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