Clinical Manual for Management of the HIV-Infected ... - myCME.com

Panic Disorder
Background
Panic disorder is persistent fear that interferes with the
ability to conduct activities of daily living. A patient is
diagnosed as having panic disorder when he or she has
experienced 4 panic attacks within a 4-week period, or
at least 1 panic attack followed by a month of persistent
fear. Panic attacks are discrete, sudden-onset episodes
of intense fear or apprehension accompanied by specific
somatic or psychiatric symptoms (eg, palpitations,
shortness of breath, or fear of losing control).
Patients may associate panic attacks with various
activities, such as leaving home, driving, and even
visiting health care providers for medical appointments.
The symptoms of panic disorder usually begin in late
adolescence to the mid-30s and may coincide with the
presentation of major depressive disorder, social phobia,
or generalized anxiety disorder. Symptoms may mimic
physical illness. Patients with panic disorder have an
increased incidence of suicide.
S: Subjective
The patient complains of panic attacks, or describes
episodes of:
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Chest pain or discomfort
Depersonalization or derealization
Dizziness, lightheadedness, faintness,
or feeling of unsteadiness
Fear of dying
Fear of going crazy or losing control
Hot flashes or chills
Nausea or abdominal distress
Numbness or tingling sensations
Palpitations or accelerated heart rate
Sensation of choking
Shortness of breath or smothering sensation
Sweating
Trembling or shaking
Section 8—Neuropsychiatric Disorders | 8–9
In the absence of physical causes, 4 or more of the
above symptoms accompanying multiple panic attacks
are diagnostic of panic disorder. Panic attacks are, by
definition, self-limited and they peak quickly, usually
within 10 minutes. Symptoms that persist continuously
for longer periods suggest other causes.
History
Inquire about the following:
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Any associated or concurrent symptoms, such as
rash, cough, or fever
Current medications, herbal products, and
supplements
Family history of mood and psychiatric illnesses,
particularly anxiety and panic
Frequency, duration, and onset of panic episodes
Any relationship to food or hunger
Settings in which attacks occur to determine
whether there are triggers, such as being outdoors
(agoraphobia)
Intake of caffeine, recreational drugs, and alcohol
(current and recent)
New onset versus previous incidents
Sleep disturbances
Concomitant illnesses
O: Objective
Perform a complete physical examination, including
vital signs and thyroid, cardiac, pulmonary, and
neurologic evaluation.
During actual panic attacks, patients may have an
increased heart rate or respiratory rate.