View source for Talk:Panic disorder

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== Re: "...or until medical intervention. ---****----  HERE WE GO - I hope some one from Wikipedia see's this - In the article/study/thesis - it says that "abuse of substances begins before panic attacks begin" - That is 100% correct.  Do you want to know why?  The research missed some key items. It tries to blame the "panic attacks" on the substance abuse.. That is not correct.. The "panic" syndrome comes on "lightly" then it builds.. It is very cunning with its attack.  You get the "light symptoms" and that draws you towards some relief... You live with the "light symptoms" for many, many years before the levee begins to break. Once the levee fails - THEN and only THEN is your article correct and accurate... Sorry to mess up your page.. 
 ==

==Untitled==
All of the training that I've done around Panic Disorder counteracts this sentence:

"These attacks typically last about ten minutes, but can be as short-lived as 1–5 minutes and last as long as twenty minutes or until ''medical intervention''." (my emphasis added)

The parasympathetic nervous system always starts up to calm someone down after a little while. Even if that 'little while' is two hours, the sentence 'or until medical intervention' gives the wrong impression, as if a panic attack could last forever until treated with sedatives.

What do people think?

[[User:SylviaBoBilvia|SylviaBoBilvia]] ([[User talk:SylviaBoBilvia|talk]]) 21:49, 22 October 2009 (UTC)

:Read my comments below "full time panic."  I had a rare panic disorder that did not go away until medical intervention.  I was stupid, and had experienced panic before, so I didn't seek help.  For a while, I thought I would panic the rest of my life.  It went on for about a week, one long attack, at best livable, at worst, a nightmare.  I still have trouble even remembering this time it was so terrible.  It was like I was living a nightmare.  Had I sought help sooner, I'd probably be much better off.  [[User:ReignMan|ReignMan]] ([[User talk:ReignMan|talk]]) 01:03, 2 April 2010 (UTC)
::My panic attacks are often "caused by" sedatives. (I think my heart is going to randomly stop, rather than the more common fear of heart attack. I can discuss this no further or chance setting myself up for random terror again. The sedatives dont actually do this, i just think they will.) However, thats a rather non-neutral statement on the deal and only applies to me personally. Never the less, I have not once, no matter how terrified, required medical intervention.  
::As for ReignMan's comments: This is refering to an individual panic episode, not the long term panic disorder over multiple sessions. It is without dispute that psychological help will reduce these symptoms, but Sylvia was discussing it on an episode-by-episode basis, which generally do not require medical assistance. Your condition as described is by far the exception; I cant even get to sleep til i calm down, for instance. Sadly, that means yours is the untypical case, and thus, not appropriate for the majority of the article. That is not to say its not important, but for this one issue, whether or not a panic *attack* needs intervention in some cases, your experience was abnormal. [[Special:Contributions/74.132.249.206|74.132.249.206]] ([[User talk:74.132.249.206|talk]]) 00:23, 4 September 2011 (UTC)

== Do not Merge ==

'''Do not Merge.''' I don't think the article on Panic Attacks should be merged with the article on Panic Disorder. They are greatly different and in fact many people can have panic attacks without having panic disorder. It is sufficient that the articles are linked by internal links etc. however they should remain two distinct articles. Lastly, the Panic Attack article describes a symptom while the Panic Disorder article discusses a disease- they are not the same and thus should not be merged. Merging them would only lead to confusion.[[User:Paulee24|Paulee24]] 00:43, 20 July 2007 (UTC)

Agree. As someone with Panic Disorder (yes, diagnosed and managed) the two are entirely different. Panic Attacks and Panic Disorders are worlds apart. As Paulee states, one is a symptom, one is a condition (I don't like the word 'disease' :) Cheers [[User:Simmons001|Simmons001]] ([[User talk:Simmons001|talk]]) 15:51, 10 September 2008 (UTC)

==DSM criteria==
Is this a quote?  If so, it needs to be a blockquote.  As it is, it would be a copyright violation. [[User:Aleta|Aleta]] 07:29, 15 January 2007 (UTC)

