Acute Panic Attack Definition An abrupt episode of intense fear associated with physical and cognitive symptoms Aetiology • • • • • Panic disorder Anxiety due to another medical condition Substance/medication induced anxiety disorder Other psychiatric disorders e.g. psychotic disorders Other psychotic disorders such as psychotic disorders Clinical Features • • • Peak within several minutes and consist of at least four of the following: Cognitive: - Fear of dying - Fear of losing control - Derealisation or depersonalisation Somatic: - Palpitations, tachycardia - Sweating ot diaphoresis - Trembling or shaking - SOB or smothering sensation - Chocking sensation - Chest pain or tightness - Abdominal discomfort or nausea - Dizziness, light-headedness or faintness - Chills or feeling hot - Parenthesis “STUDENTS FEAR the 3Cs:” Sweating, Trembling, Unsteadiness (dizziness), Derealization, Elevated heart rate (palpitations), Nausea, Tingling, and Shortness of breath; FEAR of dying or going crazy; Chest pain, Choking, and Chills. Diagnosis • • • Presence of clinical features Exclusion of other organic causes of clinical features Investigations: - CBC BMP Thyroid function tests Serum and urine toxicology screen ECG DDx • Differentials of: - Chest pain - SOB - Scope and pre-syncope - Stroke - Abdominal pain - Cardiac arrythmias - Sepsis Management • • • • Rule out life threatening causes of symptoms - E.g. MI, PNX, thyroid storm Immediate interventions - Reassurance - Deep breathing Psychological - CBT ➔Especially in those who decline pharmacotherapy Pharmacological - SSRIs, SNRI ➔Start with a low dose and titrate up as tolerated ➔Anxiety disorders usually need treatment at higher doses for longer periods of time than depression ➔Full response make take up to 12 weeks - Treat for up to 1 year after symptoms resolve to avoid relapse - Explain the adverse effects prior to minimise risk of non-adhereance - Benzodiazepines are considered second line ➔Short acting Prognosis • • • • 85% achieve satisfactory results 10 to 20% continue with significant symptoms Longer term -> 65% -> achieve remission Chronic clinical course - Episodic with psychosocial stressors