Panic Disorder

...ba href=/panic disorder/a/b, are common in chronic obstructive pulmonary disease (COPD).

Anxiety symptoms and disorders are associated with many negative consequences such as decreased physical activity and functional status, poorer self-perceptions of health, decreased life satisfaction, increased loneliness, increased physical disability, decreased quality of life, and increased service utilization (Brenes et al., 2005a, 2005b; Lenze et al., 2001; Stanley et al., 2001; van Balkom et al., 2000).

The first line of treatment for anxiety in later life is typically pharmacological.

Benzodiazepines are the most commonly used anxiety management medication, followed by serotonergic antidepressants, buspirone (BuSpar), and venlafaxine (Effexor) (Mamdani et al., 2005).

Recent research has also examined the impact of psychotherapy, typically cognitive-behavioral therapy (CBT), for late-life anxiety.

Pharmacological Interventions Approximately half of older patients diagnosed with an anxiety disorder in primary care are prescribed an anxiolytic or antidepressant medication (Stanley et al., 2001).

All pharmacological interventions reviewed are approved treatment options for anxiety disorders.

Benzodiazepines are the most frequently prescribed medications for anxiety in later life, with usage rates of 10% to as high as 43% for individuals with persistent anxiety (Gleason et al., 1998; Gray et al., 2003; Mamdani et al., 2005; Schuurmans et al., 2005).

However, benzodiazepines can lead to an increased ...

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For example, George et al.

(1987) reported a small case series of three women with PD who showed marked improvement in their panic symptoms during pregnancy.

Villeponteaux et al.

(1992) conducted a small retrospective study on pregnant women with pre-existing PD and reported that a majority of women had an improvement in panic symptoms during pregnancy.

Altshuler et al.

(1998) found that whereas pregnancy appears to exacerbate symptoms of obsessive compulsive disorder, patients with PD may remain well during pregnancy even after discontinuing medication.

In contrast to the above findings, Cohen et al.

(1996) conducted a small prospective study on the course of pre-existing PD during pregnancy and found that most patients continued to experience panic attacks during all three trimesters and required anti-panic medication.

Our group has conducted a seven-year, naturalistic follow-up study in order to examine the effect of pregnancy on the course of pre-existing ba href=/panic disorder/a/b.

Our results demonstrated that pregnancy may confer an increased risk of relapse in PD.

Moreover, when compared to patients who develop PD while not pregnant, patients who have the initial onset of PD during pregnancy appear to have a higher risk of relapse at the time of a subsequent pregnancy (Dannon, unpublished data).

While the effect of pregnancy seems to have a variable influence on the course of PD, multiple studies have demonstrated that the postpartum period appears to be associate...

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