Panic Disorder Flashcards
(18 cards)
Median age of onset for panic disorder
20-24 years of age
What percentage of those with panic disorder develop agoraphobia?
~33%
Diagnostic criteria for panic disorder
- Recurrent unexplained panic attacks
- At least one panic attack followed by >1 month of concern about having additional attacks, worry about the consequences of the attacks, or maladaptive change in behavior related to the attacks
- Attacks are not caused by physiologic effects of a substance, medication, or medical condition
Typical onset and duration of a panic attack
May or may not be provoked by exercise or an emotional or fearful event
Progresses to a peak within 10 minutes of rapidly intensifying symptoms
Lasts up to 20-30 minutes
A patient can have a variety of associated symptoms with a panic attack, but they have to have either __ or __ for it to be a panic attack
A patient can have a variety of associated symptoms with a panic attack, but they have to have either intense fear or intense discomfort for it to be a panic attack
Main ddx for panic disorder
- Heart attack
- Arryhthmia
- Paroxysmal vertigo
- Endocrine disorder (especially hyperthyroid, adrenal insufficiency, pheochromocytoma)
- Intoxication
- Medication side effect
If someone has a panic attack, do they automatically have panic disorder?
No!
Panic attacks can be seen in other disorders, such as PTSD or specific phobia
So, possible triggers must be carefully elicited.
In panic disorder, the direction of fear is. . .
. . . fear of having an attack
Not fear of something that can trigger an attack, such as agoraphobia
However, someone with panic disorder may secondarily develop agoraphobia.
First-line treatment of panic disorder
- SSRIs
- SNRIs
- TCAs (considered, often 2nd line due to side effect profile)
- Benzos OR hydroxyzine: Note, benzos or hydroxyzine are often used as a bridging therapy while the above medications take effect and are then discontinued.
OR
- CBT – CBT is as effective as a medication for this condition, and CBT + medication has enhanced efficacy.
Role of benzodiazepines in therapy of panic disorder
- As a rescue medication when a patient presents in a known panic attack
- As a bridging therapy to SSRI, SNRI, or TCA therapy
Treating resistant panic disorder
- CBT + medication
- Addition of atypical antipsychotic onto SSRI or SNRI therapy
Beta blockers in panic disorder
May be used episodically in low doses to treat the symptoms of an acute panic attack
Panic attacks in the setting of public speaking (“stage fright”) represent. . .
. . . social anxiety disorder
Not panic disorder or specific phobia
___ is commonly comorbid with panic disorder and agoraphobia
Major depressive disorder is commonly comorbid with panic disorder and agoraphobia
Diagnostic criteria for “anxiety disorder due to another medical condition”
Anxiety or panic attacks are the predominant symptom
History, PE, and/or labs strongly suggest that the symptoms are a direct physiologic consequence of a medical condition.
Syptoms do not occur only during delirium.
Treatment of anxiety disorder due to another medical condition
Obviously, the primary focus is the underlying medical condition
However, this may not totally alleviate anxiety symptoms. If this is the case, this may be treated much like GAD. SSRI therapy with benzodiazepine bridge and otherwise sparing use of benzodiazepines is appropriate if symptoms persist. Psychotherapy may also aid in relief of symptoms.
Any patient with diabetes mellitus (type I, II, or rarer type) that presents to the ED with diaphoresis and tremulousness should have STAT ___, irrespsective of other details
Any patient with diabetes mellitus (type I, II, or rarer type) that presents to the ED with diaphoresis and tremulousness should have STAT blood glucose, irrespsective of other details
Although TBH, they should probably have this STAT anyway irrespective of symptoms given their diagnosis
Someone who has panic attacks whenever they get too far from their home and therefore gets everything delivered and tries never to leave the home except with assistance has. . .
. . . agoraphobia and NOT NECESSARILY panic disorder
Remember, for it to be true panic disorder the events need to happen kind of out of the blue. If the panic attacks happen because of straying from the home, then they are induced by agoraphobia and therefore agoraphobia ALONE is the appropriate diagnosis (not panic disorder + agoraphobia).
