Case Report
Volume 3 Issue 7 - 2020
Conceptualization and Treatment Plan for Panic Disorder: A Case Report
Ileme Machemba1, Samuel Nambile Cumber2,3,4 and Catherine Atuhaire5*
1NHS Improving Access to Psychological Services, UK
2Postdoctoral Fellow, Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
3Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
4School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
5Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Uganda
*Corresponding Author: Catherine Atuhaire, Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Uganda.
Received: March 25, 2020; Published: June 29, 2020




Abstract

Background: Panic disorder is characterized by the repeated occurrence of discrete panic attacks. Panic attacks are brief periods of overwhelming fear or anxiety. The intensity of a panic attack goes well beyond normal anxiety and can include a number of physical symptoms. During panic attacks, people often fear that they are having a heart attack, they cannot breathe, or they are dying. This case study illustrates a critical, reflective and analytic conceptualisation and treatment plan for Panic disorder (PD) for an individual who was assessed under Objective Structured Clinical Examination (OSCE). To maintain the client’s confidentiality, the client is referred to by a pseudoname, Amina. Amina is a 30 years old lady of Asian origin who reports feeling anxious in public places as well as at work. She notices her heart racing, shaking and feeling dizzy of which she thinks that there is something wrong with her heart, she might lose control and pass out. She then grips onto something so that she does not fall or have a heart attack and removes herself from that situation.

Methods: This case study illustrates a critical, reflective and analytic conceptualisation and treatment plan for PD. The PD will be diagnosed using the Diagnostic and Statistical Manual (DSM-V) and International Classification of Diseases (ICD) with specific reference to this client. The diagnosis will be followed by the prevalence and incidence of PD and how PD responds to Cognitive Behavioural Therapy (CBT) interventions. A generic/cross section, longitudinal and an adapted idiosyncratical disorder specific conceptualisation of her Panic Attacks (PA) will be presented. This will be followed by a treatment and relapse prevention plan. A reflection on how the OSCE was performed mark the end of this assignment.

Results: From the diagnosis using the DSM-V and ICD-10, symptoms common to Amina, included trembling or shaking, sensations of shortness of breath, palpitations, accelerated heart rate, and feeling dizzy with a cognitive misinterpretation that she might lose control or have a heart attack and die. Amina, therefore, meets the diagnostic criteria of having PD. The DSM-V reports a 12 months prevalence rate of 2.7% to 3.3% Europeans. The general treatment plan for Anima PD will include psycho-education and physiology of anxiety, natures of phobias, anxiety management strategies and habituation. These will incorporate: Hyperventilation provocation Tests, Imaginal exposure, Stimulus exposure, Behavioural experiments and Cognitive restructuring.

Conclusion: A diagnosis, case conceptualisation and treatment plan for Amina was demonstrated in this case study. The diagnostic tools confirmed her diagnosis of panic disorder and her generic, longitudinal and idiosyncratic formulations were collaboratively completed with Amina. Prevalence and incidence of PD as well as outcomes of CBT for PD and research in support of CBT was done followed by her person-centered treatment plan. Finally, a personal reflection on OSCE showing areas that can be improved on marked the end of this study

Keywords: Panic Disorder; Diagnosis; Case Conceptualization; Treatment Plan

References

  1. Newson AJ and Lipworth W. “Why should ethics approval be required prior to publication of health promotion research?” Health Promotion Journal 3 (2016): 170-175.
  2. Association AP. “Diagnostic and statistical manual of mental disorders (DSM-5®)”. American Psychiatric Publication (2013).
  3. Organization WH. “International statistical classification of diseases and related health problems”. World Health Organization (2004).
  4. McCabe RE and Gifford S. “Psychological treatment of panic disorder and agoraphobia”. Oxford Handbook of Anxiety and Related Disorders (2009): 308-320.
  5. Schmidt NB., et al. “Classification of panic attack subtypes in patients and normal controls in response to biological challenge: implications for assessment and treatment”. Journal of Anxiety Disorders 6 (2002): 625-638.
  6. Clark GI and Egan SJ. “The Socratic method in cognitive behavioural therapy: A narrative review”. Cognitive Therapy and Research 6 (2015): 863-879.
  7. Clark DA and Beck AT. “Cognitive Therapy of Anxiety Disorders Science and Practice”. Psychotherapy and Psychosomatics 4 (2012): 263.
  8. Clark DM. “A cognitive approach to panic”. Behaviour Research and Therapy 4 (1986): 461-470.
  9. Barlow DH., et al. “Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder”. A Guid to Treat that Work 2 (2002): 301-336.
  10. Macneil CA., et al. “Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice”. BMC Medicine 1 (2012): 111.
  11. Corrie S., et al. “Assessment and Case Formulation in Cognitive Behavioural Therapy”. SAGE (2015).
  12. Kessler RC., et al. “The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication”. Archives of General Psychiatry 4 (2006): 415-424.
  13. Grant BF., et al. “The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions”. The Journal of Clinical Psychiatry (2006).
  14. Hofmann SG., et al. “The efficacy of cognitive behavioral therapy: A review of meta-analyses”. Cognitive Therapy and Research 5 (2012): 427-440.
  15. Grant A., et al. “Assessment and case formulation in cognitive behavioural therapy”. Sage (2008).
  16. Kuyken W. “Evidence-based case formulation”. Case Formulation Cognitive-Behavioral Therapy (2006): 12-35.
  17. Padesky CA and Greenberger D. “Clinician’s guide to mind over mood”. Guilford Press (2012).
  18. Kennerley H., et al. “An introduction to cognitive behaviour therapy: Skills and applications”. Sage (2016).
  19. Nordahl H and Wells A. “Testing the metacognitive model against the benchmark CBT model of social anxiety disorder: Is it time to move beyond cognition?” PLoS One5 (2017): e0177109.
  20. Beck JS. “Cognitive therapy: Basics and beyond” (1995).
  21. Weiner MF. “Cognitive Therapy of Depression”. By Aaron T. Beck, A. John Rush, Brian F. Shaw, and Gary Emery (Book Review). International Journal of Group Psychotherapy 1 (1981): 125.
  22. Roth AD and Pilling S. “The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders” (2007).
  23. Leahy RL., et al. “Treatment plans and interventions for depression and anxiety disorders”. Guilford press (2011).
  24. Arch JJ and Craske MG. “First-line treatment: A critical appraisal of cognitive behavioral therapy developments and alternatives”. Psychiatric Clinics 3 (2009): 525-547.
  25. Gorman JM., et al. “The effect of pharmacotherapist characteristics on treatment outcome in panic disorder”. Depress Anxiety2 (2003): 88-93.
  26. Prochaska JO and DiClemente CC. “The transtheoretical approach”. Handbook of Psychotherapy Integration (1992): 2.
  27. Slaap BR and Den Boer JA. “The prediction of nonresponse to pharmacotherapy in panic disorder: a review”. Depress Anxiety2 (2001): 112-122.
  28. Cammin‐Nowak S., et al. “Specificity of homework compliance effects on treatment outcome in CBT: evidence from a controlled trial on panic disorder and agoraphobia”. Journal of Clinical Psychology 6 (2013): 616-629.
  29. Wolfe B. “Treatment of panic disorder: A consensus development conference”. American Psychiatric Publishing (1994).
  30. Bandura A. “Self-efficacy conception of anxiety”. Anxiety Research 2 (1988): 77-98.
  31. McLeod SA. “Classical Conditioning-Simply Psychology”. Luettavissa (2008).
  32. Baldwin D., et al. “Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis”. British Medical Journal 342 (2011): d1199.
  33. Barlow DH and Craske MG. “Mastery of your anxiety and panic”. Oxford University Press (2006).
  34. Daniels J and Wearden AJ. “Socialization to the model: The active component in the therapeutic alliance? A preliminary study”. Behavioural and Cognitive Psychotherapy 2 (2011): 221-227.
  35. Beck AT., et al. “Beck depression inventory-II”. San Antonio 78.2 (1996): 490-498.
  36. Frets PG., et al. “Imagery rescripting as a stand-alone treatment for patients with social phobia: A case series”. Journal of Behavior Therapy and Experimental Psychiatry 1 (2014): 160-169.
Citation: Catherine Atuhaire., et al. “Conceptualization and Treatment Plan for Panic Disorder: A Case Report”. EC Clinical and Medical Case Reports 3.7 (2020): 75-89.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


April Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the April issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before April 26, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk