Difference between revisions of "Panic attack"

(Text replacement - "*Chest pain" to "*Chest pain")
 
Line 4: Line 4:
 
==Clinical Features==
 
==Clinical Features==
 
*Discrete period of intense fear or discomfort that peaks within a few minutes '''plus'' at least four of the following:<ref name="Foldes">Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.</ref>
 
*Discrete period of intense fear or discomfort that peaks within a few minutes '''plus'' at least four of the following:<ref name="Foldes">Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.</ref>
**[[Chest pain]]
+
**[[Chest pain]], [[palpitations]]
**Palpitations
+
**[[Dyspnea]], feeling of suffocation
**Dyspnea
+
**Diaphoresis, hot or cold flashes
**Feeling of suffocation
+
**[[Nausea]]
**Diaphoresis
 
**Hot or cold flashes
 
**Nausea
 
**Fear of death
 
**Fear of losing control
 
 
**Trembling
 
**Trembling
 
**Paresthesias
 
**Paresthesias
 +
**Fear of death, fear of losing control
 
**Depersonalization
 
**Depersonalization
 
*May feel the "urge to flee" or "sense of impending doom"
 
*May feel the "urge to flee" or "sense of impending doom"
Line 22: Line 18:
  
 
==Evaluation==
 
==Evaluation==
 +
*Diagnosis of exclusion: must rule out organic causes of symptoms (see [[chest pain]], [[palpitations]], [[shortness of breath]], etc.)
 
*Clinical diagnosis, based on history and physical exam.
 
*Clinical diagnosis, based on history and physical exam.
  

Latest revision as of 00:27, 11 December 2016

Background

  • Can occur de novo or in setting of psychiatric disorder (most commonly panic disorder)[1]

Clinical Features

  • Discrete period of intense fear or discomfort that peaks within a few minutes 'plus at least four of the following:[1]
    • Chest pain, palpitations
    • Dyspnea, feeling of suffocation
    • Diaphoresis, hot or cold flashes
    • Nausea
    • Trembling
    • Paresthesias
    • Fear of death, fear of losing control
    • Depersonalization
  • May feel the "urge to flee" or "sense of impending doom"

Differential Diagnosis

Acute dyspnea

Emergent

Pediatric-specific

Non-Emergent

Evaluation

Management

  • Reassurance and patient education
  • 1-2mg Lorazepam (Ativan) IV/IM

Disposition

  • Discharge

See Also

References

  1. 1.0 1.1 Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.