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Panic disorders

Last reviewed: 13 Oct 2024
Last updated: 14 Jul 2023

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
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • clinical assessment
Full details

Tests to consider

  • ECG
  • blood glucose
  • thyroid function tests
  • metabolic panel
  • toxicology screen
Full details

Treatment algorithm

ACUTE

acute panic attack

ONGOING

panic disorder

panic attacks without panic disorder

Contributors

Authors

Craig N. Sawchuk, PhD
Craig N. Sawchuk

Professor

Department of Psychiatry and Psychology

Mayo Clinic

Rochester

MN

Disclosures

CNS declares that he has no competing interests.

Jason P. Veitengruber, MD
Jason P. Veitengruber

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 Differentials
  • Guidelines

    • Anxiety disorders in adults: screening
    • Diagnostic and statistical manual of mental disorders: 5th edition, text revision (DSM-5-TR)
    More Guidelines
  • Patient information

    Panic attacks: what are they?

    Panic attacks: what treatments work?

    More Patient information
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