==Hypoglycemia==
I cut this paragraph from the article.  Even if hypoglycemia causes panic attacks, it's not panic disorder.  Therefore, I don't think this belongs in this article. 
<blockquote>
[[Hypoglycemia]] may also cause panic attacks. In this condition the [[receptor (biochemistry)|receptors]] for [[insulin]] do not respond properly to insulin, interfering with the transport of [[glucose]] across the [[cell membrane|membrane]]s of [[cell (biology)|cells]]. The [[brain]] depends on a steady supply of [[glucose]] &mdash; its only source of energy. When there is a sudden fall in blood sugar levels the brain sends a hormonal signal to the [[adrenal gland]]s to produce [[adrenaline]]. This [[hormone]] functions to raise [[blood sugar]] levels by converting [[glycogen]] into glucose, thus preventing brain starvation, but it is also a panic hormone that is responsible for attacks of fear. The non-[[medication|drug]] treatment for this is the adoption of the [[Hypoglycemia|hypoglycemic]] diet.<ref>{{cite web| url=http://www.hypoglycemia.asn.au/articles/beating_anxiety.html| title=Beating Anxiety and Panic Attacks| first=Jurriaan| last=Plesman| year=2005| accessdate=2006-05-12}}</ref></blockquote> -- [[User:Aleta|Aleta]] 09:02, 24 January 2007 (UTC)

::Rather than hacking out this important paragraph, it would have been better to explain that there are possible organic causes of panic attacks, and differentiating that from panic disorder per se. However the experience may be the same, as this paragraph alludes to. Your editing is careless and uninformed. But then again, so are most third party observers to those who suffer from this.
::[[User:Nodekeeper|Nodekeeper]] 12:28, 17 June 2007 (UTC)

Panic disorder is defined as recurrent unexpected panic attacks, amongst other DSM IV criteria. While a condition resulting in recurring hypoglycemia would seem to be able to trigger these attacks based on your description (and theories do exist that describe central norepinephrine as a player in panic attacks), the hypoglycemic condition alone would not seem like sufficient qualification for panic disorder in itself under the DSM IV criteria as it states that the panic attacks must not be due to the "direct physiological effects of a substance (eg., a drug of abuse, a medication) or a general medical condition (eg., hyperthyroidism)". I would imagine that the hypoglycemia would fall under the general medical condition.

However, according to Theory and Practice of Psychiatry (Cohen, 2003), patients with panic disorder might have an underlying etiology of a hypersensitive noradrenergic system. Hence someone with this condition who is predisposed to attacks hypoglycemia might therefore be prone to triggering his/her over-sensitive noradrenergic system and therefore his/her panic attacks.

Also, I took out "alcohol" from the section that listed possible "stimulants" that might exacerbate panic attacks soley due to the fact that it is a CNS "depressant".

Hope that helps. <small>—The preceding [[Wikipedia:Sign your posts on talk pages|unsigned]] comment was added by [[User:TomKuca|TomKuca]] ([[User talk:TomKuca|talk]] • [[Special:Contributions/TomKuca|contribs]]) 23:00, 17 April 2007 (UTC).</small><!-- HagermanBot Auto-Unsigned -->

{{reflist-talk}}

==Panic Disorder vs. ???==
It's clear to me that there is a difference between panic attacks and panic disorder and agorophobia and other related medically unclassifible conditions.  I suspect my  most recent edit crossed the line from the AMA standard panic disorder definition (which I did not look up, not being a psycologist anyway), but I see no other suitable page in wikipedia for what I consider important and relevant material.  Looks like the hypoglycemia info is similarly orphaned for now - suggestions? [[User:Stevefranks|Stevefranks]] 10:51, 5 March 2007 (UTC)

== Recent Changes to the Introduction ==

Hi Everyone... I wanted to comment on the following addition:  ''Like other psychiatric disorders, many of the symptoms of Panic Disorder mimic the symptoms of a hidden physical complications. In the case of hypoglycemia, the symptoms of sudden onset trembling, palpitation, mental confusion, increasing anxiety, sweating, dizziness and psychological distress so closely mimic Panic Disorder that physicians frequently prescribe anti-anxiety drugs. In the case of trauma, traumatized individuals are often subjected to stress which affects their access to ideal nutrition, and often attempt to self-medicate with substances known to affect their ability to metabolize glucose. Often a missing key in the treatment of Panic Disorder, physicians are looking more and more to a nutritionally supportive link in this illness.''

