| Panic disorder is characterized by sudden and unpredictable panic attacks. Panic attacks are brief episodes of intense fear, a sense of impending disaster, and bodily sensations including rapid heart rate, breathlessness, and dizziness. The attack comes "out of the blue," peaks in 10 minutes, and usually lasts less than 1 hour. Risk: Age at onset is usually between the late teens and mid-30s. Incidence and Prevalence: Panic disorder is present in 1% to 3% of individuals at some time in their lives. Women are 2 to 3 times more likely than men to have panic disorder. Individuals with a close relative with panic disorder are up to 8 times more likely than the general population to develop the disorder (DSM-IV-TR). |
Source: Medical Disability Advisor
| History: Individual has history of recurrent panic attacks that include at least four of the following: a pounding heart or rapid heart rate, sweating, trembling or shaking, shortness of breath or sensations of suffocating, feeling of choking, chest pain, nausea or abdominal distress, dizziness or faintness, feelings of unreality (derealization) or being detached from oneself (depersonalization), fear of losing control or going crazy, fear of dying, numbness or tingling sensations (paresthesias), and chills or hot flashes. Onset of the attack is sudden with symptoms reaching a peak in 10 minutes or less. For at least a month after one or more of the attacks, there is worry about having another attack, worry about the implication of the attack or its consequences (such as losing control, having a heart attack, or going crazy), or a significant change in behavior related to the attacks.
To meet the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision) diagnostic criteria, the panic attacks must not be due to the direct effects of a drug or other substance or to a general medical condition such as hyperthyroidism. The panic attacks must not be a part of, or better explained by, another disorder such as social phobia or other phobia, obsessive-compulsive disorder, post-traumatic stress disorder, or separation anxiety disorder. Physical exam: Although the physical exam does not typically contribute to this diagnosis, if performed during a panic attack, the examination may reveal a rapid heart rate and elevated blood pressure. Tests: Psychological tests can be consistent with this disorder but do not prove the diagnosis. Thyroid function tests can help rule out hyperthyroidism and serum calcium levels can help rule out hyperparathyroidism. A toxicology screen can be helpful in ruling out the possibility that the symptoms are being caused by substance abuse. |
Source: Medical Disability Advisor
| Panic disorder is treated with both panic-focused cognitive behavioral therapy and drug therapy. Because individuals with panic disorder have an intense fear of abandonment, it is essential to establish and maintain a good therapeutic relationship with a therapist who will continue to be available to the individual. The goal of cognitive therapy is to suggest that panic is a misinterpretation of body sensations and that the danger is not as extreme as perceived. Other psychotherapy may be considered but should be supplemented with or replaced with cognitive behavioral therapy if no significant improvement occurs within 6 to 8 weeks.
Relaxation training and progressive muscle relaxation may be helpful along with training in breath control. Drug therapy usually includes the use of antidepressants. MAO inhibitors may also be useful in treatment. A benzodiazepine can be used in the first weeks of treatment to help an individual calm down until the antidepressant becomes effective. Benzodiazepines should be confined to short-term use because of the risk of abuse and dependence. |
Source: Medical Disability Advisor
| Outcome is variable. Panic attacks may come and go over the years. Most individuals are able to live normal lives with few becoming significantly impaired. Outcomes in individuals who were treated in tertiary care settings 6 to 10 years after treatment show that 30% were free of symptoms, 40% to 50% had some improvement in symptoms, and 20% to 30% had no improvement or had worsening of symptoms. |
Source: Medical Disability Advisor
| Fear of a panic attack in public (agoraphobia) may cause the individual to stay at home, resulting in the loss of employment or relationships. Individuals may become convinced they have an undiagnosed life-threatening disease or are going crazy, which can limit their activities even further. Major depressive disorder occurs at some point in half the individuals with this disorder. Alcohol, substance abuse, and suicide attempts can all occur as a result of panic attacks, due to self-medication to relieve symptoms. |
Source: Medical Disability Advisor
| Time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual's condition fit the criteria for panic disorder?
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Has the diagnosis been confirmed?
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Have all cardiovascular, endocrine, respiratory and neurological disorders that can cause similar symptoms been ruled out?
Regarding treatment:
- If individual is not responding effectively to current medication, what other medication options are available?
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Is therapist trained and experienced in cognitive-behavioral therapy?
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Has individual learned to recognize early thoughts and feelings in the panic cycle?
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Has individual learned to eliminate thought patterns that contribute to panic behavior?
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Does therapy incorporate interoceptive exposure? Through repeated, controlled exposure experiences, has individual learned to cope effectively with sensations that bring on a panic attack?
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Has individual learned relaxation techniques to reduce anxiety and stress leading to a panic attack?
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Would individual benefit from psychodynamic therapy in order to uncover underlying emotional conflicts?
Regarding prognosis:
- Has individual been involved in the current form of treatment for over 6 weeks without a noticeable effect?
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Has the treatment plan been reassessed?
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Would individual benefit from extended therapy?
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Are coexisting conditions such as substance abuse (both intoxication and withdrawal states) or depression interfering with treatment? Are these conditions being appropriately addressed?
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Does individual have a functional support system?
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Besides family and one-on-one therapy support, is individual currently involved in a therapy group?
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Source: Medical Disability Advisor
| Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor