II. 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

III. 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

IV. 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

V. 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

VI. 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

VII. 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

VIII. Differential Diagnosis

IX. Management

X. Prognosis

  1. Recurs in 30-90% of patients within 1 year

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