This needs to be fixed... Firstly, the second sentence is not complete, illustrative nor accurate. I think it implies that doctors misdiagnose PD when it is actually hypoclycemia. Any one will tell you that tests for heart function (EKG), blood sugar (hypoglycemia) etc. are always performed to rule out before a diagnosis of PD is made. I have no doubt nutrition is important in treating PD, as is nutrition with any illness. However, it is completely out of place at the start of an article on PD to begin to critisize treatments, diagnosis and bring up alternative theories. This does not belong in the introduction. Before I change it I wanted to make sure everyone agreed.[[User:Unkle25|Unkle25]] 10:30, 19 August 2007 (UTC)

== Tone of article ==

I have made several edits to this page today.  While the origonal author's intentions were obviously noble, as a sufferer, I found the tone of several paragraphs to be patronizing, and frankly, somewhat insulting.  I am hoping to make the material more attractive and likely to make a postive diference to those most likely to read the article, namely those with the condition.  Appologies if I fail to make an improvement, and it is my intent not to make the article less encyclipedic, simply more sensitive.  [[User:Stevefranks|Stevefranks]] 09:05, 5 March 2007 (UTC)

As a person with PD, I feel, as was mentioned, that the article is very patronizing many places.  To the uninitiated, it would seem that panic disorder is just a set of upsetting symptoms that occur from time to time and that can reasonably easily be controlled.  No, PD can be a 24-hour a day nightmare that can last for years unabated.  It's not surprising that the Wikipedia article has this tone-90% of the internet references are similarly misinformed. I think we need to make this article a bit more real-world in content and less second-hand, often well-intended misinformation.

[[User:Dehughes|Dehughes]] 01:01, 25 September 2007 (UTC)Dehughes

:Hi Dehughes. I agree with what you are saying... Please take a look at the article on [[panic attack]] I think it has a better tone and is less patronizing. Should we all colloborate and start re-writing the PD article? Take Care[[User:Unkle25|Unkle25]] 07:06, 5 October 2007 (UTC)

:Not only do I vehemently agree with Stevefranks and Dehughes, but I find that reading the wikipedia entry on [[panic attack]] to be an extremely therapeutic exercise when actually having a panic attack.  Not so much with the panic disorder page, since a key element to the entire episode is that your body is errantly telling you that something is very physiologically wrong, and this page can re-enforce that thought by discussing hypoglycemia and other "real" conditions that might lead to what's happening.  Me and everyone I know who have suffered from this have probably been tested out the wazoo for that stuff before finally coming to an anxiety disorder diagnosis.  While hypoglycemia could certainly be a trigger for a specific attack (anything that makes you feel "weird" from a cold to a little indigestion can be, too), I don't really thing it's part of the overall disease. [[User:Samkass|--Sam]] ([[User talk:Samkass|talk]]) 15:15, 30 January 2008 (UTC)


== Orphan sentence (?) ==
This sentence:
"Multi vitamins and other medications can wear away anti-psychotics careful discretion on the part of the patient should disclose all information to Physician and staff so further intoxication does not occur."

doesn't seem to make sense any way I read it. Can we delete/fix?  <small>—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[Special:Contributions/216.231.49.161|216.231.49.161]] ([[User talk:216.231.49.161|talk]]) 03:18, 3 November 2007 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Poor wording in "substance abuse" ==

In the section regarding substance abuse, the following text:

<blockquote>
A study conducted by Dannon, Lowengrub, Amiaz, Grunhaus, & Kotler (2004)[8] on 66 adults examined the rates of comorbid cannabis use and Panic Disorder. Of the 24 participants who suffered from Panic Disorder and had comorbid chronic cannabis use, all reported that their first panic attack occurred within 48 hours of smoking marijuana.
</blockquote>

strikes me as particularly poorly worded. If you replace "chronic cannabis use" with "bathing daily", you'll see what I mean.

<blockquote>
A study conducted by Dannon, Lowengrub, Amiaz, Grunhaus, & Kotler (2004)[8] on 66 adults examined the rates of comorbid bathing and Panic Disorder. Of the 24 participants who suffered from Panic Disorder and took a daily bath, all reported that their first panic attack occurred within 48 hours of bathing.
</blockquote>

Point: If you're a chronic cannabis user you may not ever go more than 48 hours between smoking marijuana, and if you take a daily bath you may not ever go more than 48 hours between bathing.  <small>—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[Special:Contributions/80.213.156.201|80.213.156.201]] ([[User talk:80.213.156.201|talk]]) 06:43, 22 January 2008 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Capitalization ==

Call me ignorant, but why exactly is the disorder name given normal sentence casing ("panic disorder" or "Panic disorder") in the page title and is capitalized ("Panic Disorder") throughout the rest of the article? [[User:Tony Myers|Tony Myers]] ([[User talk:Tony Myers|talk]]) 02:35, 29 February 2008 (UTC)

