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Panic attacks with psychotic features.
J Clin Psychiatry. 1996 Sep; 57(9):402-6.JC

Abstract

BACKGROUND

Anxiety disorders are among the most frequently diagnosed group of psychiatric disorders in the general population. Although anxiety disorders are often comorbid with depression and personality disorders, they rarely culminate in psychosis.

METHOD

Having observed psychosis in the course of a severe panic attack, the authors prospectively identified four patients who experienced panic attacks with co-occurring psychosis. All met the DSM-IV criteria for panic disorder. Distinctive features of their clinical presentation, pharmacotherapy, and follow-up were recorded.

RESULTS

Three patients had a history of panic disorder, and one had a history of generalized anxiety disorder. In all cases, psychosis (auditory hallucinations or delusions) originated in the course of a severe panic attack. Psychotic symptoms occurred only during panic attacks; however, these could occur up to 10 to 15 times a day. In all four patients, psychotic symptoms resolved after a brief time either spontaneously or with benzodiazepine/SSRI treatment. None of the patients required neuroleptic treatment.

CONCLUSION

The cases suggest that psychosis may develop in the course of a severe panic attack in patients with panic disorder, as was reported previously for patients with obsessive-compulsive disorder and posttraumatic stress disorder. Distinguishing panic attacks with psychotic features from other psychotic disorders is clinically important since antipsychotic medication treatment for these psychotic symptoms is not indicated. Further research on the prevalence of psychotic symptoms in the anxiety disorders and the pathophysiology of this phenomenon is required to clarify the relationship between the anxiety disorders and psychosis.

Authors+Show Affiliations

Beth Israel Medical Center and Albert Einstein College of Medicine, New York, NY 10003, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9746448

Citation

Galynker, I, et al. "Panic Attacks With Psychotic Features." The Journal of Clinical Psychiatry, vol. 57, no. 9, 1996, pp. 402-6.
Galynker I, Ieronimo C, Perez-Acquino A, et al. Panic attacks with psychotic features. J Clin Psychiatry. 1996;57(9):402-6.
Galynker, I., Ieronimo, C., Perez-Acquino, A., Lee, Y., & Winston, A. (1996). Panic attacks with psychotic features. The Journal of Clinical Psychiatry, 57(9), 402-6.
Galynker I, et al. Panic Attacks With Psychotic Features. J Clin Psychiatry. 1996;57(9):402-6. PubMed PMID: 9746448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Panic attacks with psychotic features. AU - Galynker,I, AU - Ieronimo,C, AU - Perez-Acquino,A, AU - Lee,Y, AU - Winston,A, PY - 1996/9/1/pubmed PY - 1998/9/24/medline PY - 1996/9/1/entrez SP - 402 EP - 6 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 57 IS - 9 N2 - BACKGROUND: Anxiety disorders are among the most frequently diagnosed group of psychiatric disorders in the general population. Although anxiety disorders are often comorbid with depression and personality disorders, they rarely culminate in psychosis. METHOD: Having observed psychosis in the course of a severe panic attack, the authors prospectively identified four patients who experienced panic attacks with co-occurring psychosis. All met the DSM-IV criteria for panic disorder. Distinctive features of their clinical presentation, pharmacotherapy, and follow-up were recorded. RESULTS: Three patients had a history of panic disorder, and one had a history of generalized anxiety disorder. In all cases, psychosis (auditory hallucinations or delusions) originated in the course of a severe panic attack. Psychotic symptoms occurred only during panic attacks; however, these could occur up to 10 to 15 times a day. In all four patients, psychotic symptoms resolved after a brief time either spontaneously or with benzodiazepine/SSRI treatment. None of the patients required neuroleptic treatment. CONCLUSION: The cases suggest that psychosis may develop in the course of a severe panic attack in patients with panic disorder, as was reported previously for patients with obsessive-compulsive disorder and posttraumatic stress disorder. Distinguishing panic attacks with psychotic features from other psychotic disorders is clinically important since antipsychotic medication treatment for these psychotic symptoms is not indicated. Further research on the prevalence of psychotic symptoms in the anxiety disorders and the pathophysiology of this phenomenon is required to clarify the relationship between the anxiety disorders and psychosis. SN - 0160-6689 UR - https://www.unboundmedicine.com/medline/citation/9746448/Panic_attacks_with_psychotic_features_ L2 - https://medlineplus.gov/panicdisorder.html DB - PRIME DP - Unbound Medicine ER -