panic disorder

Last edited 01/2022 and last reviewed 01/2022

A panic attack is discrete paroxysm of severe anxiety which is associated with unpleasant symptoms of autonomic arousal.

Panic disorder is diagnosed when panic attacks occur:

• regularly
• without an obvious precipitant
• in the absence of other psychiatric illness

NICE suggest that there is a stepped care for panic disorder (2)

• Step 1 - recognition and diagnosis
• Step 2 - treatment in primary care
• Step 3 - review and consideration of alternative treatments
• Step 4 - review and referral to specialist mental health services
• Step 5 - care in specialist mental health services

Notes:

• according to the DSM-IV-TR , a fundamental characteristic of panic disorder is the presence of recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another panic attack and concern about the consequences of a panic attack, or a significant change in behaviour related to the attacks
  • at least two unexpected panic attacks are necessary for diagnosis and the attacks should not be accounted for by the use of a substance, a general medical condition or another psychological problem
• panic disorder can be diagnosed with or without agoraphobia
• a systematic review concluded (3):
  • SSRIs provide high rates of remission with low risk of adverse events for the treatment of panic disorder. Among SSRIs, sertraline and escitalopram were associated with high remission and low risk of adverse events

Reference:

• 1) American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington DC: American Psychiatric Association.
• 2) NICE (January 2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults
• 3) Chawla N, Anothaisintawee T, Charoenrungrueangchai K, Thaipisuttikul P, McKay G J, Attia J et al. Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials BMJ 2022; 376 :e066084 doi:10.1136/bmj-2021-066084