Panic disorder is a condition where there are recurrent unexpected panic attacks, in the absence of triggers. It is marked by persistent concern about additional panic attacks and/or maladaptive change in behaviour related to the attacks.
Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
, and during which time at least 4
of the following symptoms occur (Note: The abrupt surge can occur from a calm state or an anxious state):
10
minutes), and must be accompanied by a cluster of physical symptoms.STUDENTS FEAR the 3 C's
can be used to remember the panic disorder criteria:
S
- SweatingT
- TremblingU
- Unsteadiness, dizzinessD
- Depersonalization, derealizationE
- Excessive heart rate, palpitationsN
- NauseaT
- TinglingS
- Shortness of breathFEAR
of dyingFEAR
of losing controlFEAR
of going crazyC
- Chest painC
- ChillsC
- Choking
At least 1
of the attacks has been followed by at least 1
month of at least 1
of the following:
The disturbance is not attributable to the physiological effects of a substance (e.g. - a drug of abuse, a medication) or another medical condition (e.g. - hyperthyroidism, cardiopulmonary disorders).
The disturbance is not better explained by another mental disorder:
Criterion A
).[19]Name | Rater | Description | Download |
---|---|---|---|
Panic Disorder Severity Scale (PDSS) | Clinician | The PDSS is a 7 question scale to grade panic disorder severity. | Download |
1st line | Citalopram, escitalopram,[41] fluoxetine, fluvoxamine, paroxetine, paroxetine CR, sertraline, venlafaxine XR |
---|---|
2nd line | Alprazolam, clomipramine, clonazepam, diazepam, imipramine,[42] lorazepam, mirtazapine, reboxetine |
3rd line | Bupropion SR, divalproex, duloxetine, gabapentin, levetiracetam, milnacipran, moclobemide, olanzapine, phenelzine, quetiapine, risperidone, tranylcypromine |
Adjunctive therapy | Second-line: alprazolam ODT, clonazepam Third-line: aripiprazole, divalproex, olanzapine, pindolol, risperidone |
Not recommended | Buspirone, propranolol, tiagabine, trazodone |
Guideline | Location | Year | Website | |
---|---|---|---|---|
Canadian Clinical Practice Guidelines for the Management of Anxiety, Posttraumatic Stress and Obsessive-Compulsive Disorders | Canada | 2014 | - | Link |
National Institute for Health and Care Excellence (NICE) | UK | 2011, 2019 | - | Link |
American Psychiatric Association (APA) | USA | 2009 | - | • Guideline (2009) • Quick Reference Guide |
Royal Australian and New Zealand College of Psychiatrists (RANZCP) | AUS, NZ | 2018 | - | Link |