title: Challenges in management of complex panic disorder in a palliative care setting.
abstract: This is a complex case of post-traumatic stress disorder (PTSD) with comorbid panic disorder occurring in a woman in her mid-60s, with a family history of neurotic illness. PTSD arose in the context of treatment for terminal lung cancer. This patient who had been close to her father watched him die of cancer, when he was about her age. Her diagnosis and treatment prompted traumatic recollections of her father's illness and death that resulted in her voluntary withdrawal from cancer treatment. The goals of treatment were to promptly reduce anxiety, minimise use of sedating pharmacotherapy, promote lucidity and prolong anxiety-free state thereby allowing time for important family interactions. Prompt, sustained relief of severe anxiety was necessary to achieve comfort at the end of life. Skilled additions of psychological therapies (eye movement desensitisation reprocessing, clinical hypnosis and breathing exercises) with combined pharmacotherapy (mirtazepine and quetiapine) led to control of anxiety and reduction of post-traumatic stress.
authors.affiliation: Liaison Psychiatry, Roseberry Park Hospital, Tees, Esk, Wear Valleys NHS Foundation Middlesbrough Trust, UK. dr_itoro@yahoo.com
authors.forename: Itoro
authors.initials: I
authors.lastname: Udo
authors.forename: Amanda
authors.initials: A
authors.lastname: Gash
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000628:therapy; D001945:Breathing Exercises; D015897:Comorbidity; D003643:Death; D003987:Dibenzothiazepines / Q000627:therapeutic use; D057169:Eye Movement Desensitization Reprocessing; D005260:Female; D006801:Humans; D006990:Hypnosis; D008175:Lung Neoplasms / Q000150:complications / Q000523:psychology*; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D010166:Palliative Care; D016584:Panic Disorder / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D000069348:Quetiapine Fumarate; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D013727:Terminal Care
chemical_list: D014151:Anti-Anxiety Agents; D003987:Dibenzothiazepines; D008803:Mianserin; D000069348:Quetiapine Fumarate; D000078785:Mirtazapine