When is outpatient care indicated for patients with panic disorder, and when is inpatient care warranted?

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

Outpatient care is the general setting for uncomplicated panic disorder. Patients may be hospitalized if they display any evidence of dangerous behavior, have safety concerns, and/or report suicidal or homicidal ideation—as may occur in context of acute anxiety, fear of anxiety, or its consequences.

Considerations for admission include intoxication or withdrawal from sedative/hypnotics such as alcohol or alprazolam, which are sometimes ingested or abused in patients’ attempts to medicate or manage the anxiety. Patients may also be hospitalized if they become so incapacitated by their anxiety that they are unable to adhere to outpatient care. Inpatient treatment is also necessary in patients when the differential diagnosis includes other medical disorders that warrant admission (e.g., unstable angina, acute myocardial ischemia).

The APA recommends clinicians carefully assess the risk for suicide in patients with panic disorder as these individuals have an increased risk of suicidal ideation and behavior, regardless of whether comorbid conditions are present (e.g., major depression). [55]

In rare cases of severe panic disorder in which outpatient management is ineffective or impractical, hospitalization or partial hospitalization may be necessary. [55] Transfer to an acute psychiatric facility may be necessary for suicidal or homicidal patients.


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