eMedicine Specialties > Psychiatry > Adult

Panic Disorder: Differential Diagnoses & Workup

Author: Colin Y Daniels, MD, Consulting Staff, Department of Psychiatry, Madigan Army MedicalCenter
Contributor Information and Disclosures

Updated: Jul 29, 2009

Differential Diagnoses

Adjustment Disorders
Mental Disorders Secondary to General Medical Conditions
Anxiety Disorders
Mitral Valve Prolapse
Bipolar Affective Disorder
Myocardial Infarction
Caffeine-Related Psychiatric Disorders
Obsessive-Compulsive Disorder
Depression
Pheochromocytoma
Dissociative Disorders
Phobic Disorders
Factitious Disorder
Posttraumatic Stress Disorder
Hyperthyroidism
Social Phobia
Hypochondriasis
Somatoform Disorders
Hypoglycemia
Stimulants

Other Problems to Be Considered

Acute stress/posttraumatic stress disorder
Adrenal dysfunction
Alcohol/sedative-hypnotic withdrawal
Drug intoxication
Generalized anxiety disorder
Hyperthyroidism
Pulmonary disease
Temporal lobe seizure activity
Vestibular dysfunction

Workup

Laboratory Studies

No laboratory parameters are specific for panic disorder. Laboratory evaluation is performed to exclude any of the aforementioned differential diagnoses.

Imaging Studies

No imaging study findings are currently specific for panic disorder, although they are performed to evaluate anatomic evidence of other diagnostic possibilities. Studies may include an EEG to exclude partial complex seizures. Investigational functional neuroimaging is not used in routine clinical practice for diagnosis or for monitoring treatment response.

Procedures

No invasive procedures are required to diagnose panic disorder, although they may be useful in eliminating other differential diagnoses. History, collateral information, and physical/Mental Status Examinations remain the diagnostic cornerstones.

More on Panic Disorder

Overview: Panic Disorder
Differential Diagnoses & Workup: Panic Disorder
Treatment & Medication: Panic Disorder
Follow-up: Panic Disorder
References

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Press; 2000.

  2. Croom KF, Perry CM, Plosker GL. Mirtazapine: a review of its use in major depression and other psychiatric disorders. CNS Drugs. 2009;23(5):427-52. [Medline].

  3. American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. May 1998;155(5 Suppl):1-34. [Medline].

  4. Bandelow B, Behnke K, Lenoir S, et al. Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison. J Clin Psychiatry. Mar 2004;65(3):405-13. [Medline].

  5. Bohni MK, Spindler H, Arendt M, Hougaard E, Rosenberg NK. A randomized study of massed three-week cognitive behavioural therapy schedule for panic disorder. Acta Psychiatr Scand. Mar 10 2009;[Medline].

  6. Fogel BS, Schiffer RB, Rao SM, eds. Neuropsychiatry. ed. Baltimore, Md: Williams & Wilkins; 1996:263-8.

  7. Hales RE, Yudofsky SC, Talbott JA, eds. APA Textbook of Psychiatry. 3rd ed. Washington, DC: American Psychiatric Press; 1999.

  8. Kaplan HI, Sadock BJ, eds. Synopsis of Psychiatry. Behavioral Sciences/Clinical Psychiatry. 8th ed. Baltimore, Md: Williams & Wilkins; 1997:594-603.

  9. Kim YW, Lee SH, Choi TK, Suh SY, Kim B, Kim CM, et al. Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder. Depress Anxiety. 2009;26(7):601-6. [Medline].

  10. Kushner MG, Sletten S, Donahue C, Thuras P, Maurer E, Schneider A, et al. Cognitive-behavioral therapy for panic disorder in patients being treated for alcohol dependence: Moderating effects of alcohol outcome expectancies. Addict Behav. Jun-Jul 2009;34(6-7):554-60. [Medline].

  11. Marcks BA, Weisberg RB, Keller MB. Psychiatric treatment received by primary care patients with panic disorder with and without agoraphobia. Psychiatr Serv. Jun 2009;60(6):823-30. [Medline].

  12. Pfeiffer PN, Ganoczy D, Ilgen M, Zivin K, Valenstein M. Comorbid anxiety as a suicide risk factor among depressed veterans. Depress Anxiety. Jun 18 2009;[Medline].

  13. Pollack MH, Simon NM, Worthington JJ, et al. Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder. J Psychopharmacol. Sep 2003;17(3):276-82. [Medline].

  14. Sadock BJ, Sadock VA, Kaplan HI. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Baltimore, Md: Williams & Wilkins; 2000:1445-90.

  15. Stahl SM, Gergel I, Li D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. Nov 2003;64(11):1322-7. [Medline].

  16. Stahl's Essential Psychopharmacology, Neuroscientific Basis and Practical Applications. 3rd Ed. New York: Cambridge University Press; 2008.

  17. Swoboda H, Amering M, Windhaber J, Katschnig H. The long-term course of panic disorder--an 11 year follow-up. J Anxiety Disord. 2003;17(2):223-32. [Medline].

Further Reading

Keywords

anxiety attack, panic attack, mood disorder, agoraphobia, phobia, anxiety disorder, anxiety provocation, acute anxiety, panic, panic disorder

Contributor Information and Disclosures

Author

Colin Y Daniels, MD, Consulting Staff, Department of Psychiatry, Madigan Army MedicalCenter
Colin Y Daniels, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Mohammed A Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System
Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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