Expert opinion in panic disorder: The impact of COVID-19-related fears, protective devices, and lockdown on panic and agoraphobia

During the COVID-19 pandemic a perceived decline of mental well-being was reported both in people with preexisting psychiatric disorders and in people without. However, individuals with different psychiatric vulnerabilities may differ in their responses to COVID-19-related stressors. In this commentary we proposed a few considerations on possible peculiar patterns of pandemic-related behaviors or complaints in patients suffering from panic disorder (PD) with or without agoraphobia (AG). Individuals with PD may be particularly sensitive to multiple pandemic-related aspects involving respiration (e.g., wearing facial masks or COVID-19-related respiratory symptoms) that may worsen or trigger panic symptoms. In case of comorbid AG, an initial improvement of panic–phobic symptoms during the lockdown may have occurred, followed by a subsequent symptom exacerbation when the containment measures became less rigorous, possibly related to lockdown-associated negative reinforcement and impairment in consolidation of fear extinction. Personalized interventions should be offered to the patients to minimize the risk of worsening or relapse.