== Removed Inappropriate Tone ==
"However, experienced sufferers can often have intense panic attacks with very little outward manifestations of the attack occurring. "
I have deleted the above because of its inherent unverifiability. How do you define someone 'experienced' in panic disorder? How can one conduct a study about that? Are the people who actually have outward symptoms just not 'experienced' enough to control themselves or something? Unless there is a citation or verification of any form '''other than anecdotal''', I would prefer that this remain removed in keeping with Wikipedia policies about unverified information.[[User:Go slowly|go slowly]] ([[User talk:Go slowly|talk]]) 03:04, 11 December 2008 (UTC)

== Medications section on [[panic disorder]] copied from talk page ==

'''this is copied from a talk page'''
Hi, I do agree that the original article needed work. However, I reverted your edits because they did not reflect neutrality. Saying that benzodiazepines are  "best avoided" and are "not recommended" are loaded claims. You cite NICE guidelines and offered original research to cite your edit, but your edits cannot reflect a consensus opinion when there is no consensus that benzodiazepines should be avoided for the treatment of panic disorder. For instance, the  [[American Psychiatric Association]]'s Practice Guidelines offers benzodiazepines as first-line treatments along with CBT and antidepressants. [http://www.psychiatryonline.com/content.aspx?aID=154805 APA guidelines] 

We '''can''' make sourced claims such as:
*Benzodiazepines are widely prescribed to treat panic disorder
*They have proven efficacy in the short-term treatment of panic disorder
*Benzodiazepines have a high risk of addiction/tolerance and discontinuation side effects, and many experts agree that they should only be prescribed for the short-term and/or sparingly.
*Because of their long-term risks and risks of addiction/tolerance, the NICE does not recommend their use in the treatment of anxiety disorders.

We '''cannot''' make claims that they are "best avoided" and are "not recommended" because these claims are not encyclopedic.  [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 23:00, 24 July 2009 (UTC)

Edit: I recommend asking members from WikiProject Psychology and and Wikiproject: Medicine/Psychiatry about the best approach to this section. [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 23:03, 24 July 2009 (UTC)

::yes I agree.  Lets try and get some consensus before making further bold edits.  My terms came directly from the NICE guidelines - so maybe my mistake was not writing '''according to some clinical guidelines'''.  I wasnt aware of the APA guidelines and now suspect that this difference in our edits is due to regional differences.  So rather than writing the article from a US or UK perspective - a more balanced view is needed. 

::In addition we could also add sources to state:
::*Benzodiazepines are widely prescribed to treat panic disorder, '''but this is considered poor clinical practice'''
::*They have proven efficacy in the short-term treatment of panic disorder, '''but dont work in the longer term because of high risk of tolerance (i.e. tolerance means that you need to keep on taking an increasing dose for them to be effective'''
::*robust clinical guidelines recommend psychological treatment, then SSRI, then patient education (in that order) and '''do not recommend their use in the treatment of anxiety disorders'''.  [[User:Earlypsychosis|Earlypsychosis]] ([[User talk:Earlypsychosis|talk]]) 02:25, 26 July 2009 (UTC)

:::"Poor clinical practice" and "robust clinical guidelines" are value-laden and statements which really don't belong in an encyclopedia. I don't think we can state that benzos are not recommended in the treatment of anxiety disorders. There just is not a consensus. I don't think their controversy belongs in this article; there are already separate articles devoted to both long-term use and withdrawal from benzos. Having read UK professor Heather Ashton's benzo manual, I have to agree with you that this appears to be mainly a regional difference (she mentions the differing opinions). In the US, benzos are still very widely prescribed to people - everywhere, not just among psychiatrists. Like, temazepam is still used by GPs for short-term insomnia but in the EU it's widely abused and rarely prescribed. Very typical treatment for panic disorder in the US will be an SSRI, alprazolam, concurrent with cognitive behavioral therapy. Any more edits from me will turn this article into an edit war, and I don't want that. Further input from other users, especially if they're in WikiProject Psychology are needed. [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 02:58, 26 July 2009 (UTC)

Mutual Monarch, your edits look strangely familar and your first edits show the knowledge of wikipedia of an "advanced" or very well established long-term editor. I suspect that you are a sockpuppet, [[WP:SOCK]]. I recommend that you switch to your usual username.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 07:59, 26 July 2009 (UTC)
::Oh, for Christ's sake. Feel free to ask an administrator to do an IP check then. I have had other user names, but I have never been a "very well established long term editor." I have never before edited the panic disorder article or any articles on mental health. [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 17:00, 26 July 2009 (UTC)

