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PANIC 

DISORDERBy :Madona Clara Yosinta

Faritz Subiyaktoro Aqita Islamiah

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Definition

Panic disorder (PD) is characterized primarily

by the presence of recurrent and 

unexpected panic attacks, followed by at 

least 1 month of persistent concern about

other attacks, the possible consequences of 

attacks and a significant behavioral change

related to the attacks

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Panic attacks are a period of intense fear in

which 4 of 13 defined symptoms develop

abruptly and peak rapidly less than 10

minutes from symptom onset.

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• During the episode, patients have the urge

to flee or escape and have a sense of 

impending doom (as though they are dying

from a heart attack or suffocation).

• Other symptoms may include headache,

cold hands, diarrhea, insomnia, fatigue,

intrusive thoughts.

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Neurobiology of Panic Disorder

The neurocircuitry of fear includes two pathways

for processing of sensory information.

The shorter path :

rapid spread of autonomic

and behavioral responses in potentially hazardous

situations.

The major regions :

anterior thalamus and the

central and lateral regions of 

the amygdala.

The longer path :the information passes

through several regions,

including the cortex, which

allows for a more refined

analysis of inputs.

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Physical ExaminationNo signs on physical examination are specific

for panic disorder

• If the patient presents in an acute state of panic : – Nonspecific signs:

• Hypertension

• Tachycardia

• Mild tachypnea

•Mild tremors.

• The attack normally lasts 20-30 minutes from onset ,although in rare cases it can go on for more than an hour.

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Physical Examination

•

 Appearance : anxious

• Somatic concerns of death from cardiac or respiratory

problems may be a major focus of patients during an

attack. Patients may end up in an emergencydepartment.

• Mental Status Examination

As with the physical examination, no results on theMental Status Examination are specific for panic

disorder.

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Planning Diagnose

No invasive procedures are required to diagnose panic

disorder, although they may be useful in eliminating

other differential diagnoses.

As previously mentioned, history, collateral information,

and physical examination/Mental Status Examination

remain the diagnostic cornerstones for panic disorder

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Laboratory Test

Laboratory studies that can exclude medical disorders other than panic

disorder include the following:

• Serum electrolytes to exclude hypokalemia and acidosis

• Serum glucose to exclude hypoglycemia

• Cardiac enzymes in patients suspected of acute coronary syndromes

• Serum hemoglobin in patients with near-syncope

• Thyroid-stimulating hormone (TSH) in patients suspected of 

hyperthyroidism

• Urine toxicology screen for amphetamines, cocaine, and phencyclidine in

patients suspected of intoxication

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General Treatment

• It has a direct impact on disability, resulting inincreased absenteeism, decreasedproductivity and reduced ability to carry outdaily activities.

PanicDisorder

• Improvements in functioning, as well as insymptoms, should be part of evaluatingtreatment effectiveness.

Monitoring

• Panic Disorder patients tend to stoptreatment when they become anxious aboutsomatic sensations from medications.

TreatmentCompliance

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Level of Care

If there is a high risk of danger to

self or others or grave disability,

consider inpatient hospitalization.

Unstable patients may respond to

structured, multi-disciplinarytreatment that emphasizes skills

training, family involvement,

 psychoeducation and psychiatric

management 

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Medications 

SSRIs, SNRIs, tricyclic antidepressants, benzodiazepines

(only appropriate as monotherapy in the absence of a

comorbid mood disorder) and/or cognitive-behavioral

psychotherapy (CBT) have been shown generally to be

equally effective in the acute phase (first 12 weeks) of 

treatment

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Psychotherapy 

Consider including psychotherapy if there:

• has been a previous positive response to

psychotherapy

• is an incomplete response to an adequate trial of 

medication

• are excessive medical risks of medication

• is evidence that coping skills are inadequate to manage

psychosocial stressors

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Prognosis

• Long-term prognosis is usually good, with

almost 65% of patients with panic disorder

achieving remission, typically within 6 months.

• Appropriate pharmacologic therapy and

cognitive-behavioral therapy, individually or in

combination, are effective in more than 85% of 

cases.

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Gracias..God Bless You ^_^