Overview

• Panic Disorder → recurrent panic attacks (severe anxiety), which are not triggered by any particular situation (ie. unpredictable).

  • At least 2 within a month.
  • In between episodes, relatively fine with minimal anxiety.
  • Panic disorder should not be main diagnosis if a depressive disorder exists at the time attacks start.

  <aside> 💡 MAIN THING WITH PANIC DISORDER IS NO OBVIOUS TRIGGER.

  </aside>

Making Diagnosis

Clinical Features

• Panic Attack:
  • Sudden onset attack of extreme anxiety, lasts ≤30 mins.
  • Physical Symptoms → palpitations, trembling, sweating, SOB, depersonalisation, chest pain, choking feeling.

Investigations

• Patients with Palpitations → ECG.
• Panic Attack → respiratory alkalosis due to hyperventilation.

Management Plan

• Step 1 → recognition and diagnosis.
• Step 2 → treatment in primary care (self-help for 6 weeks).
• Step 3 → review and consideration of alternative treatments.
• Step 4 → review and referral to specialist mental health services.
• Step 5 → care in specialist mental health services.
• Treatment in Primary Care:
  • 1st Line → CBT + SSRI (typically sertraline).
  • If no response after 12 weeks → change class to TCA (imipramine/clomipramine) or add BDZ (not exceeding 2-4 weeks).
    • TCAs second line due to unfavourable side effect profile.