Panic Disorder

Overview

Main Concepts:

Notable Features:

High Yield:

Other:

Definition

Recurrent and unexpected panic attacks with 4+ following symptoms:

  • Chest pain, palpitations, SOB, choking

  • Trembling, sweating, nausea, chills

  • Dizziness, paresthesias

  • Derealization, depersonalization

  • Fear of losing control or dying

There is also worry about additional attacks and avoidance behavior. Patients usually develop anticipatory anxiety about subsequent attacks, which may develop into chronic anxiety.

Diagnostics


Assessment

An isolated panic attack can occur in many situations, but for a diagnosis of panic disorder to be made, recurrent and unprovoked panic attacks must occur, followed by excessive concern or behavioral changes aimed at avoiding further attacks.

Patients with panic disorder frequently have cardiorespiratory symptoms and may fear they are having a heart attack (thus repeatedly seeking medical care). Given possible preoccupation with symptoms and fears of having an undiagnosed condition, it may be difficult to differentiate panic disorder from a somatic symptoms disorder. Both conditions are associated with:

  • Multiple physical symptoms

  • High healthcare use

  • Preoccupation with symptoms

However, in somatic symptom disorder, physical symptoms are persistent over time, while the recurrent abrupt onset of characteristic physical symptoms that resolve within minutes should raise clinical suspicion for panic disorder.

Management

  • First-line/maintenance:

    • SSRI/SNRI +/- CBT

  • Acute:

    • Benzodiazepines