Pediatric Panic Disorder Clinical Presentation
- Author: Jeffrey S Forrest, MD; Chief Editor: Caroly Pataki, MD more...
History
Children with panic disorder may experience the following somatic symptoms during discrete panic attacks:
- Dyspnea and/or palpitations with or without tachycardia
- Diaphoresis
- Nausea and/or diarrhea
- Urinary urgency
- Cold and clammy hands
- Dry mouth
- Dysphagia or complaint of a "lump in the throat"
Patients also may have the above symptoms, to some degree, as symptoms of anticipatory anxiety or comorbid generalized anxiety disorder. Anxious muscle tension also can occur, with trembling, twitching, a feeling of shakiness, and muscle soreness or aches. Stomachaches and headaches may be the most frequent symptoms.
DSM-IV diagnosis criteria for panic disorder without agoraphobia
The DSM-IV requires the following "A" criteria to be used when diagnosing panic disorder without agoraphobia:
- Panic attacks are recurrent and unexpected.
- At least 1 of the attacks has been followed by a minimum of 1 month of 1 or more of the following: (1) persistent concern about having more attacks, (2) worry about the implications of the attack or its consequences, and/or (3) significant behavioral changes related to the attacks.
The other DSM-IV criteria used when diagnosing panic disorder without agoraphobia include the following:
- Agoraphobia is absent
- The panic attacks are not caused by the direct physiologic effects of a substance or a general medical condition
- The panic attacks are not better accounted for by another mental disorder
DSM-IV diagnosis criteria for panic disorder with agoraphobia
The DSM-IV (1994) requires the following "A" criteria to satisfy a diagnosis of panic disorder with agoraphobia:
- Panic attacks are recurrent and unexpected
- At least 1 of the attacks has been followed by a minimum of 1 month of 1 or more of the following: (1) persistent concern about having more attacks, (2) worry about the implications of the attack or its consequences, and/or (3) significant behavioral changes related to the attacks.
The other DSM-IV criteria used when diagnosing panic disorder with agoraphobia include the following:
- Agoraphobia is present
- The panic attacks are not caused by the direct physiologic effects of a substance or a general medical condition
- The panic attacks are not better accounted for by another mental disorder
Physical Examination
Children with panic disorder may have few physical findings, because the attacks rarely occur in the presence of a physician. Hyperventilation to the point of carpal-pedal spasm is rare.
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