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Panic Disorder Nursing Term Paper


Anxiety disorders are a group of disorders having in common the peculiarities of extreme fear and anxiety and associated with behavioral disturbances. Although fear is a natural emotional reply to a real or perceived threat, anxiety is characterized by the expectation of future threat. Panic disorder is related to this group of disorders and is defined by repeated sudden panic attacks. The attacks are an unexpected burst of extreme fear or discomfort, which reaches the highest level within minutes in both calm and anxious states.

During a panic attack, a person feels four or more of the following symptoms: palpitations, pounding heart, or accelerated heart rate; sweating, trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed, or faint; chills or heat sensations; paresthesias (numbness or tingling sensations), derealization (feelings of unreality) or depersonalization (being detached from oneself); fear of losing control or “going mad;” fear of dying (American Psychiatric Association, 2013).

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In addition, it is essential to underscore such symptoms as tinnitus, neck pain, headache, uncontrolled crying or screaming can be observed at the moment of occurring a panic attack, but they should not be considered as one of the four mandatory symptoms. Panic attacks have been followed by one month or more of concern about additional panic attacks or maladaptive change in behavior associated with them. They are also not caused by any physiological effects of a substance, or other medical states, or other mental disorders. However, they are linked with a heightened possibility of several comorbid mental disorders, including anxiety disorders, depressive disorders, bipolar disorders, impulse-control disorders, and substance use disorders.

As to a substance use disorder, it is characterized by a mixture of cognitive, behavioral, and physiological symptoms, which indicate the continuous use of the substance by an individual despite significant substance-related problems. One of its subclasses is caffeine-related disorder is associated with a contemporary intake of more than 250 mg of caffeine. People consume caffeine regularly since it is included in coffee, tea, caffeinated soda, “energy” drinks, chocolate, weight-loss aids, over-the-counter analgesics, cold remedies, in vitamins, and food products. However, to face the intoxication, an individual should experience five or more of the signs or symptoms occurring during or soon after caffeine consumption. Those indicators include the feeling of restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation (American Psychiatric Association, 2013). According to caffeine’s half-life of about 4-6 hours, the symptoms of caffeine intoxication usually go away within the first day and do not result in long-term effects. Nevertheless, people consuming very high doses (5-10 g) face a significant risk of urgent health care since doses can be fatal.

Caffeine intoxication also depends on age and weight factors. With advancing age, people may show more severe reactions to caffeine, with significant complaints of sleep disturbance or a feeling of hyperactivity. As to children and adolescents, they may face negative consequences because of low body weight. Other factors of possible intoxication include environmental, genetic, and physiological. The first one comprises people rarely consuming caffeine or has recently increased its consumption by a substantial amount. Caffeine intoxication may have dangerous consequences such as disfunction at work or school or negligence to perform role responsibilities. It is essential to underscore that extremely high doses may lead to death or in some cases precipitate a caffeine-induced breakdown. It is essential to mention the possibility of caffeine intoxication symptoms, which may be associated with resemble primary mental disorders. As a result, to diagnose caffeine intoxica­tion, the symptoms must not be connected with another medical state or mental disorder. Anxiety disorder, manic episodes, panic disorder, generalized anxiety disorder, amphetamine intoxication, amphetamine intoxication, or tobacco withdrawal can lead to the same clinical features as caffeine intoxication.

The therapists still have not distinguished the most efficient treatment for panic disorder, but there are various options, which may reduce the strength and regularity of a panic attack. Among different treatments, the main are psychotherapy and medications. Application of one or both treatment options depend on a patient’s preference, history, and the intensity of the disorder. Psychotherapy is believed an efficient first-choice treatment for panic attacks and panic disorder, which is directed at helping a patient to understand panic attacks and the way how to handle them. Most frequently applied a form of psychotherapy is cognitive-behavioral therapy, which assists a patient in learning through his or her experience the safety of panic symptoms. The treatment includes the attempts of the therapist to gradually recreate the symptoms of a panic attack safely and repetitively. As soon as the physical sensations of a panic cease to be felt as threats, the attacks begin to disappear. Visible results from treatment take a significant amount of time and effort. It may take several weeks for a patient to recognize the reducing of panic attack symptoms. Moreover, in most cases, the symptoms diminish significantly or disappear within several months.

