Panic attack

Question 1

Features

Answer 1

Pts experience;

• sudden
• unexpected
• short-lived episodes of intense anxiety

These tend to be recurrent and occur most often in young females.

Follow DSM-5 guidelines for diagnosis.

Question 2

Management

Answer 2

First-line

Reassurance

Explanation

Psychological support (as for generalised anxiety)

Question 3

Cognitive behaviour therapy (CBT)

Answer 3

This aims to reduce anxiety by teaching pts how to;

• identify
• evaluate
• control and
• modify their negative, fearful thoughts and behaviour.

If simple psychotherapy and stress management fails, then pts should be referred for this therapy.

If hyperventilating, breathe in and out of a paper bag

Question 4

Pharmacological treatment

Answer 4

Acute episodes:

• diazepam 5 mg (o) or
• oxazepam 15–30 mg (o) or
• alprazolam 0.25–0.5 mg (o) or
• paroxetine 20–60 mg (o)

Prophylaxis:

SSRIs and venlafaxine CR are first-line pharmacotherapy.

They should be introduced slowly and increased with care according to response and tolerance.