panic_disorder_qrg9402.pdf

TREATING PANIC DISORDER

A Quick Reference Guide

Based on Practice Guideline for the Treatment of Patients With Panic Disorder,

originally published in May 1998.

For Continuing Medical Education credit

for APA Practice Guidelines,

visit www.psych.org/cme.

To order individual Practice Guidelines or the

2002 Compendium of APA Practice Guidelines,

visit www.appi.org or call 800-368-5777.

TREATING PANIC DISORDER • 3

Introduction

“Treating Patients With Panic Disorder: A Quick Reference Guide” is a

summary and synopsis of the American Psychiatric Association’s Practice

Guideline for the Treatment of Patients With Panic Disorder, which was

originally published in The American Journal of Psychiatry in May 1998

and is available through American Psychiatric Publishing, Inc. The Quick

Reference Guide is not designed to stand on its own and should be used

in conjunction with the full text of the Practice Guideline. Algorithms illus-

trating the treatment of panic disorder are included.

Statement of Intent

The Practice Guidelines and the Quick Reference Guides are not intend-

ed to be construed or to serve as a standard of medical care. Standards

of medical care are determined on the basis of all clinical data available

for an individual case and are subject to change as scientific knowledge

and technology advance and practice patterns evolve. These parameters

of practice should be considered guidelines only. Adherence to them will

not ensure a successful outcome in every case, nor should they be con-

strued as including all proper methods of care or excluding other accept-

able methods of care aimed at the same results. The ultimate judgment

regarding a particular clinical procedure or treatment plan must be made

by the psychiatrist in light of the clinical data presented by the patient

and the diagnostic and treatment options available.

The development of the APA Practice Guidelines and Quick Reference

Guides has not been financially supported by any commercial organiza-

tion.

• TREATING PANIC DISORDER

OUTLINE

A. Formulation and

Implementation of a

Treatment Plan

1. Treatment

Setting ..............5

2. Evaluation .........5

3. Treatment

Modalities .........6

4. Length of

Treatment ..........8

B. Psychiatric Management

1. Evaluate particular

symptoms .....................9

2. Evaluate types and

severity of functional

impairment...................9

3. Establish and

maintain a

therapeutic alliance .....10

4. Monitor the patient’s

psychiatric status.........10

5. Provide education .......11

6. Consider issues

involved in working

with other

physicians ..................11

7. Enhance treatment

adherence..................12

8. Address early signs

of relapse ..................12

C. Treatment

Interventions

1. Psychosocial

Interventions ....13

2. Pharmaco-

therapies .........14

TREATING PANIC DISORDER • 5

A. Formulation and Implementation

of a Treatment Plan

1. Treatment Setting

Outpatient treatment is indicated for most patients.

Consider hospitalization for the following indications:

• Comorbid depression, especially in patients who are at risk of

suicide attempts

• Comorbid substance use disorders, especially in patients who

require detoxification

2. Evaluation

Perform a comprehensive general medical and psychiatric evaluation.

• Follow principles of APA’s Practice Guideline for the Psychiatric

Evaluation of Adults.

• Determine whether diagnosis of panic disorder is warranted.

• Assess for comorbid psychiatric or general medical conditions.

• Consider general medical conditions and substance or medication

use as causes of panic symptoms, especially in patients with new

onset of symptoms.

• Perform indicated diagnostic studies and laboratory tests.

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