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anxiety:panic [2019/05/21 22:15]
psychdb
anxiety:panic [2020/04/30 22:11] (current)
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   * ''​**C**''​ - **Choking**   * ''​**C**''​ - **Choking**
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 <callout type="​tip"​ title="​Asking 'Do you experience panic attacks?'​ Is Too Vague!"​ icon="​true">​A 'panic attack'​ means different things to different people. It is more important to explore what cluster of physical symptoms the patient experiences. It is also helpful to identify if there are specific triggers that lead to panic attacks.</​callout>​ <callout type="​tip"​ title="​Asking 'Do you experience panic attacks?'​ Is Too Vague!"​ icon="​true">​A 'panic attack'​ means different things to different people. It is more important to explore what cluster of physical symptoms the patient experiences. It is also helpful to identify if there are specific triggers that lead to panic attacks.</​callout>​
 +<callout type="​warning"​ title="​Chronic Anxiety vs. Panic Attacks"​ icon="​true">​Chronic anxiety fluctuates over hours and days. A true panic attack occurs only during a discrete period of time, must peak abruptly, and is accompanied by physical symptoms.</​callout>​
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   * Pheochromocytoma,​ rarely, this should be considered on the differential. Especially if the patient is not responding to conventional treatments[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC5890079/​|Alguire,​ C., Chbat, J., Forest, I., Godbout, A., & Bourdeau, I. (2018). Unusual presentation of pheochromocytoma:​ thirteen years of anxiety requiring psychiatric treatment. Endocrinology,​ diabetes & metabolism case reports, 2018.]])][([[https://​www.endocrine-abstracts.org/​ea/​0032/​ea0032p569|Muroya,​ Y., Kumagai, N., Shimodaira, M., Tsuzawa, K., Sorimachi, E., Arioka, H., & Honda, K. (2013, April). A case of pheochromocytoma that recognized as panic disorder before its exact diagnosis. In 15th European Congress of Endocrinology (Vol. 32). BioScientifica.]])]   * Pheochromocytoma,​ rarely, this should be considered on the differential. Especially if the patient is not responding to conventional treatments[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC5890079/​|Alguire,​ C., Chbat, J., Forest, I., Godbout, A., & Bourdeau, I. (2018). Unusual presentation of pheochromocytoma:​ thirteen years of anxiety requiring psychiatric treatment. Endocrinology,​ diabetes & metabolism case reports, 2018.]])][([[https://​www.endocrine-abstracts.org/​ea/​0032/​ea0032p569|Muroya,​ Y., Kumagai, N., Shimodaira, M., Tsuzawa, K., Sorimachi, E., Arioka, H., & Honda, K. (2013, April). A case of pheochromocytoma that recognized as panic disorder before its exact diagnosis. In 15th European Congress of Endocrinology (Vol. 32). BioScientifica.]])]
     *  The classic triad of pheochromocytoma symptoms includes headache, excessive sweating, and palpitations. Around 15%-20% of patients with a pheochromocytoma patients may be normotensive.     *  The classic triad of pheochromocytoma symptoms includes headache, excessive sweating, and palpitations. Around 15%-20% of patients with a pheochromocytoma patients may be normotensive.
-    * Testing for plasma ​metanephrines (95% sensitivity) ​and 24-hour urinary metanephrines (99% sensitivity) ​is useful. Abdominal CT has also been shown to be helpful. Howeveron MRI, pheochromocytomas demonstrate a distinctive appearance ​(100% sensitivity), and scintigraphy ​using metaiodobenzylguanidine ​(a norepinephrine analog) labeled with I-131 (I-MIBG) is particularly good at locating extra-adrenal pheochromocytomas. ​+    * Plasma ​metanephrines (95% sensitivity)24-hour urinary metanephrines (99% sensitivity),​ MRI (100% sensitivity, pheochromocytomas demonstrate a distinctive appearance),​ scintigraphy, and abdominal CT.[([[https://​www.clinicaladvisor.com/​home/​features/​an-incidental-finding-twice-removed-in-an-anxious-patient/​|Clinical Advisor: An incidental finding, twice removed in an anxious patient]])]
 ===== Investigations ===== ===== Investigations =====
   * TSH, glucose as baseline if not already done   * TSH, glucose as baseline if not already done