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Assessment and Management of Treatment Resistance in Panic Disorder 

Assessment and Management of Treatment Resistance in Panic Disorder
Assessment and Management of Treatment Resistance in Panic Disorder

R. Bruce Lydiard

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date: 21 November 2018

Panic disorder (PD) is a severe, persistent, and potentially disabling anxiety disorder that affects 3.5%–5% of individuals in the general population at some point in their lives. PD is characterized by unexpected panic attacks associated with worry about additional attacks and/or the implications of the attacks. Sufficiently severe or frequent attacks can promote marked changes in cognition, and behavioral changes, including phobic avoidance (agoraphobia). For a variety of reasons, many PD sufferers have unsatisfactory outcomes after initial treatment. In this chapter, a brief discussion of relevant neurobiology will be presented. Strategies for optimizing initial PD treatment, with emphasis on sufficient intensity of treatment, will be discussed. A differential diagnostic approach for clinical evaluation of unsatisfactory response of PD treatment will be outlined. Finally, next-step treatments for unsatisfactory PD treatment outcome will be presented.

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