Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- unexpected onset
- apprehension and worry
- behavioural avoidance
- tachycardia
- positive PRIME-MD panic screen
- Panic Disorder Severity Scale (PDSS)
- GAD-7 cute score ≥10
Other diagnostic factors
- palpitations; chest pain and discomfort
- nausea and abdominal pain
- dizziness
- perceptual abnormality
- respiratory symptoms
- reliance on safety cues
- paraesthesias
- muscle shaking
- sweating
- fainting
- chills or hot flushes
Risk factors
- history in first-degree relatives
- age 18 to 39 years
- female sex
- white ethnicity
- major life events
- comorbid disorders
- psychological factors
- asthma and respiratory variability
- cigarette smoking and caffeine use
- cardiac abnormalities
Diagnostic investigations
Investigations to consider
- ECG
- blood glucose
- thyroid function tests
- toxicology screen
Treatment algorithm
Contributors
Authors
Professor
Department of Psychiatry and Psychology
Mayo Clinic
Rochester
MN
Disclosures
CNS declares that he has no competing interests.
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
Consultant Psychiatrist
Leeds and York Partnership NHS Foundation Trust
Bootham Park Hospital
York
UK
Disclosures
PB declares that he has no competing interests.
Professor
Clinical Training Program
Department of Psychology
University of Arkansas
Fayetteville
AR
Disclosures
JML declares that he has no competing interests.
Professor of Psychopharmacology
Warneford Hospital
Oxford
UK
Disclosures
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
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.
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