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Panic Disorder

Panic Disorder Index Key Ideas
"SOAP" Outline Signs and Symptoms
Differential Diagnosis Clinical Management of Panic Disorder
Medication "Scorecard" Psychosocial, Healthcare and Economic Effects

Signs and Symptoms


Panic Attack
Diagnostic Criteria
Symptom List
Panic Disorder
Without Agoraphobia
Diagnostic Criteria
Panic Disorder
With Agoraphobia
Diagnostic Criteria

Criteria for Panic Attack

A person experiences a discrete period of intense fear or discomfort:
It occurs suddenly
It reaches a peak within 10 minutes:
A person experiences four (or more) of the following 13 symptoms
Return to Signs and Symptoms

Panic Attack Symptom List

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Paresthesias (numbness or tingling sensations)
  13. Chills or hot flushes
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Note

Panic Attack is not a codable disorder.
Code the diagnosis in which the Panic Attack occurs:
  1. Panic Disorder
  2. Panic Disorder With Agoraphobia
Return to Signs and Symptoms

Panic Disorder Diagnostic Criteria

Diagnostic criteria for 300.01 Panic Disorder Without Agoraphobia

  • A. Both (1) and (2):
    1. Recurrent unexpected Panic Attacks
    2. At least one of the attacks has been followed by at least one month with at least one of the following:
      1. Persistent concern about having additional attacks
      2. Worry about the implications of the attack or its consequences
        EXAMPLES:
        Losing control
        Having a heart attack
        "Going crazy"
      3. A significant change in behavior related to the attacks
  • B. Absence of Agoraphobia
  • C. The Panic Attacks are not due to the direct physiological effects of:
    1. A substance
    2. A general medical condition
  • D. The Panic Attacks are not better accounted for by another mental disorder:
    Social Phobia
    Panic attacks occur in feared social situations
    Specific Phobia
    Panic attacks occur a specific phobic situation
    Obsessive-Compulsive Disorder
    Panic attacks occur with exposure to dirt with an contamination obsession
    Posttraumatic Stress Disorder
    Panic attacks occur in response to stimuli associated with a severe stressor
    Separation Anxiety Disorder
    Panic atttack occur while being away from home or close relatives
Return to Signs and Symptoms

Panic Disorder Diagnostic Criteria

Diagnostic criteria for 300.21 Panic Disorder With Agoraphobia

  • A. Both (1) and (2):
    1. Recurrent unexpected Panic Attacks
    2. At least one of the attacks has been followed by at least one month with at least one of the following:
      1. (a) Persistent concern about having additional attacks
      2. (b) Worry about the implications of the attack or its consequences
        EXAMPLES:
        Losing control
        Having a heart attack
        "Going crazy"
      3. (c) A significant change in behavior related to the attacks
  • B. The presence of Agoraphobia
  • C. The Panic Attacks are not due to the direct physiological effects of:
    1. A substance
    2. A general medical condition
  • D. The Panic Attacks are not better accounted for by another mental disorder:
    Social Phobia
    Panic attacks occur in feared social situations
    Specific Phobia
    Panic attacks occur a specific phobic situation
    Obsessive-Compulsive Disorder
    Panic attacks occur with exposure to dirt with an contamination obsession
    Posttraumatic Stress Disorder
    Panic attacks occur in response to stimuli associated with a severe stressor
    Separation Anxiety Disorder
    Panic atttack occur while being away from home or close relatives
Return to Signs and Symptoms

Agoraphobia Diagnostic Criteria


Criteria for Agoraphobia

Note Regarding Coding


Criteria for Agoraphobia

  • A. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.

    NOTE:

    Consider the diagnosis of Specific Phobia:
    If the avoidance is limited to one or only a few specific situations
    Consider the diagnosis of Social Phobia
    If the avoidance is limited to social situations.
  • B. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
  • C. The Agoraphobia is not better accounted for by another mental disorder:
    Social Phobia
    Panic attacks occur in feared social situations
    Specific Phobia
    Panic attacks occur a specific phobic situation
    Obsessive-Compulsive Disorder
    Panic attacks occur with exposure to dirt with an contamination obsession
    Posttraumatic Stress Disorder
    Panic attacks occur in response to stimuli associated with a severe stressor
    Separation Anxiety Disorder
    Panic atttack occur while being away from home or close relatives
Return to Agoraphobia Diagnostic Criteria

Note Regarding Coding

Agoraphobia is not a codable disorder.
Code the disorder in which the Agoraphobia occurs:
  1. Panic Disorder With Agoraphobia (300.21)
  2. Agoraphobia Without History of Panic Disorder (300.22)

Return to Agoraphobia Diagnostic Criteria

Return to Signs and Symptoms

References:

(1)DSM-IV, American Psychaitric Association, 1994.

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