Panic Disorder Differential Diagnoses

  • Author: Mohammed A Memon, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Mar 29, 2011
 
 

Diagnostic Considerations

Many of the symptoms of an anxiety attack correspond with symptomatology found in life-threatening medical disorders eg, pulmonary embolus, which may manifest with anxiety as a primary symptom.

Go to Anxiety Disorders; Anxiety Disorder, Specific Phobia; Anxiety Disorder, Separation Anxiety and School Refusal; and Phobic Disorders for more complete information on these topics.

Cardiovascular disease and panic disorder

Persons with panic disorder are no less likely (and are perhaps even twice as likely) to have coronary artery disease than is the general population.[23] In one study, approximately 44% of emergency department patients with panic disorder had a history of coronary disease.[2]

Exclude acute coronary syndromes in patients with risk factors, history, and electrographic findings before labeling the event as panic. (Patients with supraventricular tachycardia have the potential to be misdiagnosed with panic disorder in more than 50% of cases; panic disorder may be missed if event monitoring is not obtained.)

Conditions with symptomatology that may mimic panic disorder

When making a diagnosis, keep in mind the symptomatology of medical conditions such as the following:

  • Angina and myocardial infarction (eg, dyspnea, chest pain, palpitations, diaphoresis)
  • Cardiac dysrhythmias (eg, palpitations, dyspnea, syncope)
  • Mitral valve prolapse
  • Pulmonary embolus (eg, dyspnea, hyperpnea, chest pain)
  • Asthma (eg, dyspnea, wheezing)
  • Hyperthyroidism (eg, palpitations, diaphoresis, tachycardia, heat intolerance)
  • Hypoglycemia
  • Pheochromocytoma (eg, headache, diaphoresis, hypertension)
  • Hypoparathyroidism (eg, muscle cramps, paresthesias)
  • Transient ischemic attacks (TIAs)
  • Seizure disorder

In addition, consider other mental illnesses that may result in panic attacks, including schizophrenia, manic disorder, depressive disorder, posttraumatic stress disorder, phobic disorders, and somatization disorder.

An understanding of panic disorder is important for emergency physicians, because patients with this condition frequently present to the emergency department with various somatic complaints. As many as 70% of persons with panic disorder are unrecognized as having this condition, and few individuals with panic disorder are referred to mental health professionals.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

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.

Coauthor(s)

Colin Y Daniels, MD  Consulting Staff, Department of Psychiatry, Madigan Army Medical Center

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.

Robert Harwood, MD, MPH, FACEP, FAAEM  Senior Physcian, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine

Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Michael C Plewa, MD  Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Mercy Saint Vincent Medical Center

Michael C Plewa, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sandra Yerkes to the development and writing of this article.

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