Follow-up
Further Inpatient Care
Inpatient care is rarely considered for uncomplicated panic disorder. Patients may get admitted if they display any evidence of dangerous behavior, safety concerns, report suicidal or homicidal ideation as may occur in context of acute anxiety, fear of anxiety or its consequences. Patients may require hospitalization for intoxication or withdrawal from sedative/hypnotics such as alcohol or Xanax, which sometimes get ingested or abused in attempts to medicate or manage the anxiety. Patients may also get hospitalized if they become so incapacitated by their anxiety that they are unable to adhere to outpatient care.
Further Outpatient Care
- Initial follow-up care should occur within 2 weeks because SSRIs can cause an initial exacerbation of panic symptoms. For this reason, begin with the lowest dose with the understanding that the dose must be increased at the initial follow-up visit.
- Providing a few doses of a benzodiazepine as needed (prn) can enhance patient confidence and compliance. Total tablet dispensing should remain limited to ensure patients understand they have a limited supply and that this medicine represents a temporary or emergency use option and reaffirm the importance of longer term management with SSRI medication and psychotherapeutic techniques (eg, cognitive behavior therapy). Avoid benzodiazepine prescriptions in patients with a known history of substance misuse or alcoholism.
- Assess potential suicide risk at all appointments.
- Ensure continuing treatment of any concurrent substance use disorders.
Prognosis
Prognosis is excellent with adherence to medical management.
Patient Education
- Educate patients on potential adverse effects of their treatment medications.
- Obtain informed consent for psychotropic medications.
- Document the discussion of the risks and benefits of treatment medications.
- Inform patients that causes are likely biological and psychosocial.
- Advise patients to avoid anxiogenic substances such as caffeine, energy drinks, other OTC stimulants or recreational drugs.
- Consider educating patients diagnosed with panic disorder on cognitive distortions that may help amplify anxiety. Also educate patients about recognizing trigger stimuli so they can contribute this to their psychological treatment approach.
- Discuss alcohol consumption and any recreational drug use because these psychoactive substances can impact the course of panic disorder. While some substances may seem to avert the anguish of an acute attack, they often compromise the long-term treatment plan.
- Educate the patient’s family, if available, on the important issues of minimizing any avoidance behaviors from the patient, ensuring adherence to therapy appointments and pharmacologic compliance, and understanding the nature of the anxiety symptoms with reasonable accommodation without enabling dysfunctional behaviors or alcohol/prescription drug use. Family members can be particularly helpful in helping the patient overcome unrealistic fears and ingrained avoidance behaviors, in context of ongoing cognitive behavior therapy where the patient has learned coping skills to manage the anxiety.
- National Institute of Mental Health, Panic Disorder
- MedlinePlus, Panic Disorder
- MayoClinic, Panic attacks and panic disorder
- For excellent patient education resources, visit eMedicine's Anxiety Center. Also, see eMedicine's patient education articles Anxiety, Panic Attacks, and Hyperventilation.
Miscellaneous
Medicolegal Pitfalls
- Failure to recognize an underlying medical etiology
- Failure to document informed consent for medications
- Failure to document warnings to patients about the potential adverse effects (eg, sedation or suicidal ideation) of treatment medications
- Failure to assess suicide risk and ensure safety plan in case these thoughts occur
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sandra Yerkes to the development and writing of this article.
More on Panic Disorder |
| Overview: Panic Disorder |
| Differential Diagnoses & Workup: Panic Disorder |
| Treatment & Medication: Panic Disorder |
 Follow-up: Panic Disorder |
| References |
| « Previous Page |
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Further Reading
Keywords
anxiety attack, panic attack, mood disorder, agoraphobia, phobia, anxiety disorder, anxiety provocation, acute anxiety, panic, panic disorder
