The diagnosis of panic disorder requires the presence of panic attacks, anticipatory anxiety or fear of having an attack, and functional impairment. In a panic attack, patients experience four or more of 13 criteria: palpitations/pounding heart, sweating, trembling, shortness of breath/smothering sensations, feelings of choking, chest pain or discomfort, dizziness/lightheadedness, derealization/depersonalization, gastrointestinal distress, fear of losing control or going crazy, fear of dying, paresthesias, chills/flushes. Attacks peak within 10 minutes and subside in less than 1 hour. This patient clearly meets criteria for panic attacks; the next step is to determine whether she also has anticipatory anxiety. Her family history might be helpful as a risk factor for either heart disease or mental illness but is not necessary for the diagnosis of panic disorder. Restlessness is a common associated symptom of panic attacks, but this symptom does not rule in or rule out panic disorder. Panic attacks that occur during sleep do not differentiate among anxiety disorders or between panic disorder and heart disease. MVP is an incidental finding, not a causal factor.
- Excessive worry about having future episodes.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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