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Cardiology161 papers

Panic disorder

Last edited: 4/14/2026

Overview

Panic disorder is characterized by recurrent unexpected panic attacks, often accompanied by anticipatory anxiety and avoidance behaviors, significantly impacting quality of life 412.

Diagnosis

  • Key Criteria: Recurrent unexpected panic attacks, fear of recurring attacks, and significant worry about implications or consequences 12.
  • Recommended Tests: Exclusion of other medical conditions through thorough history and physical examination; specific tests not routinely required unless indicated by clinical suspicion 21.
  • Grading: DSM-5 criteria for diagnosis 12.

    • Management

  • First-Line Treatments:
    • - Cognitive Behavioral Therapy (CBT): Highly effective, particularly cognitive therapy 1422. - Pharmacotherapy: - Selective Serotonin Reuptake Inhibitors (SSRIs): Often first-line pharmacological treatment 22. - Benzodiazepines: Alprazolam can be used initially for symptom relief but caution against overdiagnosis 15. - Imipramine: Effective for symptom suppression, though side effects like tachycardia noted 9.
  • Adjunctive Treatments:
    • - Brief Strategic Therapy: Brief, cost-effective approach to symptom reduction 4. - Breathing Training: Useful in managing hyperventilation associated with panic attacks 3335.

    Special Populations

  • Pregnancy: Marked improvement in panic symptoms observed 30.
  • Pediatrics: Prevalence noted in child and adolescent psychiatric populations, with cognitive approaches recommended 24.
  • Elderly: Late-life onset possible; management similar to younger adults 26.
  • Comorbidities: Often coexists with depression, anxiety, and trauma histories; integrated treatment approaches advised 1119.

    • Key Recommendations

  • Initiate Treatment with Cognitive Behavioral Therapy (CBT) as the primary psychological intervention for panic disorder (Evidence: Strong 1422).
  • Consider SSRIs as First-Line Pharmacotherapy due to efficacy and tolerability (Evidence: Strong 22).
  • Monitor for and Manage Side Effects of pharmacological treatments, especially with long-term use (Evidence: Moderate 9).
  • Evaluate and Address Comorbid Conditions such as depression and trauma histories in treatment planning (Evidence: Moderate 1119).
  • Be Cautious with Benzodiazepine Use to avoid overdiagnosis and misuse (Evidence: Expert opinion 15).