:::If you have multiple accounts wikipedia policy asks that you identify those alternative accounts on your userpage.[[Wikipedia:MULTIPLE#Using_multiple_accounts]] You can use this template [[Template:User_Alternate_Acct]] to do it if you like or you can just type them onto your userpage manually. Having multiple accounts is not necessarily a bad thing. Some people use them in good faith and not being aware of wiki policies, it is just requested that you identify your other accounts.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 18:38, 26 July 2009 (UTC)
::::OK, thank you for the head-up; my last account I simply forgot the password to my old account. In the meantime, I see that you have been very involved in the editing of benzodiazepine articles. Do you have any suggestions? I am starting to think we should just get to the point, in a couple sentences: SSRIs and benzodiazepines are used to treat panic disorder. Their effectiveness, long-term use, and withdrawal symptoms are already well-covered on WP. [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 23:21, 26 July 2009 (UTC)

:::::Thank you for the explaination of your old account and for posting your old username on your userpage. I don't agree that we should just say they are used for panic disorder, the reader will want to know more than that and not have to go digging around wikipedia for the info. I disagree with several of your edits and your reasoning for them in the edit summary. You seem to be of the view that wikipedia cannot cite sources even clinical guidelines or systematic reviews of the literature if they say benzos are ineffective long-term and that we can only say they are effective. We just follow what the sources say is all. I think that we should discuss things over the coming days and come to some sort of an agreement and not rush into doing major bold edits seeing as there is a disagreement both on talk page and editing history of article recently amongst editors here.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 23:55, 26 July 2009 (UTC)

:::::My edits were trying to reflect neutrality and prevent undue weight, by attributing research and views, such as journal article and guidelines, directly to the source. Statements like "Benzodiazepines are best avoided to prevent..." and "not recommended in the treatment of panic disorder" were inferred from their sources, and need to be attributed to their source. NICE does not recommend their use in panic disorder, but their recommendation does not make it fact. Many other scientists and physicians would disagree with their recommendation. We can't make a recommendation either way. [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 01:04, 27 July 2009 (UTC)
::::::Your edits eliminated one viewpoiint in favour of the other viewpoint, so I disagree that your edits brought due weight and neutrality. Do you have a source for the "many other scientists"? If you look at the conflict of interest at the top of the AMA it might reveal why they have a different viewpoint. The studies they use for their viewpoints are not even placebo controlled. You can prove tap water capsules helps schizophrenia if you don't use placebo controlled. The NICE study did ref a study which was controlled and long-term I believe which showed those on benzos did the worst versus those who were not on any benzos. The reason NICE came to a different conclusion is because they did not include flimsy evidence and the authors of NICE as far as I know did not have any COI. However, with that said the AMA is a reliable and notable source and based on [[WP:MEDRS]] it is a good and notable source so can be used for this article. We will need to come to a consensus on wording.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 18:06, 30 July 2009 (UTC)

'''Yeah, this whole section needs a re-write.''' Wiki is not here to offer advice or your personal opinion. Benzos are an important tool in the treatment of Panic Disorder and their long term use is considered acceptable for resistant cases or where SSRI's are unacceptable due to side effects. I agree some Doctors over prescribe but most also over prescribe antibiotics. Shall we ban those as well? Doctors (and others is seems) will argue about this until the cows come home, quoting studies that support their own position, but at the end of the day the preponderance of opinion is that they are beneficial in some cases. Black and white never applies in medicine and certainly not in mental health. Whilst they are not the best option for all by any means, monitored long term use with a close relationship with a GP can be beneficial. Panic Disorder is different for everyone, the childish back an forward here is unhelpful. In my personal experience my recovery was delayed years by doctors stuffing around with various SSRI's as they were unwilling to prescribe benzos (obviously a bit behind on their research) with no follow up or support and limited access to Mental Health professionals. During these years whilst the attacks continued, i found CBT was a pile of crap (it works great for others), numerous SSRI's gave unacceptable side effects (I add that some DID work, but the side effects of all were unacceptable) and it wasn't until I undertook ACT with the collaborative support of an excellent psych and a close relationship with a new dedicated GP, on a newer SNRI with benzos used occasionally and symptomatically that i improved. I am now near attack free, happy and pretty healthy, off the SNRIs and with benzos in the cupboard for rare use as needed. I am happily in a maintenance state. Your statements re "you can do this, you can't do that, you should, you shouldn't' show a lack of both understanding and empathy. At the end of the day 

