Panic disorders

Frequency of panic attacks may vary considerably in panic disorder, with some individuals reporting brief clusters of several panic episodes in a short period of time, weekly panic attacks, or periodic attacks over the course of several months.

Higher risk among first-degree relatives; onset of attacks triggered by stress; often comorbid with other anxiety, mood, and substance-use disorders.

Assessment is made through ruling out organic causes; self-report; clinical interview; and behavioural observation.

Self-help, cognitive behavioural therapy, selective serotonin-reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors are first-line treatments.

Long-term management includes relapse prevention after treatment discontinuation.

Panic disorder is characterised by recurring unexpected panic attacks over a 1-month period. People with panic disorder are persistently concerned about having another panic attack, and/or about the consequences of this (e.g., having a heart attack or losing control). People with panic disorder may also change their behaviour in an attempt to avoid having more panic attacks (e.g., avoiding situations that may trigger the panic sensations; engaging in various safety-related behaviours).[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision, (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. Panic attacks involve the sudden onset of intense physical and cognitive symptoms of anxiety that may be triggered by specific cues or occur unexpectedly. For a diagnosis of panic disorder, panic attacks must be recurrent; note that non-recurrent panic attacks are relatively common in the general population.[2]Olaya B, Moneta MV, Miret M, et al. Epidemiology of panic attacks, panic disorder and the moderating role of age: results from a population-based study. J Affect Disord. 2018 Dec 1;241:627-33. http://www.ncbi.nlm.nih.gov/pubmed/30172214?tool=bestpractice.com [3]de Jonge P, Roest AM, Lim CC, et al. Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depress Anxiety. 2016 Dec;33(12):1155-77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143159 http://www.ncbi.nlm.nih.gov/pubmed/27775828?tool=bestpractice.com In panic disorder, frequency of attacks may vary widely, with some individuals reporting brief clusters of several panic episodes in a short period of time, weekly panic attacks, or periodic attacks over the course of several months. Regardless of frequency, the person remains persistently concerned or anxious about the possibility of another attack.[4]Andrews G, Bell C, Boyce P, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Australian & New Zealand Journal of Psychiatry. 2018;52(12):1109-172. https://journals.sagepub.com/doi/full/10.1177/0004867418799453