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. Distinguishing panic attacks with psychotic features from other psychotic disorders is clinically important since antipsychotic medication treatment for these psychotic symptoms is not indicated. 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. While experiencing an auditory hallucination, the affected person would hear a sound or sounds which did not come from the natural environment. None of the patients required neuroleptic treatment. An auditory hallucination, or paracusia, 1 is a form of hallucination that involves perceiving sounds without auditory stimulus. In all four patients, psychotic symptoms resolved after a brief time either spontaneously or with benzodiazepine/SSRI treatment. Hallucinations (erroneous percepts in the absence of identifiable stimuli 1) have been widely investigated in both adult and younger populations, and new insights continue to emerge, both from studies on hallucinations (especially auditory hallucinations) in particular, as well as from complementary research on broader psychotic experiences (PE).

Psychotic symptoms occurred only during panic attacks however, these could occur up to 10 to 15 times a day. In all cases, psychosis (auditory hallucinations or delusions) originated in the course of a severe panic attack. Three patients had a history of panic disorder, and one had a history of generalized anxiety disorder. Distinctive features of their clinical presentation, pharmacotherapy, and follow-up were recorded. All met the DSM-IV criteria for panic disorder. 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. Although anxiety disorders are often comorbid with depression and personality disorders, they rarely culminate in psychosis.

Anxiety disorders are among the most frequently diagnosed group of psychiatric disorders in the general population.

Anxiety and auditory hallucinations