Panic disorder

• Panic disorder consist of recurrent, unpredictable episodes of severe acute anxiety, which is not restricted to particular stimuli or situations
• Characteristic features:

  • A crescendo of anxiety, usually resulting in exit from the situation
  • Somatic symptoms - palpitations, sweating, trembling, dyspnoea, chest pain, dizziness - often leading to hyperventilation syndrome
  • Secondary fear of dying/losing control (often related to somatic symptoms)
• Epidemiology:

  • Women 2-3 times more likely to be affected
  • Bimodal distribution
  • Highest peak incidence at 15-24 years
  • Second incidence at 45-54 years
  • Risk factors - widowed, divorced, living in a city, limited education, early parental loss, physical or sexual abuse
• Management:

  • Initially in primary care
  • First step - self help - provide info for support groups, benefits of exercise
  • If moderate to severe - referral for CBT and/or antidepressant (if disorder longstanding) - first line SSRIs
  • Benzodiazepines should not be used for chronic panic disorder - may be effective for severe acute symptoms
  • Referral to mental health services if 2 interventions provided in primary care and the patient still has significant symptoms
• First line SSRIs:

  • Citalopram
  • Escitalopram
  • Paroxetine
  • Sertraline
• Pharmacological management:

  • SSRIs (first line), SNRIs, and TCAs can be used
  • Escitalopram, sertraline, citalopram, paroxetine and venlafaxine are licensed for the treatment of panic disorder