What features of the patient history should be included in the assessment of panic disorder?

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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Answer

Assess precipitating events (e.g., major life events), phobias, agoraphobia, obsessive-compulsive behavior, and suicidal ideation and/or plan. In one study, lifetime rates of suicide attempts in patients with uncomplicated panic disorder were consistently higher (7%) than in individuals without a psychiatric disorder (1%). [69] Also assess whether there is a family history of panic or other psychiatric illness.

Exclude involvement of alcohol, nicotine, illicit drugs (e.g., cocaine, amphetamine, phencyclidine, amyl nitrate, lysergic acid diethylamide [LSD], yohimbine, 3,4-methylenedioxymethamphetamine [MDMA, ecstasy]), cannabis, and medications (e.g., caffeine, theophylline, sympathomimetics, anticholinergics), including OTC agents.

In experimental settings, symptoms can be elicited in people with panic disorder by hyperventilation, inhalation of carbon dioxide, [8] caffeine consumption, or intravenous infusions of hypertonic sodium lactate or hypertonic saline, [9] cholecystokinin, isoproterenol, flumazenil, or naltrexone. [10] The carbon dioxide inhalation challenge is especially provocative of panic symptoms in smokers. [11]


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