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What is panic disorder?
Panic disorder is an anxiety disorder characterized by whereby the individual suffers from unexpected, unprovoked panic attacks. It is also characterized by persistent concern about additional panic attacks and/or maladaptive change in behavior related to the attacks. In the United States, the lifetime prevalence of panic disorder is 2-3%, affected women roughly twice as much as men. The median age of onset is between ages 20-24. Panic disorder is chronic with periods of worsening and periods of improvement.
Prevalence of panic attacks outside of panic disorder
What does panic disorder look like?
Risk Factors
- Family history of panic attacks or panic disorder
- Higher intolerance of uncertainty
- Major life stress or traumatic events
- Major life changes
- Adverse childhood events
- Smoking, excessive caffeine intake
- Medical comorbidities, including thyroid disease, cancer, chronic pain, cardiac disease, irritable bowel syndrome, migraine, and allergic and respiratory diseases
Differential Diagnosis
- Other specified anxiety disorder or unspecified anxiety disorder
- Anxiety disorder due to another medical condition
- Acute coronary syndrome or myocardial infarction
- Endocrinopathies
- Substance/medication-induced anxiety disorder
- Other mental disorders with panic attacks as an associated feature (e.g. - other anxiety disorders and psychotic disorders)
How is panic disorder investigated?
- Labwork: CBC, fasting glucose, fasting lipid profiles, electrolytes, liver enzymes, serum bilirubin, serum creatinine, thyroid stimulating hormone (TSH)
- Urinalysis, urine toxicology for substance use
- Electrocardiogram (ECG) to assess for signs of ventricular preexcitation (short PR and delta wave), for short or long QT interval in patients with palpitations, and for ischemia, infarction, or pericarditis patterns in patients with chest pain
- Cardiac, respiratory, and abdominal exam should be performed according to the clinical presentation
Screening/Scale | Rater | Description |
Panic Disorder Severity Scale (PDSS) | Clinician | 7 questions to grade panic disorder severity |
How is panic disorder treated?
Psychotherapy is the first-line monotherapy treatment option for panic disorder as it has been extensively researched and proven to be very effective for this condition.
First-line medications:
- Selective serotonin reuptake inhibitors (SSRI)
Second-line medications:
- Benzodiazepines
- Tricyclic antidepressants
- Tetracyclic antidepressants
- Noradrenaline reuptake inhibitors (NARI)
Third-line medications:
- Norepinephrine and dopamine reuptake inhibitors (NDRI)
- Serotonin and norepinephrine reuptake inhibitors (SNRI)
- Antiepileptics
- Atypical antipsychotics
Nursing Management
See nursing management for generalized anxiety disorder.
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.
[3] Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M. (2014). “But it might be a heart attack”: Intolerance of uncertainty and panic disorder symptoms. Journal of Anxiety Disorders, 28(5), 463-470.
[4] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.