Characterised by recurring expected or unexpected panic attacks, worry about future attacks over a 1-month period, and changes in behaviour as a consequence of the attacks.
Frequency of panic attacks may vary considerably, with some individuals reporting brief clusters of several panic episodes in a short period of time, weekly panic attacks, or periodic attacks over the course of several months.
Higher risk among first-degree relatives; onset of attacks triggered by stress; often comorbid with other anxiety, mood, and substance-use disorders.
Assessment is made through ruling out organic causes; self-report; clinical interview; and behavioural observation.
Selective serotonin-reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, and cognitive behavioural psychotherapy are first-line treatments; benzodiazepines may be used cautiously in patients without comorbid depression.
Long-term management includes relapse prevention after treatment discontinuation.
Panic disorder is characterised by recurring unexpected panic attacks over a 1-month period and associated worry about their recurrence or implications. Panic attacks involve the sudden onset of intense physical and cognitive symptoms of anxiety that may be triggered by specific cues or occur unexpectedly. Panic disorder may also be characterised by avoidance of situations that may trigger the panic sensations.
History and exam
Department of Psychiatry and Psychology
CNS declares that he has no competing interests.
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine
JPV declares that he has no competing interests.
Leeds and York Partnership NHS Foundation Trust
Bootham Park Hospital
PB declares that he has no competing interests.
Clinical Training Program
Department of Psychology
University of Arkansas
JML declares that he has no competing interests.
Professor of Psychopharmacology
PJC declares that he has no competing interests.
Professor and Chair
Department of Psychiatry and Cognitive-Behavioral Medicine
Graduate School of Medical Sciences
Nagoya City University
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.
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