Anxiety Disorders
Panic Disorder
ICD-10-CM: F41.0
1. Criteria
DSM Criteria
Criterion A
- Recurrent unexpected panic attacks occur.
- A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.
- During the surge, 4 or more symptoms occur such as palpitations, sweating, trembling, shortness of breath, feelings of choking, chest discomfort, nausea, dizziness, chills or heat sensations, paresthesias, derealization or depersonalization, fear of losing control, or fear of dying.
DSM Criteria
Criterion B
- At least one attack has been followed by 1 month or more of persistent concern or worry about additional attacks or their consequences.
- At least one attack has been followed by significant maladaptive behavior change related to the attacks, such as avoidance.
DSM Criteria
Criterion C
- The disturbance is not attributable to a substance or another medical condition.
DSM Criteria
Criterion D
- The disturbance is not better explained by another mental disorder such as social anxiety disorder, specific phobia, OCD, PTSD, or separation anxiety disorder.
2. Context
- Panic disorder is more than having panic attacks. The syndrome becomes panic disorder when the attacks are recurrent, seem to come out of the blue, and leave behind ongoing fear, avoidance, or behavior change that starts organizing the person's life around the next attack.
- Unexpected attacks: What makes this different from simple situational anxiety is that the attacks feel abrupt and are not always tied to the same obvious trigger.
- Aftermath matters: The aftermath is what makes the diagnosis. Patients often start scanning their body, avoiding places, or reorganizing routines out of fear of another attack.
- Medical rule-outs: Because the symptoms can look medical, it is important to think through cardiopulmonary, endocrine, vestibular, and substance-related explanations too.
- Clinical focus: Most common clinician-rated and self-report tool for panic disorder severity.
3. Validated scales
Panic Disorder Severity Scale
Most common clinician-rated and self-report tool for panic disorder severity.
CGI-S
Fast global severity impression during follow-up.
4. FDA approved treatments
FDA-indicated medications commonly used for panic disorder
Several SSRIs carry panic-disorder labeling; verify exact formulation and patient age indications in the current package insert.
Common off-label medications
Interventional psychiatry modalities
- TMS is being explored for panic-spectrum symptoms.
- ECT is not standard for primary panic disorder.
- Ketamine remains investigational rather than routine care here.
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5. Top management articles
- Panic disorder and agoraphobia The Lancet review
- CBT and medication for panic disorder Comparative treatment literature
- Guidelines for the treatment of panic disorder Guideline literature