How are treatment outcomes evaluated and modified when necessary in panic disorder?

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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Treatment is working if the patient’s key symptoms (e.g., frequency/intensity of panic attacks, level of anticipatory anxiety, degree of agoraphobic avoidance, severity of functional interference and distress related to the disorder) decrease. [55] Be aware that changes may occur more quickly in some domains than others.

Regularly evaluate the severity of any co-occurring psychiatric conditions, such as major depression and other anxiety disorders. Useful adjunctive tools for evaluating treatment outcome include rating scales on an ongoing basis. [55]

First-line treatments for panic disorder may result in a partial response or no response. In such cases, reevaluate the patient as early as possible for any untreated underlying medical conditions that could cause the patient’s symptoms, as well as the presence of any co-occurring general medical or psychiatric conditions (e.g., depression, substance abuse), treatment noncompliance, problems with the collaboration between therapist and patient, psychosocial stressors, motivational factors, and treatment intolerance. [55, 56] Clinicians goals should be toward remission whenever feasible, rather than accepting partial improvements as satisfactory outcomes.

Consider a change in treatment strategy when the treatment outcome remains unsatisfactory despite an adequate trial, particularly when significant panic symptoms persist despite a long course of a specific treatment. [55, 56] The types of changes must be personalized for each individual.

If, after any key clinical issues have been addressed, and a change in treatment is still desired: (1) The current treatment strategy can be augmented with either another medication or treatment modality, if some significant benefits were noted with the current treatment, or (2) the patient can switch to another treatment strategy with different drug or modality, if the initial therapy did not provide any significant relief of the patient’s symptoms. [55]

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