The guideline provides recommendations for care at different stages of the person's journey, represented as different steps:. The standards required for Membership of the Royal College of General Practitioners are a good example of standards for consulting skills. The accurate diagnosis of panic disorder is central to the effective management of this condition.
It is acknowledged that frequently there are other conditions present, such as depression, that can make the presentation and diagnosis confusing. In determining the priorities of the comorbidities, the sequencing of the problems should be clarified.
This can be helped by drawing up a timeline to identify when the various problems developed. By understanding when the symptoms developed, a better understanding of the relative priorities of the comorbidities can be achieved, and there is a better opportunity of developing an effective intervention that fits the needs of the individual. It is important to remember that a panic attack does not necessarily constitute a panic disorder and appropriate treatment of a panic attack may limit the development of panic disorder.
Two other variables, atypical chest pain and self-reported anxiety, may also be associated with panic disorder presentations, but there is insufficient evidence to establish a relationship.
The recommended treatment options have an evidence base: psychological therapy, medication and self-help have all been shown to be effective. The choice of treatment will be a consequence of the assessment process and shared decision-making.
This recommendation is taken from the NICE guideline on common mental health problems. Support groups may provide face-to-face meetings, telephone conference support groups [which can be based on CBT principles], or additional information on all aspects of anxiety disorders plus other sources of help. Antidepressants should be the only pharmacological intervention used in the longer-term management of panic disorder.
The classes of antidepressants that have an evidence base for effectiveness are the selective serotonin reuptake inhibitors SSRIs , serotonin-noradrenaline reuptake inhibitors SNRIs and tricyclic antidepressants TCAs. At the time of this amendment June escitalopram, sertraline, citalopram, paroxetine and venlafaxine are licensed for the treatment of panic disorder.
Also see recommendation 1. Written information appropriate to the person's needs should be made available. Note that this is an off-label use for imipramine and clomipramine.
Side effects on the initiation of antidepressants may be minimised by starting at a low dose and increasing the dose slowly until a satisfactory therapeutic response is achieved. In some instances, doses at the upper end of the indicated dose range may be necessary and should be offered if needed.
If the person is showing improvement on treatment with an antidepressant, the medication should be continued for at least 6 months after the optimal dose is reached, after which the dose can be tapered. These symptoms are usually mild and self-limiting but occasionally can be severe, particularly if the drug is stopped abruptly. If severe symptoms are experienced after discontinuing an antidepressant, the practitioner should consider reintroducing it or prescribing another from the same class that has a longer half-life and gradually reducing the dose while monitoring symptoms.
Possible questions include:. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis Personality disorders, including borderline personality disorder, are diagnosed based on a: Detailed interview with your doctor or mental health provider Psychological evaluation that may include completing questionnaires Medical history and exam Discussion of your signs and symptoms.
More Information Psychotherapy. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Borderline personality disorder. Arlington, Va. Accessed May 8, Borderline personality disorder. National Institute of Mental Health. Skodol A. Obsessive-compulsive personality disorder : a pattern of preoccupation with orderliness, perfection and control.
A person with obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively not allowing time for leisure or friends, or may be inflexible in their morality and values. This is NOT the same as obsessive compulsive disorder. Paranoid personality disorder : a pattern of being suspicious of others and seeing them as mean or spiteful. Schizoid personality disorder: being detached from social relationships and expressing little emotion.
A person with schizoid personality disorder typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others. Schizotypal personality disorder: a pattern of being very uncomfortable in close relationships, having distorted thinking and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety.
Learn about the condition. Knowledge and understanding can help empower and motivate. Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Avoid drugs and alcohol. Alcohol and illegal drugs can worsen symptoms or interact with medications. Get routine medical care. Gabbard GO. Antisocial personality disorder. In: Gabbard's Treatment of Psychiatric Disorders.
Thylstrup B, et al. Psycho-education for substance use and antisocial personality disorder: A randomized trial. BMC Psychiatry. Antisocial personality disorder ASPD. Merck Manual Professional Version. Treatment of antisocial personality disorder: Development of a practice focused framework. International Journal of Law and Psychiatry. Bateman AW, et al. Treatment of personality disorder.
Black DW. The natural history of antisocial personality disorder. Canadian Journal of Psychiatry.
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