Frequency of panic attacks may vary considerably in panic disorder, 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 behavioral observation.
Self-help, cognitive behavioral therapy, selective serotonin-reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are first-line treatments.
Long-term management includes relapse prevention after treatment discontinuation.
Panic disorder is characterized by recurring unexpected panic attacks over a 1-month period. People with panic disorder are persistently concerned about having another panic attack, and/or about the consequences of this (e.g., having a heart attack or losing control). People with panic disorder may also change their behavior in an attempt to avoid having more panic attacks (e.g., avoiding situations that may trigger the panic sensations; engaging in various safety-related behaviors). Panic attacks involve the sudden onset of intense physical and cognitive symptoms of anxiety that may be triggered by specific cues or occur unexpectedly. For a diagnosis of panic disorder, panic attacks must be recurrent; note that nonrecurrent panic attacks are relatively common in the general population. In panic disorder, frequency of attacks may vary widely, 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. Regardless of frequency, the person remains persistently concerned or anxious about the possibility of another attack.
History and exam
Key diagnostic factors
- unexpected onset
- apprehension and worry
- behavioral avoidance
- 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
- perceptual abnormality
- respiratory symptoms
- reliance on safety cues
- muscle shaking
- chills or hot flushes
- 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
1st investigations to order
- clinical assessment
Investigations to consider
- blood glucose
- thyroid function tests
- metabolic panel
- toxicology screen
acute panic attack
panic attacks without panic disorder
- Specific phobia
- Social anxiety disorder
- Diagnostic and statistical manual of mental disorders: 5th edition, text revision (DSM-5-TR)
- Generalised anxiety disorder and panic disorder in adults: management
Panic attacks: what are they?
Panic attacks: what treatments work?More Patient leaflets
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