Anxiety

Panic Disorder

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Panic Disorder, Panic Attack

  • See Also
  1. Panic Disorder Diagnosis
  2. Panic Disorder Management
  3. Agoraphobia
  4. Anxiety Disorder
  5. Anxiety Secondary Cause
  6. Anxiety Symptoms
  7. Generalized Anxiety Disorder
  8. Obsessive Compulsive Disorder
  9. Body Dysmorphic Disorder
  10. Social Anxiety Disorder (Social Phobia)
  11. Acute Stress Disorder
  12. Post-Traumatic Stress Disorder
  13. Excessive Worry
  14. Anxiety Non-pharmacologic Management
  15. Anxiety Pharmacologic Management
  • Definitions
  1. Panic Attack
    1. Abrupt, intense fear peaking within minutes
    2. Symptoms include Palpitations, diaphoresis, Tremor, Dyspnea, Chest Pain, Nausea, Dizziness, impending doom
  2. Panic Disorder
    1. Recurrent, unexpected Panic Attacks (1 or more)
    2. At least 1 month of persistent worry about additional attacks or associated maladaptive avoidance behavior
  • Epidemiology
  1. Lifetime Prevalence: 7.0% in women, 3.3% in men
  2. Age of onset: 20 to 25 years old
  3. Women affected more often than men
  • Types
  1. Avoidance behaviors
    1. Panic Disorder with Agoraphobia
    2. Panic Disorder without Agoraphobia
  2. Trigger
    1. Spontaneous Panic Attack
      1. Unidentifiable trigger
    2. Situational Panic Attack
      1. Social Phobia
      2. Fear of flying
      3. Stage fright
      4. Fear of animals, Insects or snakes
  • Findings
  • Symptoms and Signs
  1. See Panic Symptoms
  2. Panic Disorder is recurrent, unexpected Panic Attacks
    1. At least 1 month of persistent worry about additional attacks or associated maladaptive avoidance behavior
  3. Panic Symptoms (at least 4 are present for diagnosis)
    1. Palpitations
    2. Diaphoresis or Hot Flashes
    3. Tremor
    4. Dyspnea
    5. Hyperventilation
    6. Chest Pain
    7. Nausea
    8. Dizziness
    9. Paresthesias (esp. lips and fingers)
    10. Impending doom
    11. Derealization or depersonalization
  • Diagnosis
  1. See Panic Disorder Diagnosis
  2. Severity Measure for Panic Disorder - Adult
    1. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Severity-Measure-For-Panic-Disorder-Adult.pdf
  3. Question: "In the last 4 weeks, have you had an anxiety attack (sudden feeling of panic)?"
    1. Positive Likelihood Ratio: 4.2
    2. Negative Likelihood Ratio: 0.09
  • Associated Conditions
  1. Headache Disorder
  2. Gastrointestinal Disorder (e.g. Chronic Diarrhea)
  3. Insomnia
  4. Hand coldness
  5. Chronic Fatigue
  6. Suicidal Ideation
  7. Alcohol Abuse or Drug Abuse
  8. Major Depression
  9. Interpersonal conflict
  • Differential Diagnosis
  1. See Anxiety Secondary Causes
  2. Other psychiatric conditions
    1. Social Anxiety Disorder
    2. Specific Phobias
    3. Obsessive Compulsive Disorder
    4. Posttraumatic Stress Disorder
    5. Separation Anxiety Disorder
  3. Substances
    1. Stimulants (e.g. Cocaine, Amphetamines, excessive Caffeine)
    2. Depressant Substance Withdrawal (e.g. Alcohol, Benzodiazepines, Opioids)
  4. Medical Conditions
    1. Hyperthyroidism
    2. Cardiopulmonary Disease (e.g. Asthma, Congestive Heart Failure, Atrial Fibrillation)
  • Management
  1. See Panic Management
  • Prognosis
  1. Recurs in 30-90% of patients within 1 year
  • References
  1. APA (1994) DSM IV, APA, p. 395
  2. Starr (November, 1998) Patient Care
  3. Katerndahl (1997) Postgrad Med, 101(1): 147-66 [PubMed]
  4. Katerndahl (1996) J Fam Pract, 43(3): 275-82 [PubMed]
  5. Kowalchuk (2022) Am Fam Physician 106(6): 657-64 [PubMed]
  6. Locke (2015) Am Fam Physician 91(9): 617-24 [PubMed]
  7. Rubin (1996) Phys Sportsmed, 24(12):54-65 [PubMed]
  8. Saeed (1998) Am Fam Physician, 57(10):2405-12 [PubMed]
  9. Weinstein (1995) Am Fam Physician, 52(7):2055-63 [PubMed]