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Panic disorder

Introduction

Panic disorder is an anxiety disorder characterized by recurrent unexpected panic attacks. A panic attack is characterised by an acute onset of intense anxiety accompanied by a sense of dread/impending threat, usually for no apparent reason.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

The patient will experience significant fear and emotional discomfort, typically peaking within 10 minutes and resolving within 30 minutes. There will usually be accompanying physical symptoms including:

• Rapid pulse/palpitations
• Shortness of breath
• Dizziness
• Sweating

Investigations

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Managemet

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  • Non-pharmacological

    • Psycho-education and reassurance
    • Psychotherapy, e.g. cognitive-behaviour therapy
    • Exclude an underlying medical condition, e.g. thyrotoxicosis

  • Pharmacological

    Panic attack

    Acute management

    The initial aim is to control the panic symptoms and exclude an underlying medical cause.

    • Diazepam (PO) 5mg stat (repeated as necessary to control symptoms)
    OR
    • Lorazepam (PO) 2mg stat (repeated as necessary to control symptoms)
    OR
    • Clonazepam (PO) 1mg stat (repeated as necessary to control symptoms)

    Panic disorder

    • Fluoxetine (PO) 20–40mg daily
    OR
    • Citalopram (PO) 10–40mg daily
    OR
    • Amitriptyline (PO) 25–75mg daily at night



    Note:

    • Initiate at low dose and gradually titrate to therapeutic dosages according to tolerability.
    • Duration of therapy: variable, initially 6 months–1 year.
    • Long term medicine treatment may be necessary.
    • Relapses may occur when treatment is discontinued.
    • Consider short term co-administration of a benzodiazepine, due to the slow onset of action and the potential for increased anxiety during the initial phase of treatment with antidepressants.

Prevention

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Updated on,

20 Novemba 2020, 08:01:24

References

    1. STG
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