WHAT IS IT?
Panic disorder is a particular type of anxiety disorder that is defined by recurrent panic attacks. These panic attacks are characterized by intense fear and discomfort that are characterized more below (see “History Of Present Illness”).
WHAT CAUSES IT?
It is important to note that panic attacks in this condition occur out of the blue and do not have a clear trigger.
WHY IS IT A PROBLEM?
This can be a very frightening and concerning experience for patients
WHAT MAKES US SUSPECT IT?
Common Chief Complaints:
- Recurrent panic attacks
History Of Present Illness
No clear trigger in this condition for the onset of the panic attacks.
Panic attacks generally have at least 4 of the following characteristics:
- Abdominal distress/Nausea
- Intense fear of dying
- Intense fear of losing control/going crazy
- Light headedness
- Chest pain
- Shortness of breath
Timing of attacks: generally these are recurrent attacks that occur over and over again.
Agoraphobia is often associated with panic disorder. It does not always present however. Patients may avoid going outside and stay secluded at home.
Physical Exam Findings
Patient physical exam is generally not remarkable for this condition.
Generally this condition specifically does not require a clinical workup behind the history taking. Other causes of some of the symptoms (such as heart palpitations) may need to be explored however.
AT WHAT POINT DO WE CONFIDENT IN MAKING THE DIAGNOSIS?
Generally the diagnosis requires a history of panic attacks with 1 or more of the following changes (that last a month or more after the panic attack/attacks):
- Persistent concern of additional attacks
- Worrying about the consequences of an attack
- Behavior changes that relate to the attack
HOW DO WE TREAT IT?
Cognitive behavioral therapy (CBT)
Long term treatment options include:
- SSRI medications can be used as a first line option:
- SNRI medications also can have utility (Venlafaxine is first-line).
Short term treatment options (immediate relief):
- Benzodiazepines (such as Lorazepam) are not a first-line treatment option, but can be used in patients who are having an acute episode. Th also can be used in patients who do not respond to other therapies.
ARCHIVE OF STANDARDIZED EXAM QUESTIONS
This archive compiles standardized exam questions that relate to this topic.
Page Updated: 08.12.2016