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Staging of Panic Disorder: Implications for Neurobiology and Treatment

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Panic Disorder

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Abstract

The staging model of panic includes the following stages. Stage 1 in which subclinical symptoms of agoraphobia or social phobia or generalized anxiety disorder or hypochondriasis are present. Stage 2 characterized by the acute manifestations of agoraphobia or social phobia or generalized anxiety disorder or hypochondriasis. Panic Disorder (PD) with worsening of anxiety and hypochondriacal symptoms characterizes stage 3 together with demoralization or major depression. Chronic PD and agoraphobia or social phobia or generalized anxiety disorder or hypochondriasis together with increased liability to major depression may occur at stage 4. This staging model is applicable in clinical practice. In a substantial proportion of patients with PD a prodromal phase and, despite successful treatment, residual symptoms can be identified. Both prodromes and residual symptoms allow to monitor the evolution of the disorder during recovery via the rollback phenomenon. The different stages of PD and the steps of the rollback have a correspondence in its neurobiology and in its treatment. The translation of staging in the neurobiology of panic identifies different phases in the development of PD which involve the amygdala, the hippocampus, and the medial/orbital prefrontal cortex. The treatment implications, although still too disregarded, emphasize the importance to consider residual symptoms as the final target of the therapy. In addition, psychotherapy (mainly cognitive-behavioral therapy) has shown good effectiveness while sequential or stage-oriented treatments have shown promising results.

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  1. Department of Health Sciences, University of Florence, Florence, Italy

    Fiammetta Cosci

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  1. Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Antonio Egidio Nardi

  2. Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Rafael Christophe R. Freire

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Cosci, F. (2016). Staging of Panic Disorder: Implications for Neurobiology and Treatment. In: Nardi, A., Freire, R. (eds) Panic Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-12538-1_5

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