in Eastern Europe. European Psychiatry 2011; 26(7): 414-418.
4. Szalontay A., Burtea V., Ifteni P. Blood Alcohol Concentration in Suicide: A 10 Years Study. Revista de Cercetare și Intervenție Socială 2014; 46: 144-151.
5. Katzman M. et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014; 14(Suppl 1): S1.
6. Dima-Cozma C., Patacchioli FR., Ghiciuc CM., Szalontay A., Mitu F., Azoicăi D. Current perspectives in stress research and cardiometabolic risk. Revista de Cercetare și Intervenție Socială 2014; 45: 175-188.
7. Dima-Cozma C., Mitu F., Szalontay A., Cojocaru DC. Socioeconomic Status and Psychological Factors in Patients with Essential Hypertension. Revista de Cercetare și Intervenție Socială 2014; 44: 147-159.
8. Szalontay AS., Chele G., Dima-Cozma C., Cozma S., Burlea AM., Chiriță R. Comorbidity and health condition: the necessity for integrated care. Romanian Journal of Oral Rehabilitation 2012; 4(2): 29-32.
9. Wändell P. et al. Depression or anxiety and all-cause mortality in adults with atrial fibrillation - A cohort study in Swedish primary care. Ann Med 2016; 48(1-2); 59-66.
10. Thompson T.S. et al. The effect of anxiety and depression on symptoms attributed to atrial fibrillation. Pacing Clin Electrophysiol 2014; 37(4): 439-446.
11. Atmaca M. et al. QT wave dispersion in patients with panic disorder. Neurosci Bull 2012. 28(3):247-252.
12. Mitte K. A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 2005; 88(1): 27-45.
13. Szalontay A., Burtea V., Ifteni P. Predictors of Institutionalization in Dementia. Revista de Cercetare și Intervenție Socială 2015. 49: 249-256.
14. Azhar M.Z. Comparison of Fluvoxamine Alone Fluvoxamine and Cognitive Psychotherapy and Psychotherapy Alone in the Treatment of Panic Disorder in Kelantan - Implications for Management by Family Doctors. Med J Malaysia. 2000; 55(4): 402-408.
15. Watanabe N. et al. Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review. BMC Psychiatry 2007; 7: 18.
16. Krysta et al. Impact of pharmacological and psychological treatment methods of depressive and anxiety disorders on cognitive functioning. J Neural Transm 2015; 122 (Suppl 1): S 101-S 110.
17. Hofmann S. et al. Preliminary evidence for cognitive mediation during cognitive-behavioral therapy of panic disorder. J Consult Clin Psychol 2007; 75(3): 374-379.
18. Mu-Hong C., Shih-Jen T. Treatment-resistant panic disorder: clinical significance, concept and management. Progress in Neuro Pshychopharmacology & Biological Psychiatry 2016.219-226.
19. Ballanger J.C. Clinical guidelines for establishing remission in patients with depression and anxiety. J of Clin Pshych 1999; 60 (Suppl. 22): 29-34.
20. Ballanger J.C. Treatment of anxiety disorders to remission. J of Clin Psych. 2001. 62 (Suppl. 12);5-9.
21. Liebscher C. et al. Facing the fear - clinical and neural effects of cognitive behavioral and pharmacotherapy in panic disorder with agoraphobia. European Neuropshychopharmachology. 2016; 26: 431-444.
22. Meuldijk D., Carlier I. et al. The clinical effectiveness of concise cognitive behavioral therapy with or without pharmacotherapy for depressive and anxiety disorders; a pragmatic randomized controlled equivalence trial in clinical practice. Contemporary Clinical Trials 2016; 47: 131-138.
23. Rodrigues H., Figueira I. et al. CBT for pharmacotherapy non-remitters - a systematic review of a next-step strategy. J Affective Disorders 2011;129: 219-228.
24. Postolache P, Costin M, Dumbravă (Chirilă) E, Cojocaru D. Anxiety and depression in patients with chronic obstructive pulmonary disease: an open agenda for research Rev. Med. Chir. Soc. Med. Nat. Iasi 2014; 118(1); 39-44.
25. Nechita P, Vicol MC, Pantea AP, Petrariu FD, Crăciun G. Informed consent in psychiatric medical care: a prospective quantitative study Rev. Med. Chir. Soc. Med. Nat. Iasi 2015; 119(4); 1025-1030.
26. Bolos A., Gafencu-Savlovschi D., Szalontay AS. An overview of the most important side effects of the psychotropic medication. Buletin de Psihiatrie Integrativă 2016; 22(2): 17-30.
Published
2018-04-04
Section
INTERNAL MEDICINE - PEDIATRICS