Panic Disorder A Patient-Centered, Evidence-Based Diagnostic and Treatment Process A Presentation for the Students of Ohio University College of Osteopathic Medicine. Kendall L. Stewart, M.D. November 29, 2010.
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Panic DisorderA Patient-Centered, Evidence-Based Diagnostic and Treatment Process A Presentation for the Students of
Ohio University College of Osteopathic Medicine
Kendall L. Stewart, M.D.
November 29, 2010
1 My goal with these talks is to provide you with the minimum practical information you will need to treat these patients.
2 Please let me know whether I have succeeded on your evaluation forms.
1 Paradoxically, marijuana often triggers panic in first-time users.
1 If you make this diagnosis early and initiate treatment quickly, you may prevent many complications.
1 The peak age of onset of spontaneous panic attacks is between 15 and 25 years. (Goldman, 2000)
2 Panic attacks may result from noradrenergic dysfunction in the locus ceruleus (Nutt, et al, 1992)
3 Twin studies reveal some genetic basis for the disorder, but the exact inheritance is not clear.
1 A panic attack cannot be coded as a psychiatric disorder (DSM-IV-TR).
1 Agoraphobia cannot be coded as a psychiatric disorder (DSM-IV-TR).
1 Whether agoraphobia is present or absent clarifies the specific diagnosis. (DSM-IV-TR).
What are the criteria for agoraphobia without a history of panic disorder?
1 In clinical settings, over 95% of people presenting with agoraphobia also have panic disorder.
What associated features might you see? panic disorder?
1 One of my patients saw a specialist in Columbus (naturally) who said my medication stretched her heart valves.
2 Be careful when your patients tell you what other doctors said. A daughter refused to face her father’s dementia.
1 I attributed a patient’s tachycardia to her antidepressant. I was wrong.
1 A surprising number of these people will elect to simply “gut it out.”
1 It’s always best to be the third or fourth psychiatrist in these cases.
The Psychiatric Interview diagnosis?A Patient-Centered, Evidence-Based Diagnostic and Therapeutic Process
Where can you learn more? diagnosis?
1,2Please note that you must master all of the information in a basic neurology textbook and a basic psychiatry
textbook to do well on the comprehensive, standardized final examination.
How can you contact me? disorders?1
Kendall L. Stewart, M.D.
VPMA and Chief Medical Officer
Southern Ohio Medical Center
Chairman & CEO
The SOMC Medical Care Foundation, Inc.
1805 27th Street
Portsmouth, Ohio 45662
1Speaking and consultation fees benefit the SOMC Endowment Fund.
Are there other questions? disorders?
Ryan Foor, DO
Sarah Porter, DO
SOMC FP 2007