panic disorder

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Introduction

An anxiety disorder characterized by discrete intense periods of fear & associated symptoms.

Panic disorder may be accompanied by agoraphobia.

Etiology

Epidemiology

  • 30-40% of patients with recurrent or atypical chest pain presenting to the emergency room
  • 1.5-3.5% lifetime prevalence
  • more common in women than men
  • less common in the elderly
    • 1% of community-dwelling elderly
    • onset is typically before age 25

Clinical manifestations

Diagnostic criteria

Differential diagnosis

Management

* agents of choice during pregnancy[2] & in the elderly[3]; SSRI as first line medication[1]

* only escitalopram with strong evidence supporting use[8]

More general terms

Additional terms

References

  1. 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2021.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
    Work Group on Panic Disorder. American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Am J Psychiatry. 1998 May;155(5 Suppl):1-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9585731 (Corresponding NGC guideline withdrawn Jan 2015)
  2. 2.0 2.1 Prescriber's Letter 7(11):65 2000
  3. 3.0 3.1 3.2 3.3 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
    Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
    Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  4. 4.0 4.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  5. Katon WJ. Clinical practice. Panic disorder. N Engl J Med 2006 Jun 2; 354:2360 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16738272
  6. 6.0 6.1 Hurley RA, Fisher R, Taber KH. Sudden onset panic: epileptic aura or panic disorder? J Neuropsychiatry Clin Neurosci. 2006 Fall;18(4):436-43. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17135371
  7. Katon WJ. Clinical practice. Panic disorder. N Engl J Med. 2006 Jun 1;354(22):2360-7. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16738272
  8. 8.0 8.1 Wong J, Motulsky A, Abrahamowicz M et al. Off-label indications for antidepressants in primary care: Descriptive study of prescriptions from an indication based electronic prescribing system. BMJ 2017;356:j603 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28228380 Free PMC Article <Internet> http://www.bmj.com/content/356/bmj.j603
  9. NEJM Knowledge+ Question of the Week. Oct 28, 2020 https://knowledgeplus.nejm.org/question-of-week/1827/
  10. 10.0 10.1 Soreff S Fast Five Quiz: Anxiety Medscape. August 9, 2021 https://reference.medscape.com/viewarticle/955963
    Memon MA, Welton RS Panic Disorder Medscape. March 21, 2018 https://emedicine.medscape.com/article/287913-overview
  11. 11.0 11.1 Chawla N et al. Drug treatment for panic disorder with or without agoraphobia: Systematic review and network meta-analysis of randomised controlled trials. BMJ 2022 Jan 19; 376:e066084. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35045991 Free article https://www.bmj.com/content/376/bmj-2021-066084
  12. 12.0 12.1 NEJM Knowledge+ Question of the Week. Nov 1, 2022 https://knowledgeplus.nejm.org/question-of-week/1287/
    Herr NR et al. Does this patient have generalized anxiety or panic disorder? The rational clinical examination systematic review. JAMA 2014 Jul 2; 312:78. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25058220 https://jamanetwork.com/journals/jama/fullarticle/1884581
  13. 13.0 13.1 NEJM Knowledge+ Psychiatry

Patient information

panic disorder patient information