eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Anxiety Disorder: Panic Disorder: Differential Diagnoses & Workup

Author: David S Reitman, MD, MBA, Director of Pediatric and Adolescent Health, John L Gildner Regional Institute for Children and Adolescents; Chairman of Pediatrics, Department of Pediatrics, Suburban Hospital; University Physician, George Washington University; Clinical Assistant Professor of Pediatrics, George Washington University; Attending Staff, Children's National Medical Center
Coauthor(s): Lene Holm Larsen, PhD, Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago; Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Contributor Information and Disclosures

Updated: May 24, 2006

Differential Diagnoses

Anxiety Disorder: Generalized Anxiety
Hyperthyroidism
Anxiety Disorder: Separation Anxiety and School Refusal
Hypoglycemia
Anxiety Disorder: Social Phobia and Selective Mutism
Anxiety Disorder: Specific Phobia
Hyperinsulinemia

Other Problems to Be Considered

Anxiety disorder caused by a general medical condition
Substance-induced anxiety disorder
Delusional disorder
Psychotic disorder

Workup

Laboratory Studies

  • Excessive medical workup without clear indication by history and physical examination is contraindicated because it can exacerbate anxiety.
  • The relatively rare medical causes of panic in pediatric patients, such as hyperinsulinemia or hyperthyroidism, should be documented with appropriate laboratory studies.

Other Tests

  • A structured interview, such as the Anxiety Disorders Interview Schedule for DSM-IV Child and Parent Versions (ADIS-C/P), can be employed.
  • Questionnaires, such as the Revised Children's Manifest Anxiety Scale (RCMAS), the Multidimensional Anxiety Scale for Children (MASC), and the Screen for Child Anxiety Related Emotional Disorders (SCARED), child and parent versions, can be used to further assess anxiety symptoms.

More on Anxiety Disorder: Panic Disorder

Overview: Anxiety Disorder: Panic Disorder
Differential Diagnoses & Workup: Anxiety Disorder: Panic Disorder
Treatment & Medication: Anxiety Disorder: Panic Disorder
Follow-up: Anxiety Disorder: Panic Disorder
References
[ CLOSE WINDOW ]

References

  1. Barrett PM, Rapee RM, Dadds MM, Ryan SM. Family enhancement of cognitive style in anxious and aggressive children. J Abnorm Child Psychol. Apr 1996;24(2):187-203. [Medline].

  2. Birmaher B, Brent DA, Chiappetta L, et al. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. Oct 1999;38(10):1230-6. [Medline].

  3. Green WH. Child and Adolescent Clinical Psychopharmacology. 3rd ed. Philadelphia:. Lippincott Williams & Wilkins;2001.

  4. Hayward C, Killen JD, Kraemer HC. Predictors of panic attacks in adolescents. J Am Acad Child Adolesc Psychiatry. Feb 2000;39(2):207-14. [Medline].

  5. Kendall PC. Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol. Feb 1994;62(1):100-10. [Medline].

  6. Kendall PC, Sugarman A. Attrition in the treatment of childhood anxiety disorders. J Consult Clin Psychol. Oct 1997;65(5):883-8. [Medline].

  7. Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. Nov 1996;35(11):1502-10. [Medline].

  8. March JS, Parker JD, Sullivan K, et al. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. Apr 1997;36(4):554-65. [Medline].

  9. Ost L, Treffers PD. Onset, course, and outcome for anxiety disorders in children. In: Silverman W, Treffers PD, eds. Anxiety Disorders in Children & Adolescent. 2001:293-312.

  10. Reynolds CR, Richmond BO. What I think and feel: a revised measure of children''s manifest anxiety. J Abnorm Child Psychol. Jun 1978;6(2):271-80. [Medline].

  11. Silverman WK, Albano AM. The Anxiety Disorders Interview Schedule for Children (DSM-IV). San Antonio, TX:. Psychological Corporation;1997.

  12. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

panic disorder, hyperventilation syndrome, agoraphobia, panic attacks, unexpected panic attacks, situationally bound panic attacks, situationally predisposed panic attacks, recurrent panic attacks

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

David S Reitman, MD, MBA, Director of Pediatric and Adolescent Health, John L Gildner Regional Institute for Children and Adolescents; Chairman of Pediatrics, Department of Pediatrics, Suburban Hospital; University Physician, George Washington University; Clinical Assistant Professor of Pediatrics, George Washington University; Attending Staff, Children's National Medical Center
David S Reitman, MD, MBA is a member of the following medical societies: American Academy of Pediatrics, American College Health Association, American College of Physician Executives, American College of Sports Medicine, American Medical Association, Phi Beta Kappa, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Lene Holm Larsen, PhD, Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago
Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.