Panic Disorder

Aka: Panic Disorder, Panic Attack

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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

  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)

IX. Management

  1. See Panic Management

X. Prognosis

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

XI. 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]

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Related Studies

Ontology: Panic Disorder (C0030319)

Definition (MEDLINEPLUS)

Panic disorder is a type of anxiety disorder. It causes panic attacks, which are sudden feelings of terror when there is no real danger. You may feel as if you are losing control. You may also have physical symptoms, such as

  • Fast heartbeat
  • Chest or stomach pain
  • Breathing difficulty
  • Weakness or dizziness
  • Sweating
  • Feeling hot or a cold chill
  • Tingly or numb hands

Panic attacks can happen anytime, anywhere, and without warning. You may live in fear of another attack and may avoid places where you have had an attack. For some people, fear takes over their lives and they cannot leave their homes.

Panic disorder is more common in women than men. It usually starts when people are young adults. Sometimes it starts when a person is under a lot of stress. Most people get better with treatment. Therapy can show you how to recognize and change your thinking patterns before they lead to panic. Medicines can also help.

NIH: National Institute of Mental Health
Definition (NCI) An anxiety disorder characterized by multiple unexpected panic attacks with persistent concern of recurring attacks. Panic disorder may or may not be accompanied by agoraphobia.
Definition (MSH) A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait.
Definition (CSP) specific psychological phenomenon characterized by sudden onset of anxiety (often unrelated to objective events), accompanied by autonomic symptoms such as tachycardia, paresthesia, flushing, and sweating.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D016584
ICD10 F41.0
SnomedCT 191705007, 192400001, 268627007, 371631005
LNC LA10582-7
English Disorders, Panic, Panic Disorders, Disorder, Panic, Episodic paroxysml anx disord, Panic disorder [episodic paroxysmal anxiety], Panic Disorder, PANIC DIS, [X]Panic episodic paroxysm anx, Panic episodic paroxysm anx, [X]Panic disorder [episodic paroxysmal anxiety], panic anxiety syndrome, Panic Disorder [Disease/Finding], Disorder;panic, panic disorder, panic disorders, Panic disorder NOS, [X]Panic disorder [episodic paroxysmal anxiety] (disorder), Panic disorder (finding), panic disorder (diagnosis), Panic disorders, -- Panic Disorder, Panic disorder, Episodic paroxysmal anxiety disorder, Panic disorder (disorder), disorder; panic, panic; disorder, [X]Panic disorder [episodic paroxysmal anxiety] (finding)
Italian Disturbo di panico, Disturbo di panico NAS, Disturbo da attacco di panico
Dutch paniekstoornis NAO, paniek; stoornis, stoornis; paniek, Paniekstoornis [episodische paroxysmale angst], paniekstoornis, Paniekstoornis
French Trouble panique SAI, Trouble panique, Anxiété épisodique paroxystique
German Panikstoerung NNB, Panikstoerung [episodisch paroxysmale Angst], Panikstoerung, Panikstörung
Portuguese Perturbação de pânico NE, Perturbação de pânico, Transtorno de Pânico
Spanish Trastorno de angustia NEOM, [X]trastorno de pánico [ansiedad paroxística episódica], [X]trastorno de pánico [ansiedad paroxística episódica] (trastorno), episodio paroxístico de trastorno de ansiedad, trastorno de pánico (trastorno), trastorno de pánico, Trastorno de angustia, Trastorno de Pánico
Japanese パニック障害ＮＯＳ, パニック障害, ﾊﾟﾆｯｸｼｮｳｶﾞｲ, ﾊﾟﾆｯｸｼｮｳｶﾞｲNOS
Swedish Panikattack
Czech panická porucha, Panická porucha NOS, Panická porucha
Finnish Paniikkihäiriö
Russian PANICHESKIE PSIKHICHESKIE RASSTROISTVA, PANICHESKIE PRISTUPY, ПАНИЧЕСКИЕ ПРИСТУПЫ, ПАНИЧЕСКИЕ ПСИХИЧЕСКИЕ РАССТРОЙСТВА
Korean 공황장애[우발적 발작성불안]
Polish Zespół paniki, Zaburzenia lękowe z napadami lęku panicznego, Napady paniki
Hungarian Pánik betegség, Pánik betegség k.m.n.
Norwegian Panikkangst, Panikklidelse, Panikkforstyrrelse
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Panic Attacks (C0086769)

Definition (NCI) An episode of intense fear accompanied by symptoms such as heart palpitations, sweating and chills or hot flushes , a sensation of dyspnea, chest pain, abdominal distress, depersonalization, fear of going crazy, and fear of dying.
Definition (PSY) An episode of intense fear and anxiety that may be accompanied by one or more of the following symptoms: heart palpitations, sweating, shortness of breath, chest pain, nausea, dizziness, and trembling. Generally, attacks are unexpected and last no longer than 15 minutes.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D016584
ICD10 F41.0
SnomedCT 154882009, 268752000, 191705007, 225624000
English Attacks, Panic, Attack, Panic, Panic attacks, Attack(s);panic, panic attack, Panic Attack, Panic attack, Panic attack (finding), attack; panic, panic; attack, Panic Attacks, panic attacks
Italian Attacco di panico, Attacchi di panico
Dutch paniekaanvallen, aanval; paniek, paniek; aanval, paniekaanval, Paniekaanvallen
French Crises de panique, Attaques de panique, Attaque de panique
German Panikanfaelle, Panik-Attacken, Panikattacke
Portuguese Ataques de pânico, Ataques de Pânico, Ataque de pânico
Japanese パニック発作, ﾊﾟﾆｯｸﾎｯｻ
Czech záchvaty paniky, Panická ataka, Panické ataky, panická ataka
Spanish Ataques de Pánico, ataque de pánico (hallazgo), ataque de pánico, crisis de angustia, crisis de pánico, Crisis de angustia
Hungarian Pánik roham, Pánik rohamok
Norwegian Panikkanfall, Episodisk paroksysmal angst
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Anxiety Disorders

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