Panic disorder

Question 1

Screening questions for panic attacks

Answer 1

Have you had an intense feeling of fear or anxiety that happened out of the blue?

PHYSICAL SYMPTOMS
o During the attack did you feel – your heart racing, difficulty breathing? sweating? Shaking? Nausea? Dizziness?
- Feeling pins and needles?

DEPERSONALISATION
- Feeling separate from your body?
DEREALISATION
- Feel like your surroundings are not real?
CATASTROPHISING
- Feeling like you are going to die or going crazy?

DURATION
o How often do you get these episodes?- How long do they usually last?
o What brings them on?
o Following the attack, did you worry about having them more?

FUNCTION
o What were you afraid might happen from these attacks?
o Did the attacks change your behaviour or routine in your daily life?

Question 2

Additional screening needed questions for panic disorder

Answer 2

screening for other anxiety disorders
- esp agoraphobia
mood disorders
neurovegetative symptoms
psychotic symptoms

Question 3

What are the screening questions for agoraphobia

Answer 3

“Some people have very strong fears of being in certain places or in certain situations - do any of the following make you feel very fearful or anxious or nervous?”
- Being away from home alone
- Being in crowded places
- Being on a bridge or tunnel
- Public transportation
- Driving or riding in a car
- Being home alone
- Being in wide open spaces
- Being in a close space

“To what degree do you avoid this situation?”

“What do you do to cope?” “Does having someone with you help?”

• “How bad does the anxiety get?”

Question 4

DSM criteria for panic disorder

Answer 4

A. Recurrent unexpected panic attacks (i.e. abrupt surge of intense fear/discomfort that reaches a peak within approx 10-20 minutes) during which time ≥4 of the following symptoms occur:
- Palpitations, pounding, accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain/discomfort
- Nausea/abdominal distress
- Feeling dizzy/unsteady/light-headed/faint
- Chills or heat sensations
- Paraesthesias (numbness/tingling sensations)
- Derealisation or depersonalisation
- Fear of losing control or going crazy
- Fear of dying

B. ≥1 of the attacks is followed by a ≥1 month period of ≥1 of:
- Persistent concern/worry about additional panic attacks or their consequences (e.g.
losing control, having a heart attack)
- A significant maladaptive change in behaviour related to the attacks (e.g. avoidance of
exercise or unfamiliar situations)

C. Disturbance not attributable to a substance (drug of abuse, medication) or medical condition (e.g. hyperthyroidism,
cardiopulmonary disorder)

D. Disturbance not better explained by another psychiatric disorder eg. - Panic disorder with agoraphobia
- Panic disorder without agoraphobia
- Agoraphobia without a history of panic disorder

Question 5

Management of Panic disorder

Answer 5

Acute panic attack treatment:
o Safety
o Exclude medical causes – ECG, bloods, urine tox
o Short term course of benzos +/- breathing in a paper bag (if
hyperventilating)

Long-term management:
o Antidepressants = SSRI / SNRI, TCAs
- Benzodiazepines - can be used until SSRIs take effect
- Can help stop/prevent panic attacks which may be useful to move forward in therapy (exposure tasks etc.)

Psycho
o Psychoeducation
o CBT