Open Access Peer-Reviewed



Panic disorder: theory and practice

Panic disorder: theory and practice

Rafael Faria Sanches1, Simone Bianchi2

It is with great interest and pleasure that we accepted the invitation to write a review of a book that is part of a series aimed at approximating the current literature with daily clinical practice.

This is a new book organized by professionals who deal with the characteristics, resources and challenges of a physician's work in Brazil and who therefore know the scenario and peculiarities of patients seeking medical and psychotherapy treatment in our context.

The book is organized into 20 chapters, and its purpose is to thoroughly present panic disorder (PD). Therefore, the book can be used as a complete reference material on PD (including concepts, diagnosis, comorbidities, treatments, and recent trends) as well as for consulting a chapter of specific interest.

In this sense, each person can read the book in the way they find most convenient. We found that the first two chapters should be a reference for those who study and teach anxiety disorders.

The first chapter presents a historical description of reports on anxiety as part of the human condition and follows each step of its insertion in the diagnostic classification. Therefore, the book begins with a general perspective followed by a more specific one. This strategy is implemented throughout the book, and it can be used as a guide to gradually approach the patient.

Similarly, chapter 2 presents specific and essential characteristics in the diagnostic evaluation of PD. Therefore, this book offers efficient and didactic tools that may help even the general practitioner.

In the various following chapters, the book consistently calls attention to important issues that should be taken into account by physicians and researchers, such as the interface between the symptoms of PD and somatic symptoms, especially cardiovascular symptoms, which increases the relevance of differential diagnosis.

We also highlight the discussion on the limitations of the retrospective approach to panic crises compared with studies that have evaluated patients at the moment of crisis, not only in a natural environment but also through crisis induction.

In addition, some chapters are dedicated to comorbidities, either psychiatric or clinical, and clearly discuss the increased risks and extra difficulties in medication management and treatment approaches. In fact, the chapters that discuss pharmacological options present the most traditional choices and the most innovative ones, especially for refractory patients whose response to the conventional approach is partial or inconsistent.

The book presents some comments on recent studies or interventions, such as the transcranial magnetic stimulation, always emphasizing the necessary strictness in the entire therapeutic indication. The possibilities of the PD treatment can be supplemented by information on cognitive behavioral psychotherapy, combined or not with other therapeutic indications, including the practice of physical exercises, which is discussed in a specific chapter, therefore reinforcing the multidisciplinary approach of the material.

The book also presents the diagnostic classifications and evaluation instruments specific for PD in a consistent and didactic way. As would be expected, the classifications and scales suggest the importance of attempts at defining subtypes, especially if we consider respiratory symptoms, which are also widely discussed in various chapters, each with its own peculiarity.

All these aspects are enriched by the chapters dedicated to innovations provided by genetic, neurobiology and neuroimaging studies, which seem to converge into identifying important aspects in brain networks that are included in the alert, fear and stress models.

To conclude, we would like to highlight the innovative discussion in chapter 6, which presents the effects of technology on human behavior, especially on dependent behavior, which tends to be more frequent among individuals with agoraphobia.

Therefore, it is possible to say that this material accomplishes its aim of presenting diagnostic classifications, acknowledging its relevance and, at the same time, putting clinical practice as the support and basis for all interventions.

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