The Case of James Dire: The Problem with Panic

  • Liliya GershengorenEmail author


Panic disorder typically develops in young adulthood and can be associated with impairment in functioning. This can be particularly debilitating for medical trainees who are striving to work to their full potential in a notably stressful and demanding medical environment. Furthermore, stigma associated with psychiatric diagnosis and treatment may preclude a much needed comprehensive symptoms evaluation and management. Successful engagement, with the use of psychoeducation and alliance building, can allow for important work – management of the presenting anxiety symptoms – and, in some cases, further psychological work to improve emotional health and well-being. Panic disorder can have many underlying psychological themes, which the psychiatrist can be attuned to as potential areas of exploration with the student-patient, who is at an important and complex developmental stage of life.


Panic disorder Panic attacks Doctor-patient confidentiality Psychoeducation Cognitive behavioral therapy for panic disorder 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. 2.
    Roy-Byrne PP, Craske MG, Stein MB, Sullivan G, Bystritsky A, Katon W, Sherbourne CD. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry. 2005;62(3):290–8.CrossRefGoogle Scholar
  3. 3.
    Milrod B, Chambless DL, Gallop R, Busch FN, Schwalberg M, McCarthy KS, Gross C, Sharpless BA, Leon AC, Barber JP. Psychotherapies for panic disorder: a tale of two sites. J Clin Psychiatry. 2016;77:927–35.CrossRefGoogle Scholar
  4. 4.
    Furukawa TA, Watanabe N, Churchill R. Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database Syst Rev. 2007;(1):CD004364.Google Scholar

Suggested Reading

  1. Barlow DH, Craske MG. Mastery of your anxiety and panic: workbook. 4th ed. New York: Oxford University Press; 2006.CrossRefGoogle Scholar
  2. Busch FN, Milrod BL, Sandberg LS. A study demonstrating efficacy of a psychoanalytic psychotherapy for panic disorder: implications for psychoanalytic research, theory, and practice. J Am Psychoanal Assoc. 2009;57:131–48.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Weill Cornell Medical College/New York-Presbyterian HospitalNew YorkUSA

Personalised recommendations