Anxiety disorders: Panic disorder

Question 1

Define Panic Disorder

Answer 1

Recurrent, episodic severe panic attacks which are unpredictable and not restricted to a particular situation or circumstance

Question 2

Give risk factors for Panic Disorder

Answer 2

• Family History
• Major life events
• Female
• age 20-30
• recent trauma
• other mental disorders
• white ethnicity
• asthma
• cigarette smoking
• medication

Question 3

How does a Panic Attack normally present

Answer 3

Peaks within 10 minutes and rarely persists longer than an hour

Question 4

Describe the ICD10 diagnosis of Panic Disorder

Answer 4

A - Recurrent panic attacks not associated with specific situations/objects
B - Discrete episode of intense fear, starts abruptly, reaches a crescendo within a few minutes and lasts at least some minutes, at least one episode of autonomic arousal (palpitations, sweating, shaking, tremor, dry mouth)

Question 5

Describe the pharmacological management of Panic Disorder

Answer 5

First line is SSRIs

If no improvement after 12 weeks - TCAs (Imipramine etc)

Question 6

Describe the non pharmacological management of Panic Disorder

Answer 6

CBT

Self help methods (Bibliotherapy, Support Groups)

Question 7

pneumonic PANICS D for some of the key features of panic disorders

Answer 7

Palpitations

Abdominal distress

Numbness/nausea

Intense fear of death

Choking feeling/Chest pain

Sweating/shaking/SOB

Depersonslisation/Derealisation

Question 8

MSE features of panic disorders

Answer 8

similar to those of GAD - if having a panic attack at time of consultation

appearance and behaviour may be more intense such as hyperventilation and restlessness

Question 9

what pharmacological management options are there for panic disorders?

Answer 9

SSRIs 1st line

if no improvement after 12 weeks then TCA

Question 10

explain the stepped care model for management of panic disorder

Answer 10