Panic disorder is repeated, unexpected panic attacks, sudden surges of intense fear with strong body symptoms, followed by ongoing worry about more attacks. Medical causes must be ruled out first, then therapy and SSRIs control symptoms well.
Key symptoms
- Sudden pounding heart, chest pain or tightness
- Shortness of breath or feeling of choking
- Sweating, shaking, numbness or tingling
- Dizziness and fear of dying or losing control
- Avoiding places where attacks happened
What you find on exam
- Vital signs: fast heart rate, fast breathing
- Heart and lung exam to look for a medical cause
- Look for thyroid enlargement
- Ask about caffeine, stimulants and alcohol withdrawal
Tests
- ECG and troponin if chest pain, especially with risk factors
- Thyroid tests and glucose
- Urine drug screen
- GAD-7 and PHQ-9 for anxiety and depression
Treatment basics
- Reassure and explain the body's fear response
- Cognitive behavioral therapy with exposure to feared sensations
- SSRI such as sertraline or escitalopram, started at a low dose
- Short course of a benzodiazepine only in select cases
- Slow breathing and less caffeine
Red flags
- Chest pain with ECG changes or cardiac risk factors
- Low oxygen saturation or signs of pulmonary embolism
- Suicidal thoughts
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.