Panic Disorder

What is the name of the anxiety disorder where you regularly have sudden attacks of panic or fear?

Panic disorder

What are the main symptoms of panic disorder?

Uneasy feeling, panic attacks

What are the symptoms of a panic attack?

Dissociation, sweating, feeling faint/dizziness, nausea/churning in stomach, SOB, hot/cold flushes, tremor, dry mouth, need to go to toilet, tinnitus, tingling/numbness

How long can panic attacks last?

5-20 mins, can be up to an hour

What is the harm level of panic attacks?

Attack itself has no harm, just feels dangerous

What are some potential differentials for panic disorder?

Hyperthyroidism, other anxiety disorders, bipolar, depression, PTSD, specific phobias, MI

How many steps are there in panic disorder treatment?

5

What is step 1 of panic disorder?

Recognition and diagnosis

What is step 2 of panic disorder?

Treatment in primary care

What is step 3 of panic disorder?

Review and consideration of alternative treatments

What is step 4 of panic disorder?

Review and referral to specialist mental health services

What is step 5 of panic disorder management?

Care in specialist mental health services

What should be used to diagnose panic disorder?

Ask about common comorbidities, ask about prescribed/recreational use drugs

What recreational drug can interact with medications used to manage panic disorder?

Cocaine use

What should NOT be used to diagnose panic disorder?

Questionnaires

What is involved in step 2 of panic disorder?

Improve access to self help, support groups, can have face to face meetings, telephone conference support groups - benefits of exercise reinforced

What is involved in step 3 of panic disorder?

CBT or antidepressant

When are antidepressants prescribed in panic disorder?

If person has long-standing symptoms and declined psychological intervention

What is CBT like in panic disorder?

Takes 1-2 hours per week for sessions, completed within maximum of 4 months

What pharmacotherapy is avoided in panic disorder?

Benzodiazepines, sedating antihistamines, antipsychotics

What is first line pharmacotherapy treatment for panic disorder?

SSRI licensed for panic disorder e.g., citalopram, escitalopram, paroxetine, sertraline or venlafaxine

What should be discussed when initiating pharmacotherapy?

Potential side effects, risk of withdrawal if stopped suddenly/missed dose or reduced dose, delayed onset

When may an antidepressant used for panic disorder be switched?

Unsuitable or used for 12+ weeks with no improvement

How often is efficacy of antidepressants measured?

At 2, 4, 6 and 12 weeks

What team is involved in step 4 of panic disorder?

Community mental health

What is involved in step 5 of panic disorder?

Speak to patients and potential outpatient secondary care treatment where comorbidities are treated, full exploration of pharmacotherapy and may need assessment at tertiary centres

What is second line pharmacotherapy in panic disorder?

Clomipramine, imipramine