Panic Disorder Differential Diagnoses

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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DDx

Diagnostic Considerations

An understanding of panic disorder is particularly important for emergency physicians, because patients with this condition frequently present to the ED with various somatic complaints. Many of the symptoms of an anxiety attack correspond with symptomatology found in life-threatening medical disorders, such as myocardial infarction (MI) and pulmonary embolus, which may manifest with anxiety as a primary symptom. Approximately 25% of patients who present to an emergency department with chest pain have panic anxiety disorder [70] and few individuals with panic disorder are referred to mental health professionals.

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

  • Angina and myocardial infarction (e.g., dyspnea, chest pain, palpitations, diaphoresis)

  • Cardiac dysrhythmias (e.g., palpitations, dyspnea, syncope)

  • Mitral valve prolapse

  • Pulmonary embolus (e.g., dyspnea, hyperpnea, chest pain)

  • Asthma (e.g., dyspnea, wheezing)

  • Hyperthyroidism (e.g., palpitations, diaphoresis, tachycardia, heat intolerance)

  • Hypoglycemia

  • Pheochromocytoma (e.g., headache, diaphoresis, hypertension)

  • Hypoparathyroidism (e.g., muscle cramps, paresthesias)

  • Transient ischemic attacks (TIAs)

  • Seizure disorder

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

For more information, see the Medscape Reference topics Anxiety Disorders; 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 cardiac event monitoring is not obtained.

Differential Diagnoses