What are the treatments for reducing or preventing disorientation, depersonalization, psychosis, anxiety attacks, and panic attacks?

From the Guidelines

To reduce and prevent disorientation, depersonalization, psychosis, anxiety attacks, and panic attacks, focus on a combination of professional treatment and self-management strategies, with the most recent evidence suggesting the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line pharmacotherapy options 1. Seek help from a mental health professional who can provide proper diagnosis and treatment, which may include medications such as SSRIs (like sertraline 50-200mg daily or escitalopram 10-20mg daily) or SNRIs (like venlafaxine), as well as psychotherapy, particularly cognitive-behavioral therapy (CBT), which is highly effective and typically involves 12-16 weekly sessions. Some key points to consider in treatment include:

• Establishing a consistent daily routine with regular sleep patterns, balanced nutrition, and limited caffeine and alcohol
• Practicing grounding techniques during episodes, such as the 5-4-3-2-1 method (identifying 5 things you see, 4 things you feel, 3 things you hear, 2 things you smell, and 1 thing you taste)
• Regular mindfulness meditation for 10-15 minutes daily to help manage symptoms by increasing awareness of thought patterns
• Deep breathing exercises (inhaling for 4 counts, holding for 2, exhaling for 6) to quickly reduce anxiety
• Adjusting the treatment regimen after 8 weeks if there is little improvement in symptoms despite good adherence, as suggested by recent guidelines 1 These approaches work by addressing both the neurochemical imbalances and thought patterns that contribute to these conditions, helping to regulate the body's stress response system and increase psychological resilience. It's also important to note that combination treatment (CBT and an SSRI) could be offered preferentially over monotreatment (therapy or medication alone) to patients with social anxiety, generalized anxiety, separation anxiety, or panic disorder, as suggested by previous studies 1. Overall, a comprehensive treatment plan that incorporates both pharmacotherapy and psychotherapy, along with self-management strategies, can help reduce and prevent disorientation, depersonalization, psychosis, anxiety attacks, and panic attacks, and improve overall quality of life.

From the FDA Drug Label

Alprazolam tablets are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety Panic Disorder Alprazolam tablets are also indicated for the treatment of panic disorder, with or without agoraphobia Demonstrations of the effectiveness of alprazolam tablets by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit.

The treatments for reducing or preventing anxiety attacks and panic attacks include alprazolam.

• Alprazolam is indicated for the management of anxiety disorder and the treatment of panic disorder.
• The effectiveness of alprazolam has been demonstrated in systematic clinical studies for up to 4 months for anxiety disorder and 4 to 10 weeks for panic disorder. However, there is no information in the provided drug labels that directly supports the use of these medications for reducing or preventing disorientation, depersonalization, or psychosis. The provided drug labels do mention depersonalization as a symptom of panic disorder, but they do not provide information on treatments for this specific symptom. Therefore, no conclusion can be drawn regarding the treatment of disorientation, depersonalization, or psychosis based on the provided information 2.

From the Research

Treatments for Anxiety and Panic Disorders

• Benzodiazepines, such as diazepam, clorazepate, oxazepam, and lorazepam, are effective in lessening acute or chronic sustained levels of anxiety, but may not be as effective for panic attacks 3, 4
• Alprazolam is effective for short- and long-term treatment of panic disorders, but carries a risk of withdrawal reactions 4, 5
• Antidepressant drugs, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors, are standard treatments for panic disorder and can be used in combination with cognitive behavior therapy 5, 6, 7
• Tricyclic antidepressants are also effective, but may be less well tolerated due to adverse effects such as orthostatic hypotension and weight gain 5, 6
• Buspirone is a new class of anxiolytic agent that has advantages in patients who can tolerate its slow onset of action, with reduced psychomotor effects and lower interactive effects with cortical depressant substances 4

Treatments for Disorientation, Depersonalization, and Psychosis

• There is limited information available on the treatment of disorientation, depersonalization, and psychosis in the provided studies
• However, benzodiazepines and antidepressant drugs may be used to treat anxiety and panic disorders that can contribute to disorientation and depersonalization 3, 4, 5, 6, 7
• Neuroleptic agents may be used to treat psychosis, but their general usefulness as anxiolytic drugs is restricted due to their acute and long-term toxicity 4

Comparison of Treatment Options

• SSRIs and benzodiazepines are among the most frequently prescribed drugs for panic disorder, but have different efficacy, adverse events, and limitations 7
• SSRIs are associated with a delay of several weeks in onset of therapeutic effect and have the potential to exacerbate anxiety and panic early in the treatment course, while benzodiazepines present rapid onset of action, but can cause tolerance and dependence 7