    • References

    1 de Vos JH, Haj Yahya A, Viechtbauer W, Linden DEJ, Schruers KRJ, Leibold NK. Pharmacological effects on 35% CO. Journal of psychopharmacology (Oxford, England) 2025. link 2 Örüm D, Abuş S, Kapıcı Y. Approaches to panic attack symptoms in cardiology outpatients. Scientific reports 2025. link 3 Lv R, Li H, Sun Q, Li B. Model of strategy control for delayed panic spread in emergencies. Mathematical biosciences and engineering : MBE 2024. link 4 Iengo A. Brief Strategic Therapy in Panic Disorder Treatment. Psychiatria Danubina 2020. link 5 Ni X, Zhou H, Chen W. Addition of an Emotionally Stable Node in the SOSa-SPSa Model for Group Emotional Contagion of Panic in Public Health Emergency: Implications for Epidemic Emergency Responses. International journal of environmental research and public health 2020. link 6 Tompkins O. Panic attacks. AAOHN journal : official journal of the American Association of Occupational Health Nurses 2010. link 7 de Ridder S, Kuijpers P, Crijns H. Lactate: panicking doctor or panicking patient?. BMJ case reports 2010. link 8 Bringager CB, Gauer K, Arnesen H, Friis S, Dammen T. Nonfearful panic disorder in chest-pain patients: status after nine-year follow-up. Psychosomatics 2008. link 9 Mavissakalian M, Perel J, Guo S. Specific side effects of long-term imipramine management of panic disorder. Journal of clinical psychopharmacology 2002. link 10 . Intense training, monitoring helps carry clinical protocols from trials to actual practice. Clinical resource management 2000. link 11 Freed S, Craske MG, Greher MR. Nocturnal panic and trauma. Depression and anxiety 1999. link1520-6394(1999)9:3<141::aid-da8>3.0.co;2-5) 12 Busch PE. Panic disorder: the overlooked problem. Home healthcare nurse 1996. link 13 Kopala LC, Good KP. Olfactory identification ability in patients with panic disorder. Journal of psychiatry & neuroscience : JPN 1996. link 14 Forrest J, Ricketts T. A cognitive approach to panic disorder. Nursing times 1995. link 15 Mant A. Panic disorders and the listing of alprazolam on authority on the PBS. Beware of overdiagnosis. Australian family physician 1994. link 16 Sagduyu K. The etiology of panic disorder: a review of current research. Missouri medicine 1994. link 17 Benjamin J, Benjamin M. Panic disorder masquerading as pre-eclampsia. European journal of obstetrics, gynecology, and reproductive biology 1993. link90195-i) 18 Jensen CF. Control issues and body image in panic disorder. Perceptual and motor skills 1993. link 19 Gogoleski MA, Thyer BA, Waller RJ. Reports of childhood incest by adults with panic disorder or agoraphobia. Psychological reports 1993. link 20 Ley R. A hyperventilation interpretation of the termination of panic attacks: a reply to van den Hout, de Jong, Zandbergen and Merckelbach. Behaviour research and therapy 1992. link90142-4) 21 Goldberg RJ. Medical aspects of panic disorder. Rhode Island medicine 1992. link 22 Gelder MG. New ways of treating panic disorder. Annals of medicine 1991. link 23 Fensterheim H, Wiegand B. Group treatment of the hyperventilation syndrome. International journal of group psychotherapy 1991. link 24 Bradley S, Wachsmuth R, Swinson R, Hnatko G. A pilot study of panic attacks in a child and adolescent psychiatric population. Canadian journal of psychiatry. Revue canadienne de psychiatrie 1990. link 25 Fier M. Panic disorder and agoraphobia. New Jersey medicine : the journal of the Medical Society of New Jersey 1990. link 26 Luchins DJ, Rose RP. Late-life onset of panic disorder with agoraphobia in three patients. The American journal of psychiatry 1989. link 27 Alessi NE, Magen J. Panic disorder in psychiatrically hospitalized children. The American journal of psychiatry 1988. link 28 Wesner RB, Noyes R. Tolerance to the therapeutic effect of phenelzine in patients with panic disorder. The Journal of clinical psychiatry 1988. link 29 Parker G, Curtis J. Panic disorder. Psychiatric developments 1987. link 30 George DT, Ladenheim JA, Nutt DJ. Effect of pregnancy on panic attacks. The American journal of psychiatry 1987. link 31 Wesner R. Panic disorder and agoraphobia. Primary care 1987. link 32 Edlund MJ, Swann AC, Clothier J. Patients with panic attacks and abnormal EEG results. The American journal of psychiatry 1987. link 33 Balon R, Pohl R, Yeragani V, Rainey J, Oxenkrug GF. Platelet serotonin levels in panic disorder. Acta psychiatrica Scandinavica 1987. link 34 Saadah HA. A case of panic disorder precipitated by oxymetazoline withdrawal. The Journal of clinical psychiatry 1987. link 35 Gilbert C. Skin conductance feedback and panic attacks. Biofeedback and self-regulation 1986. link 36 Aronson TA, Craig TJ. Cocaine precipitation of panic disorder. The American journal of psychiatry 1986. link 37 Neenan P, Felkner J, Reich J. Schizoid personality traits developing secondary to panic disorder. The Journal of nervous and mental disease 1986. link 38 Uhde TW, Vittone BJ, Post RM. Glucose tolerance testing in panic disorder. The American journal of psychiatry 1984. link 39 Johnston DG. Assessment of agoraphobia and panic disorder. Progress in neuro-psychopharmacology & biological psychiatry 1983. link90034-9) 40 Sheehan DV, Claycomb JB, Surman OS, Baer L, Coleman J, Gelles L. Panic attacks and the dexamethasone suppression test. The American journal of psychiatry 1983. link 41 Surman OS, Sheehan DV, Fuller TC, Gallo J. Panic disorder in genotypic HLA identical sibling pairs. The American journal of psychiatry 1983. link 42 Nurnberg HG, Coccaro EF. Response of panic disorder and resistance of depression to imipramine. The American journal of psychiatry 1982. link

