← Diagnosis and Management Guides
Panic Attack / Panic Disorder
Key considerations: Myocardial infarction, Pulmonary embolism, Thyrotoxicosis
Cannot miss
- Myocardial infarction
- Pulmonary embolism
- Thyrotoxicosis
- Pheochromocytoma
Likely diagnoses
- Panic attack
- Panic disorder
- Generalized anxiety disorder
- Somatic symptom disorder
Red flags
- Chest pain with cardiac risk factors
- New onset after age 50
- Vital sign abnormalities
- History of substance use
Workup
- history: Sudden onset fear/discomfort, palpitations, chest pain, dyspnea, numbness, derealization, fear of dying; exam: Vital signs, cardiac and pulmonary exam, neuro exam; labs: ECG, troponin if cardiac concern, TSH, BMP, D-dimer if PE concern; imaging: CXR if dyspnea, CT/CTA if PE suspected; bedside: ECG
Management
- immediate: Reassurance and calm environment; Benzodiazepine PRN for acute episode (lorazepam 0.5-1mg PO/IV); general: SSRI first-line for panic disorder (sertraline, escitalopram); CBT is highly effective; Short-term benzodiazepine bridge while SSRI takes effect; Avoid long-term benzodiazepine monotherapy
Disposition
- admit: Only if medical cause identified requiring admission; discharge: After medical workup negative, with PCP/psychiatry follow-up; consults: Psychiatry for refractory panic disorder
Clinical pearls
- Panic disorder is a diagnosis of exclusion — always rule out life-threatening mimics before diagnosing
- Panic attacks peak within 10 minutes and typically resolve within 20-30 minutes
Source and review
- APA Anxiety Disorder Guidelines 2023. Last reviewed: 2024-11-01