''"Benzo's are commonly prescribed as a short term treatment for Panic Disorder whilst other support and treatments such as SSRI, SNRI, CBT, ACT etc is commenced and undertaken. Whilst their usage long term may not be recommended due to the cessation of effectiveness and addictive properties demonstrated in some patients and studies, each person's treatment is unique. The best course of action for each patient needs to be discussed between the treating professional and patient in collaboration and with close monitoring"'' 

or something very similar is all you need. '''Pull your heads in'''. [[User:Simmons001|Simmons001]] ([[User talk:Simmons001|talk]]) 08:35, 21 October 2009 (UTC)

'''Agree completely.'''..I find it amazing that the well-documented lack of tolerance of panic disorder patients to antidepressants (trust me, AD's will make you jump through the roof if you have panic disorder, even at low starting doses)-plus the withdrawal problems with the most effective AD's for panic (e.g. Paxil, Effexor) don't suggest to the informed reader why benzos are so widely prescribed. CBT used to be all the rage, but 90% "cure" rate?-a more balanced view would be that it is helpful for some individuals with milder anxiety symptoms or isolated panic attacks. It's like saying chemotherapy is bad for you if you have cancer; very true, but what are the alternatives?  There is a very good reason so many people use alprazolam (which is FDA-approved for the condition, btw) for panic disorder: it works and many, if not most panic disorder sufferers would love an alternative, but there just isn't one.  Since benzos are approved for panic disorder by at least some experts, perhaps it's not Wikipedia's role to get into the prescribing business.
[[User:Dehughes|Dehughes]] ([[User talk:Dehughes|talk]]) 16:26, 22 December 2011 (UTC)

:You say that you use benzos occasionally or rarely; there is actually little to no controversy about such usage, i.e. use in acute situations such as a bad panic attack. The controversy is their chronic frequent use, not chronic occasional/rare use as you describe. The discussion above was actually based on which references to use and due weight and so forth. I don't mean to be rude but respectfully you are telling us not to give our personal opinion (when we were actually discussing article content and citations) but you are asking that we rewrite the article based on your personal opinion and anecdotal experience. Your suggested text is based on [[WP:NOR|original research]] so we cannot just add it to the article, sorry. However, [http://www.ncbi.nlm.nih.gov/pubmed/12516310 here is a good quality reference] which says that they can be used in treatment resistant cases which is basically what you are saying I think? I would have no opposition to this reference being used in the article. :)--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 11:52, 21 October 2009 (UTC)
:Also please see [[WP:CIVIL]] telling people to pull their heads in is not the way to go about getting your original research inserted into articles.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 11:53, 21 October 2009 (UTC)


Yep, fair enough. I accept that feedback. Whilst yes, i was professing personal experience, it is, as you note, supported by research and professional references of which i was well aware which is why I found it important to illustrate. Perhaps I should have got more ducks in a row. I am still of the opinion that my suggested text, with appropriate references is the way to go. There should be no stigma or encouragement of benzo use either way. It is a medical decision to be discussed and agreed between Dr and patient. [[User:Simmons001|Simmons001]] ([[User talk:Simmons001|talk]]) 09:42, 22 October 2009 (UTC)

:I think that you are maybe misunderstanding what an encylopedia does, it is not meant to be a medical advice for patients, we just report facts reliable sources say, not what editors think that they should say. This suggested sentence is medical advice, "The best course of action for each patient needs to be discussed between the treating professional and patient in collaboration and with close monitoring". Don't take this the wrong way, I am happy to incorporate the suggested reference above, infact I think that I will do that now after sending this message.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 01:30, 23 October 2009 (UTC)

::Ok, I have made some changes which I believe that you will be happy with. If you have references feel free to improve it or raise any problems with the wording etc.--[[User:Literaturegeek|<span style="color:blue">Literature</span><span style="color:red">geek</span>]]&nbsp;|&nbsp;[[User_talk:Literaturegeek |<span style="color:orange">''T@1k?''</span>]] 01:53, 23 October 2009 (UTC)

:::For me, it's a good improvement, because it addresses short-term use and problematic long-term use. And the sources reflect appropriate medical consensus. My primary objection was that the original article did not really make a distinction between using benzos long-term, or using them for short-term control of panic symptoms. [[User:Mutual monarch|Mutual monarch]] ([[User talk:Mutual monarch|talk]]) 04:34, 23 October 2009 (UTC)