Another way of treatment is medications, and there are several types of them, which have shown the most significant effect in maintaining the symptoms. Selective serotonin reuptake inhibitors (SSRIs) are commonly secure with a low risk of severe side effects and typically prescribed as the first choice of medicines to manage panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft) (Mayo Clinic Staff, 2018). Another efficient class of antidepressants is serotonin and norepinephrine reuptake inhibitors (SNRIs), which is also approved by the FDA. And the last but not the least is benzodiazepines, which are considered to be sedatives depressants for the central nervous system. The FDA also approves them for the treatment of panic disorder includes alprazolam (Xanax) and clonazepam (Klonopin) (Mayo Clinic Staff, 2018). They are usually used only for a short time because of the possibility to cause mental or physical dependence. However, benzodiazepines are not the best option for treatment if a patient has had problems with alcohol or drug use. In addition, interacting with other medications, they can cause severe side effects.

However, not every medication may be helpful for a patient because of his or her individual features. In this case, the therapist may propose to switch to another or combine particular pills to increase the effect. It is essential to underscore that the improvement of mental health can be noticed in several weeks. Treatment of caffeine-related disorder does not require any additional medications. In most cases, it requires the lowering of consuming levels or withholding from beverages with caffeine. During the treatment, people may experience withdrawal symptoms, which are characterized by headaches, irritability, and irregularly nausea, but these usually resolve swiftly. To contrast with alcohol or nicotine addiction, caffeine consumption has comparatively weak social reinforcement. In other words, it is more accessible to select a drink without caffeine in a restaurant or at a party without attracting comments. Consequently, physical dependence on caffeine is less complicated by social factors that increase nicotine and other narcotic habits (Encyclopedia of Mental Disorders, n.d.). However, some studies have shown the caffeine addicts report frequent relapses due to unsuccessful attempts to quit caffeine.
Even though typical treatments reduce the symptoms of panic disorder for various patients, even some of them may remain to have occasional panic attacks or their recurrence after remission. As a result, people have to be informed about the possibility of their occurring during or after reduction. In the case of occasional panic attacks after remission, the therapist has to provide a patient with a plan for how to respond and handle them. Both panic disorder and caffeine-related disorder are usually carried out on an outpatient basis since the conditions rarely require hospitalization. However, it may be necessary to hospitalize a patient with those disorders because of symptoms of co-occurring disorders (e.g., when acute suicidality associated with a mood disorder is present or when inpatient detoxification is required for a substance use disorder) (American Psychiatric Association, 1998). In the case of ineffective outpatient treatment, in severe situations, a patient may require hospitalization or partial hospitalization. Among other options of treatment are home visits and telephone- or Internet-based ones.

In the case of unsatisfactory treatment response, the therapist should consider the possibility of fundamental clinical factors such as a significant untreated medical illness that explains symptoms, intervention due to concomitant general medical or psychiatric conditions. They may include depression and substance use), inadequate treatment adherence, problems in the therapeutic alliance, presence of psychosocial stressors, motivation factors, and inability to tolerate a specific treatment (American Psychiatric Association, 1998). Psychiatrists are recommended to seek advice from experienced colleagues while creating treatment plans for patients whose symptoms are resistant to standard treatments.

To conclude, panic disorder is a subclass of anxiety disorder and is characterized by extreme fear and anxiety, which completely differs from the natural feeling of fear. This disorder may be diagnosed in case of occurring five or more symptoms mentioned in “Diagnostic and Statistical Manual of Mental Disorders.” For treating panic attacks are proposed two main options: psychotherapy and medications. Usually applied a form of psychotherapy is cognitive-behavioral therapy. In case of unsatisfactory treatment, a patient may be recommended such depressants as SSRIs, SNRIs, and benzodiazepines. As to caffeine-related disorder, the subclass of a substance use disorder, it is followed by cognitive, behavioral, and physiological symptoms, which show the continuous use of the substance by an individual. The caffeine-related disorder may lead to caffeine intoxication, which in severe cases may result in death. As to treatment options, patients are recommended to reduce or refuse from consuming caffeine beverages. However, some studies have shown that patients face significant challenges. In case of unsatisfactory treatment, the therapist should try to find any underlying features, which may influence the ineffective results. In addition, the psychotherapist is also advised to communicate with experienced colleagues to develop a new treatment plan.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
American Psychiatric Association. (1998). Practice Guideline for the Treatment of Patients with Panic Disorders. American Psychiatric Association Practice Guidelines.
Encyclopedia of Mental Disorders. (n.d.). Caffeine-related disorders. Retrieved from http://www.minddisorders.com/Br-Del/Caffeine-related-disorders.html
Mayo Clinic Staff. (2018, May 04). Panic attacks and panic disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/panic-attacks/diagnosis-treatment/drc-20376027

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