Panic Disorder

The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

Aetiology

• Typical onset late adolescence to mid-30’s

• Comorbid with other anxiety disorders (>50% also have agoraphobia), depression, drug and alcohol misuse

Clinical presentation

• As with other anxiety disorders, the dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization)

• There is often also a secondary fear of dying, losing control, or going mad

• May occur with, or without, agoraphobia

• Not due to the direct physiological effects of a substance (drug) or geeral medical condition e.g. hyperthyroidism

Investigations

• Clinical diagnosis - ICD-10

Management

1. Self-help

2. CBT or SSRI if long standing or no benefit from CBT
1. Do not use benzodiazepines or sedating antihistamines as associated with a less good outcome in the long term
2. Avoid propranalol, buspirone, buprioprion

3. Consider tricyclics e.g. clomipramine, desipramine if there is no improvement after 12 weeks and further medication is indicated