:::Yep, me too. Like it. The previous editorial bias is gone, now it simply reports current thinking. Cheers [[User:Simmons001|Simmons001]] ([[User talk:Simmons001|talk]]) 13:47, 25 October 2009 (UTC)

==Copyright problems with diagnostic criteria==
The [[American Psychiatric Association]] has not released its ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' into [[public domain]], but claims copyright. The Wikimedia Foundation has received a letter of complaint ([[Ticket:2010030910040817]], for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at [[Wikipedia:Copyright_problems/2010_March_9#DSM_Complaint_.28Ticket:2010030910040817.29|the copyright problems board listing]] during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you.  [[User:Moonriddengirl|Moonriddengirl]] <sup>[[User talk:Moonriddengirl|(talk)]]</sup> 13:58, 11 March 2010 (UTC)

: I fixed the problem in ''[[Talk:Panic disorder/Temp]]''. [[User:Eubulides|Eubulides]] ([[User talk:Eubulides|talk]]) 03:53, 13 March 2010 (UTC)
::Thank you. --[[User:Moonriddengirl|Moonriddengirl]] <sup>[[User talk:Moonriddengirl|(talk)]]</sup> 13:15, 13 March 2010 (UTC)

== Substance Abuse and Panic Disorder - Marijuana ==
No mention of marijuana? I don't know of any other substance more notorious for triggering panic attacks (and this is coming from a stoner).
[[Special:Contributions/67.61.186.51|67.61.186.51]] ([[User talk:67.61.186.51|talk]]) 17:48, 19 October 2011 (UTC)

==[[WP:MEDRS]]==
We need better sources, thus moved this here... 
<blockquote>For children with panic disorder, CBT is the only scientifically-proven psychotherapeutic treatment. The methods used are similar to those used with adults, but may be modified to be developmentally-appropriate {{cite web|title=Evidence-Based Treatment for Anxiety|url=http://www.abct.org/sccap/?m=sPublic&fa=pub_Anxiety#AnxietyTable}}
Cognitive behavioral therapy is seen as the most effective form of treatment for people who experience panic attacks. This type of therapy focuses on the thinking patterns and behaviors that people continue to engage in without noticing that they may be the cause of their panic attacks. The acceptability and low cost of CBT makes it a very valued option in treating panic disorder.<ref>{{cite journal|last=Otto|first=C|coauthors=Deveney|title=C|journal=Cognitive-behavioral therapy and the treatment of panic disorder: efficacy and strategies.|year=2005|volume=66|url=http://ukpmc.ac.uk/abstract/MED/15842185/reload=0;jsessionid=C3D81C7503A91680583917ADD4DD2403|accessdate=11/28/11|pmid=15842185|pages=28–32}}</ref>Below are several strategies that have been proven to be effective in decreasing anxiety for many people with panic disorder<ref>{{cite web|title=Panic Attacks and Panic Disorder|url=http://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htm|accessdate=11/28/11}}</ref> : 

'''Thought stoppage and Calmative Breathing:'''
When a negative thought comes into the mind, it is important for the person to recognize and the label the thought as negative. The person should say “STOP” and should inhale deeply for four seconds, hold their breath for four more seconds, and exhale through pursed lips, always at the appearance of a negative thought.<ref name="Liebgold2004">{{cite book|last=Liebgold, M.D.|first=Howard|title=Freedom From Fear|year=2004|publisher=Citadel Press|location=New York, NY|pages=47–81}}</ref>  

'''Cortical Shifting:'''
In cortical shifiting, the person can shift their thoughts to something else in order to reduce their anxiety. There are twelve things the person can think about in order to reduce anxiety if they feel an anxiety attack coming on: three things you can do (e.g. count to 100, talk to someone), three things you can see, three things you can hear, or three things you can touch.:<ref name="Liebgold2004" />

'''“Best Case Scenario”:'''
Anxiety causes many people to think of exaggerated catastrophes. One way to dispute and reframe is to create the “best case scenario” which gives the mind other possible and positive alternatives rather than destructive exaggerated ones.<ref name="Liebgold2004" /> 

'''Eye Movement Desensitization and Reprogramming (EMDR):'''
This is a technique of imaginary desensitization with accompanying eye movements. The participant follows a moving finger at the same time as they are focused on past emotional events. A therapist then coaches progressive relaxation while focusing on past traumatic experiences.<ref name="Liebgold2004" />