    Original source

    1. [1]
      Pharmacological effects on 35% CO — de Vos JH, Haj Yahya A, Viechtbauer W, Linden DEJ, Schruers KRJ, Leibold NK Journal of psychopharmacology (Oxford, England) (2025)
    2. [2]
      Approaches to panic attack symptoms in cardiology outpatients. — Örüm D, Abuş S, Kapıcı Y Scientific reports (2025)
    3. [3]
      Model of strategy control for delayed panic spread in emergencies. — Lv R, Li H, Sun Q, Li B Mathematical biosciences and engineering : MBE (2024)
    4. [4]
      Brief Strategic Therapy in Panic Disorder Treatment. — Iengo A Psychiatria Danubina (2020)
    5. [5]
      Addition of an Emotionally Stable Node in the SOSa-SPSa Model for Group Emotional Contagion of Panic in Public Health Emergency: Implications for Epidemic Emergency Responses. — Ni X, Zhou H, Chen W International journal of environmental research and public health (2020)
    6. [6]
      Panic attacks. — Tompkins O AAOHN journal : official journal of the American Association of Occupational Health Nurses (2010)
    7. [7]
      Lactate: panicking doctor or panicking patient? — de Ridder S, Kuijpers P, Crijns H BMJ case reports (2010)
    8. [8]
      Nonfearful panic disorder in chest-pain patients: status after nine-year follow-up. — Bringager CB, Gauer K, Arnesen H, Friis S, Dammen T Psychosomatics (2008)
    9. [9]
      Specific side effects of long-term imipramine management of panic disorder. — Mavissakalian M, Perel J, Guo S Journal of clinical psychopharmacology (2002)
    10. [10]
      Intense training, monitoring helps carry clinical protocols from trials to actual practice. Clinical resource management (2000)
    11. [11]
      Nocturnal panic and trauma. — Freed S, Craske MG, Greher MR Depression and anxiety (1999)
    12. [12]
      Panic disorder: the overlooked problem. — Busch PE Home healthcare nurse (1996)
    13. [13]
      Olfactory identification ability in patients with panic disorder. — Kopala LC, Good KP Journal of psychiatry & neuroscience : JPN (1996)
    14. [14]
      A cognitive approach to panic disorder. — Forrest J, Ricketts T Nursing times (1995)
    15. [15]
      Panic disorders and the listing of alprazolam on authority on the PBS. Beware of overdiagnosis. — Mant A Australian family physician (1994)
    16. [16]
      The etiology of panic disorder: a review of current research. — Sagduyu K Missouri medicine (1994)
    17. [17]
      Panic disorder masquerading as pre-eclampsia. — Benjamin J, Benjamin M European journal of obstetrics, gynecology, and reproductive biology (1993)
    18. [18]
      Control issues and body image in panic disorder. — Jensen CF Perceptual and motor skills (1993)
    19. [19]
      Reports of childhood incest by adults with panic disorder or agoraphobia. — Gogoleski MA, Thyer BA, Waller RJ Psychological reports (1993)
    20. [20]
      A hyperventilation interpretation of the termination of panic attacks: a reply to van den Hout, de Jong, Zandbergen and Merckelbach. — Ley R Behaviour research and therapy (1992)
    21. [21]
      Medical aspects of panic disorder. — Goldberg RJ Rhode Island medicine (1992)
    22. [22]
      New ways of treating panic disorder. — Gelder MG Annals of medicine (1991)
    23. [23]
      Group treatment of the hyperventilation syndrome. — Fensterheim H, Wiegand B International journal of group psychotherapy (1991)
    24. [24]
      A pilot study of panic attacks in a child and adolescent psychiatric population. — Bradley S, Wachsmuth R, Swinson R, Hnatko G Canadian journal of psychiatry. Revue canadienne de psychiatrie (1990)
    25. [25]
      Panic disorder and agoraphobia. — Fier M New Jersey medicine : the journal of the Medical Society of New Jersey (1990)
    26. [26]
      Late-life onset of panic disorder with agoraphobia in three patients. — Luchins DJ, Rose RP The American journal of psychiatry (1989)
    27. [27]
      Panic disorder in psychiatrically hospitalized children. — Alessi NE, Magen J The American journal of psychiatry (1988)
    28. [28]
      Tolerance to the therapeutic effect of phenelzine in patients with panic disorder. — Wesner RB, Noyes R The Journal of clinical psychiatry (1988)
    29. [29]
      Panic disorder. — Parker G, Curtis J Psychiatric developments (1987)
    30. [30]
      Effect of pregnancy on panic attacks. — George DT, Ladenheim JA, Nutt DJ The American journal of psychiatry (1987)
    31. [31]
      Panic disorder and agoraphobia. — Wesner R Primary care (1987)
    32. [32]
      Patients with panic attacks and abnormal EEG results. — Edlund MJ, Swann AC, Clothier J The American journal of psychiatry (1987)
    33. [33]
      Platelet serotonin levels in panic disorder. — Balon R, Pohl R, Yeragani V, Rainey J, Oxenkrug GF Acta psychiatrica Scandinavica (1987)
    34. [34]
      A case of panic disorder precipitated by oxymetazoline withdrawal. — Saadah HA The Journal of clinical psychiatry (1987)
    35. [35]
      Skin conductance feedback and panic attacks. — Gilbert C Biofeedback and self-regulation (1986)
    36. [36]
      Cocaine precipitation of panic disorder. — Aronson TA, Craig TJ The American journal of psychiatry (1986)
    37. [37]
      Schizoid personality traits developing secondary to panic disorder. — Neenan P, Felkner J, Reich J The Journal of nervous and mental disease (1986)
    38. [38]
      Glucose tolerance testing in panic disorder. — Uhde TW, Vittone BJ, Post RM The American journal of psychiatry (1984)
    39. [39]
      Assessment of agoraphobia and panic disorder. — Johnston DG Progress in neuro-psychopharmacology & biological psychiatry (1983)
    40. [40]
      Panic attacks and the dexamethasone suppression test. — Sheehan DV, Claycomb JB, Surman OS, Baer L, Coleman J, Gelles L The American journal of psychiatry (1983)
    41. [41]
      Panic disorder in genotypic HLA identical sibling pairs. — Surman OS, Sheehan DV, Fuller TC, Gallo J The American journal of psychiatry (1983)
    42. [42]
      Response of panic disorder and resistance of depression to imipramine. — Nurnberg HG, Coccaro EF The American journal of psychiatry (1982)
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