Panic disorder (neurotic disorders)

Question 1

Who does panic disorder affect?

Answer 1

-1.7% UK prevalence

Question 2

What causes it?

Answer 2

-A panic attack is a discrete episode of intense subjective fear, with associated symptoms arise rapidly and peak within 10 minutes of onset
-Panic disorder involves panic attacks associated with persistent anxiety about recurrence and consequences of the attacks
-Specific behavioural changes also occur
-Can occur with or without agoraphobia
-First episode may be associated with a stressful event but gradually they tend to occur out of the blue

Question 3

How does panic disorder present?

Answer 3

NB anxiety disorders often go unrecognised as patients complain of physical problems rather than anxiety itself
Characteristic symptoms of a panic attack:
-Palpitations, accelerated heart rate
-Chest pain
-Sweating
-Dry mouth
-SOB, smothering sensation
-Feeling of choking
-Nausea / abdo distress
-Feeling dizzy / faint
-Derealisation / depersonalisation
-Fear of dying / losing control

Question 4

What are the differential diagnoses for panic disorder?

Answer 4

-Agoraphobia
-Social anxiety disorder
-GAD
-Adjustment disorders
-Bipolar disorder
-Depression
-Somatisation
-OCD
-PTSD

Question 5

What treatment would you consider for someone with panic disorder?

Answer 5

Step 1: recognition and diagnosis
Step 2: treatment in primary care
-Avoid anxiety-producing substances eg caffeine
-Offer CBT
-Offer SSRI (imipramine / clomipramine if no improvement after 12 weeks)
-Promote social interventions eg exercise, sleep hygiene
Step 3: consider referral to specialist if no improvement after 2 interventions