'''Humor:'''
As a person gets better with dealing with phobais and obsessions, humor can become a powerful tool. Humor can stop or decrease the amount of adrenaline released into the body that causes subsequent anxiety. Even death, a topic many people with anxiety disorder think about, can be dealt with through humor. Humor is a good way to get rid of anxiety and is a good strategy to implement for overcoming anxiety.<ref name="Liebgold2004" /></blockquote>[[User:Jmh649|<span style="color:#0000f1">'''Doc James'''</span>]] ([[User talk:Jmh649|talk]] · [[Special:Contributions/Jmh649|contribs]] · [[Special:EmailUser/Jmh649|email]]) 02:02, 31 January 2012 (UTC)
{{ref list}}

== Therapy Statistics Info ==

While reading an Abnormal Psychology textbook by Susan Nolen-Hoeksema, I found a few topics very interesting about treatments for panic disorder. I believe that it is important to mention how affective the therapy techniques are to a patient. Many patients might opt out of attending therapy because they believe that it will not be helpful. If it is mentioned, individuals may develop more hope and will be willing to get treatment. 
That is why I propose that we include these statistics under the treatment section: 
Several studies show that 85 to 90 percent of panic disorder patients treated with CBT recover completely from their panic attacks within 12 weeks. <ref> {{cite book |title=Abnormal Psychology |last=Nolen-Hoeksema |first=Susan |publisher=McGraw-Hill |isbn= 0078035384|page=132}} </ref>(Where it mentions CBT) A number of randomized clinical trials have shown that CBT achieves reported panic-free status in 70-90% of patients about 2 years after treatment.<ref> {{cite book |title=Abnormal Psychology |last=Nolen-Hoeksema |first=Susan |publisher=McGraw-Hill |isbn= 0078035384|page=132}} </ref> <ref name="Choy"/>

[[User:Shruti1994|Shruti1994]] ([[User talk:Shruti1994|talk]]) 19:06, 20 March 2014 (UTC)

{{reflist-talk}}


== Slightly Wrong Term used  ==

In 

[...] There are other researchers studying some individuals with panic disorder and propose they may have a chemical imbalance within the limbic system and one of its regulatory chemicals GABA-A. The reduced production of GABA-A sends false information to the amygdala which regulates the body's "fight or flight response" mechanism and in return, produces the physiological symptoms that lead to the disorder. [...]

The neurotransmitter you likely mean is just GABA. Not GABA-A, which is one receptor
for GABA.



----------

== Causes ==

The article states: 
While there is not just one explanation for the cause of panic disorder, there are certain perspectives researchers use to explain the disorder. The first one is the biological perspective. Past research concluded that there is irregular norepinephrine activity in people who have panic attacks.[11] Current research also supports this perspective as it has been found that those with panic disorder also have a brain circuit that performs improperly. This circuit consists of the amygdala, central gray matter, ventromedial nucleus of the hypothalamus, and the locus ceruleus.[12]

This is NOT supported by modern research.  <small class="autosigned">—&nbsp;Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[Special:Contributions/69.77.143.230|69.77.143.230]] ([[User talk:69.77.143.230|talk]]) 16:13, 27 April 2016 (UTC)</small><!-- Template:Unsigned IP --> <!--Autosigned by SineBot-->

== Alternative medications ==

There's other medications that are used for panic disorder. In the UK, Lyrica is used as a safer form of benzodiazepine. [[User:Earthcosmos|Earthcosmos]] ([[User talk:Earthcosmos|talk]]) 18:49, 25 March 2018 (UTC)

Gabapentin is also similar and used. [[User:Earthcosmos|Earthcosmos]] ([[User talk:Earthcosmos|talk]]) 18:49, 25 March 2018 (UTC)

== Req for expert assistance at [[Future Tripping]] ==
[[Future Tripping]] was recently created. There is a proposal to move it to [[anticipatory anxiety]], which currently redirects to [[panic attack]]. Anticipatory anxiety appears to be a symptom of [[Panic disorder]], but is not explicitly mentioned at that article. (will post in a few places) <span style="font-size: 80%;color:blue"><sup>~</sup>[[User:Hydronium Hydroxide|Hydronium<sup>~</sup>Hydroxide]]<sup>~[[User talk:Hydronium Hydroxide|(Talk)]]~</sup></span> 03:11, 29 August 2023 (UTC)