Panic disorder

Question 1

Define panic disorder

Answer 1

Recurrent, episodic*, severe panic attacks, which are unpredictable + not restricted to any particular situation or circumstance**

• differentiates it from GAD
• *differentiates it from phobias

Question 2

Epidemiology panic disorder

Answer 2

• 1% population

* W:M= 3:1

Question 3

RFs panic disorder

Answer 3

FHx
Female
recent trauma
major life events
age 20-30
other mental disorders
white
asthma
cigarette smoking
medication (BDZ withdrawal)

Question 4

Aetiology panic disorder

Answer 4

Biological

a. Genetics
b. Neurochemical: post-synaptic hypersensitivity to 5-HT + Adrenaline
c. Sympathetic NS stimulation (by fear + worry) → ^ CO → further anxiety

Cognitive (psychological)
a. Misinterpretation of somatic symptoms (e.g. fear palpitations will lead to heart attack)

Environmental (social)
a. Presence of life stressors

Question 5

CFs panic disorder

Answer 5

Panic Sx’s peak 10 mins and rarely persist beyond hour

PANIC’S Disorder
•	Palpitations
•	Abdominal distress
•	Numbness/Nausea
•	Intense fear of death
•	Choking feeling/Chest pain
•	SOB/Shaking/Sweating
•	Depersonalisation/Derealisatio

Question 6

ICD-10 dx panic disorder

Answer 6

1. Recurrent panic attacks that are not consistently assoc. w/ specific situation or object and often occurs spontaneously
2. Needs ALL of: (1) discrete episode of intense fear or discomfort (2) starts abruptly (3) reaches crescendo w/in a few mins and lasts at least some minutes (4) at least 1 of: palp., sweating, shaking/tremor, dry mouth (5) other Sx’s: GAD Sx’s

Question 7

Ix panic disorder

Answer 7

Same as GAD

1. Bloods: TFTs, FBC (anaemia), glucose (hypoglycaemia)
2. ECG (sinus tachycardia)
3. Urine catecholamines (rule out Phaeochromocytoma)
4. Questionnaires: GAD-2, GAD-7 [SCREENING]…

Question 8

Rx panic disorder

Answer 8

Medications: First line (SSRIs) → second line (TCA: imipramine)

Psychological therapies: CBT (recognition of panic triggers)

Self help methods: bibliotherapy (giving written info on panic disorder + how to overcome it) + support groups + encouraging exercise