ACTA FAC MED NAISS 2012;29(3):159-163

Case report

UDC:616.89-008.441.1:615.851        DOI: 10.2478/v10283-012-0022-6

Case of Panic Disorder with Agoraphobia - Continuum Through Cognitive-Behavioural Therapy

Lidija Sushevska Panevska

Faculty of Medical Sciences, State University “Goce Delchev “ Štip, Macedonia


sUMMARY

Panic disorder is characterized by spontaneous and unexpected occurrence of panic attacks, the frequency of which can vary from several attacks per day to only a few attacks per year. Panic disorder is usually qualified with the presence or absence of agoraphobia. Panic disorder with agoraphobia is an anxious disorder where repeated attacks of fear and anxiety appear at places and situations out of the family surrounding, places where the escape is difficult and where someone would be helpless, as for an example crowded places, passing over bridges, traveling by public transport, walking in an open space. Depressive episodes, as well as obsessive-compulsive procedures, can also follow this condition. A female person aged 25 years presents with a classical panic disorder with an agoraphobia and a classic and secure behaviour. She also suffers from dysthymia and a chronic fluctuating mood and low self-confidence. The patient gets panic attack when travelling by public transport in the morning when going to work, in a restaurant, in a supermarket, in a disco, when walking in an open space. The symptomatology started half a year before going to the psychiatrist, after several close persons died. A short description of CBT. CBT is based on the cognitive model of an emotional answer and aspects of stoic philosophy. CBT is based on an idea that our thoughts cause emotions and different behavior, so that we can change the way of thinking, and after that feelings/behaviour unchaged situations. CBT uses Sokrates method and some techniques from psychodrama, as well as relaxing techniques. Giving «homework» and keepingg a diary is also a very important part of this therapy. Seven therapeutic sessions of a cognitive-bihavioural psychoteraphy in a combination with the antidepressants (one session weekly) were performed. Cognitive-behavioural therapy is a leading therapy in dealing with agoraphobia and panic attacks. In combination with SSRI, it gives excellent results in reduction of the symptomatology. At the end of the treatment, the mental state was significantly improved. The patient came in contact with her beliefs and the basic models developed in childhood, and learned how to cope with negative thoughts, feelings and maladaptive behaviour.

Key words: panic attacks, agoraphobia, CBT (cognitive-behavioural therapy), SSRI (selective serotonergic reuptake inhibitors)