Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach

Panic Disorder is one of the most common anxiety disorders. Its impact on quality of life can be significant and incapacitating. One third to one half of panic patients demonstrate incomplete or absent remission after treatment. This Roundtable addressed the importance of the bio-psycho-social components of the evaluation and treatment of the resistant panic disorder patient. The clinical team is challenged with determining what rendered the individual patient treatment resistant. Examples of complicating variables in such patients include medical mimics of panic disorder, occult substance use disorders, co-morbid psychiatric disorders like trauma syndromes, obsessive compulsive and pediatric spectrum disorders.

Treatment often entails a multi-modality approach that identifies the critical variables discovered during the evaluation phase. At our center the presence of multi-disciplinary clinicians in one location allows for ongoing case discussion and most importantly reassures the patient that they are being supported by an interactive treatment team.

This Roundtable reviewed the appropriate psychopharmacological interventions during the course of treatment that can provide a synergistic addition to the cognitive behavioral treatment plan. The CBT plan must be individually tailored to the patient since not all panic disorders are alike. When possible, we have found that a manualized workbook approach can be invaluable and supports greater patient adherence.

Recent technological advances have allowed for the development of state of the art clinical tools that incorporate specific biofeedback and virtual reality protocols. We will present examples of both and discuss the importance of a multi-pronged approach to the difficult to treat patient. Prevention is the core goal of mental healthcare and early childhood detection of panic disorder has become a major goal. This Roundtable will review early warnings of future panic disorder and importance of interventions that foster resilience and stress control capabilities in children.

1. Recognize the seriousness and frequency of treatment resistant panic disorder. 2. Apply the contents of this Roundtable to develop a multimodality treatment plan. 3. Demonstrate an effective systems approach to the evaluation of the treatment resistant panic disorder patient .