Summary
Definition
History and exam
Key diagnostic factors
- unexpected onset
- apprehension and worry
- behavioral avoidance
- tachycardia
- positive PRIME-MD panic screen
- Panic Disorder Severity Scale (PDSS)
- GAD-7 cut score ≥10
Other diagnostic factors
- palpitations; chest pain and discomfort
- nausea and abdominal pain
- dizziness
- perceptual abnormality
- respiratory symptoms
- reliance on safety cues
- paresthesias
- muscle shaking
- sweating
- fainting
- chills or hot flushes
Risk factors
- history in first-degree relatives
- age 18 to 39 years
- female sex
- white and Native American ethnicity
- major life events
- comorbid disorders
- psychological factors
- asthma and respiratory variability
- cigarette smoking
- caffeine use
Diagnostic tests
1st tests to order
- clinical assessment
Tests to consider
- ECG
- blood glucose
- thyroid function tests
- metabolic panel
- toxicology screen
Treatment algorithm
acute panic attack
panic disorder
panic attacks without panic disorder
Contributors
Authors
Craig N. Sawchuk, PhD
Professor
Department of Psychiatry and Psychology
Mayo Clinic
Rochester
MN
Disclosures
CNS declares that he has no competing interests.
Jason P. Veitengruber, MD
Associate Professor
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine
Seattle
WA
Disclosures
JPV declares that he has no competing interests.
Peer reviewers
Tanveer A. Padder, MD
Chairman
Department of Psychiatry
Trinity School of Medicine
Warner Robins
GA
Disclosures
TAP declares that he has no competing interests.
Paul Blenkiron, BM BCh, MA
Consultant Psychiatrist
Leeds and York Partnership NHS Foundation Trust
Bootham Park Hospital
York
UK
Disclosures
PB declares that he has no competing interests.
Philip J. Cowen, MD, FRCPsych, FMedSci
Professor of Psychopharmacology
Warneford Hospital
Oxford
UK
Disclosures
PJC declares that he has no competing interests.
Toshiaki A. Furukawa, MD, PhD
Professor and Chair
Department of Psychiatry and Cognitive-Behavioral Medicine
Graduate School of Medical Sciences
Nagoya City University
Nagoya
Japan
Disclosures
TAF has received research funds and speaking fees from Astellas, Dai-Nippon, Sumitomo, Eli Lilly, GlaxoSmithKline, Janssen, Meiji, Otsuka, Schering-Plough, and Yoshitomi. He was on a research advisory board for Meiji and Mochida, and is currently on research advisory boards for Sekisui chemicals and Takeda Science Foundation. He has received royalties from Igaku-Shion and Seiwa-Shoten Publishers. The Japanese Ministry of Education, Science, and Technology and the Japanese Ministry of Health, Labor, and Welfare have also funded his research.
Differentials
- Agoraphobia
- Specific phobia
- Social anxiety disorder
More DifferentialsGuidelines
- Anxiety disorders in adults: screening
- Diagnostic and statistical manual of mental disorders: 5th edition, text revision (DSM-5-TR)
More GuidelinesPatient information
Panic attacks: what are they?
Panic attacks: what treatments work?
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