Pediatric Panic Disorder Workup

  • Author: Jeffrey S Forrest, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Dec 16, 2011
 

Approach Considerations

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.

A comprehensive review of medications is indicated to ascertain the potential influence of any illicit or over-the-counter substances in the presentation of the patient’s symptoms.[8]

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Structured Interview

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),[9] and the Screen for Child Anxiety Related Emotional Disorders (SCARED),[10] child and parent versions, can be used to further assess anxiety symptoms.

The Anxiety Disorders Interview Schedule for Children is a comprehensive semistructured interview administered by clinicians to children age 7-17 years. It differentiates between each type of childhood anxiety disorder. It assures the collection of high-quality data, enables clinicians to indicate a primary or most-impairing diagnosis, and has good inter-rater reliability.

Preliminary studies have demonstrated the Autonomic Nervous System (ANS) Questionnaire as another screening test that is sensitive for panic disorder in the adolescent patient population.[5]

Self- and parent-report measures used in evaluating pediatric panic disorder include the School Refusal Assessment Questionnaire and the Social Phobia and Anxiety Inventory for Children.

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Contributor Information and Disclosures
Author

Jeffrey S Forrest, MD 

Disclosure: Nothing to disclose.

Coauthor(s)

Nirupama Natarajan, MD  Fellow in Child and Adolescent Psychiatry, Carilion Clinic, Virginia Tech Carilion School of Medicine

Nirupama Natarajan, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, American Association for Emergency Psychiatry, American Association of Physicians of Indian Origin, American Medical Association, American Psychiatric Association, American Society for Adolescent Psychiatry, American Society of Clinical Psychopharmacology, Association for Academic Psychiatry, Association of Clinical Research Professionals, and Medical Society of Virginia

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

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.

Additional Contributors

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.

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 Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Meuret AE, Rosenfield D, Hofmann SG, Suvak MK, Roth WT. Changes in respiration mediate changes in fear of bodily sensations in panic disorder. J Psychiatr Res. Mar 2009;43(6):634-41. [Medline].

  2. 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].

  3. 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.

  4. 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].

  5. Queen AH, Ehrenreich-May J, Hershorin ER. Preliminary Validation of a Screening Tool for Adolescent Panic Disorder in Pediatric Primary Care Clinics. Child Psychiatry Hum Dev. Sep 22 2011;[Medline].

  6. Agency for Healthcare Research and Quality. Guideline summary: Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. Accessed December 7, 2011. National Guideline Clearinghouse (NGC). [Full Text].

  7. Doerfler LA, Connor DF, Volungis AM, Toscano PF Jr. Panic disorder in clinically referred children and adolescents. Child Psychiatry Hum Dev. Jun 2007;38(1):57-71. [Medline].

  8. Agency for Healthcare Research and Quality (AHRQ). Guideline summary: Practice guideline for the treatment of patients with panic disorder. Accessed December 7, 2011. National Guideline Clearinghouse (NGC). [Full Text].

  9. 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].

  10. 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].

  11. 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].

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

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

  14. Chavira DA, Stein MB, Golinelli D, Sherbourne CD, Craske MG, Sullivan G, et al. Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. J Nerv Ment Dis. Oct 2009;197(10):715-21. [Medline].

  15. Teachman BA, Marker CD, Smith-Janik SB. Automatic associations and panic disorder: trajectories of change over the course of treatment. J Consult Clin Psychol. Dec 2008;76(6):988-1002. [Medline].

  16. Masi G, Toni C, Mucci M, Millepiedi S, Mata B, Perugi G. Paroxetine in child and adolescent outpatients with panic disorder. J Child Adolesc Psychopharmacol. Summer 2001;11(2):151-7. [Medline].

  17. Lepola UM, Wade AG, Leinonen EV, et al. A controlled, prospective, 1-year trial of citalopram in the treatment of panic disorder. J Clin Psychiatry. Oct 1998;59(10):528-34. [Medline].

  18. 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].

 
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