Review Question - QID 217086

This patient with signs and symptoms of a panic attack (chest pain, shortness of breath, dizziness, chills, nausea, tingling, tachycardia, tachypnea) that spontaneously resolve after 30 minutes, 4 panic attacks in a month, and persistent concerns about having a panic attack most likely has panic disorder. Agoraphobia is a potential complication of panic disorder.

Panic disorder is defined by spontaneous, recurrent panic attacks with persistent concerns about having another panic attack or maladaptive behavioral changes in response to panic attacks. Panic disorder affects 2-6% of adults in the United States, more commonly develops in women 18 to 45 years old, and is associated with mood disorders, other anxiety disorders, cluster C personality disorders, and obsessive-compulsive disorders. Symptoms of a panic attack include an intense fear of dying, sympathetic hyperactivity, paresthesias, chest pain, depersonalization/derealization, and light-headedness. These symptoms usually peak within 10 minutes and last approximately 20-30 minutes. Panic disorder may be complicated by agoraphobia and medication noncompliance. Agoraphobia may develop in patients with panic disorder due to fear or anxiety about having a panic attack in a public place, whereby a patient may perceive difficulty escaping or seeking help.

Locke et al. review the epidemiology, screening, diagnosis, and treatment for generalized anxiety disorder and panic disorder.

Incorrect Answers:
Answer 2: Bipolar disorder is a mood disorder associated with panic disorder. There is no evidence that panic disorder is complicated by bipolar disorder. However, comorbid panic disorder can predict slower treatment response to bipolar disorder due to medication noncompliance.

Answer 3: Brief psychotic disorder is defined by a sudden onset of psychotic behaviors such as hallucinations or delusions that occur after a stressful event. Both brief psychotic disorder and panic attacks may be precipitated by a stressful event; however, there is no evidence that brief psychotic disorder is a complication of panic disorder.

Answer 4: Substance use disorder is a risk factor for panic disorder, but not a complication. For example, alcohol withdrawal can precipitate panic disorder, and daily smoking is strongly associated with panic disorders and other anxiety disorders. Benzodiazepines are effective for treating acute panic attacks and may be used as a bridging therapy for long-term management of panic disorder, but they should be avoided in patients with substance use disorder.

Answer 5: Trichotillomania is an irresistible compulsion to pull out one’s hair. Trichotillomania co-occurs with an anxiety disorder in approximately 1 in 4 cases, but there is no evidence that panic disorders cause trichotillomania.

Bullet Summary:
Panic disorder is characterized by recurrent panic attacks followed by fear of another panic attack; agoraphobia is a potential complication of panic disorder.