Panic attacks with psychotic features.
BACKGROUND
Anxiety disorders are among the most frequently diagnosed group of psychiatric disorders in the general population. Although anxiety disorders are often comorbid with depression and personality disorders, they rarely culminate in psychosis.


METHODS
Having observed psychosis in the course of a severe panic attack, the authors prospectively identified four patients who experienced panic attacks with co-occurring psychosis. All met the DSM-IV criteria for panic disorder. Distinctive features of their clinical presentation, pharmacotherapy, and follow-up were recorded.


RESULTS
Three patients had a history of panic disorder, and one had a history of generalized anxiety disorder. In all cases, psychosis (auditory hallucinations or delusions) originated in the course of a severe panic attack. Psychotic symptoms occurred only during panic attacks; however, these could occur up to 10 to 15 times a day. In all four patients, psychotic symptoms resolved after a brief time either spontaneously or with benzodiazepine/SSRI treatment. None of the patients required neuroleptic treatment.


CONCLUSIONS
The cases suggest that psychosis may develop in the course of a severe panic attack in patients with panic disorder, as was reported previously for patients with obsessive-compulsive disorder and posttraumatic stress disorder. Distinguishing panic attacks with psychotic features from other psychotic disorders is clinically important since antipsychotic medication treatment for these psychotic symptoms is not indicated. Further research on the prevalence of psychotic symptoms in the anxiety disorders and the pathophysiology of this phenomenon is required to clarify the relationship between the anxiety disorders and psychosis.
Galynker
I
I
Beth Israel Medical Center and Albert Einstein College of Medicine, New York, NY 10003, USA.
Ieronimo
C
C
Perez-Acquino
A
A
Lee
Y
Y
Winston
A
A
D000328:Adult; D017668:Age of Onset; D001307:Auditory Perception; D001569:Benzodiazepines / Q000627:therapeutic use; D015897:Comorbidity; D003702:Delusions / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005476:Fluphenazine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006212:Hallucinations / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D001569:Benzodiazepines; D005476:Fluphenazine; D017367:Selective Serotonin Reuptake Inhibitors