The DSM-V [1] defines panic disorder (PD) as the recurrent onset of sudden fear accompanied by somatic symptoms like palpitations, excessive sweating, and dyspnea. Other criteria include persistent anxiety about recurrence and its consequences or inappropriate behavioral changes. In order to diagnose PD, it is important to exclude medical illnesses, substance abuse, and other psychiatric disorders as the cause of the panic attacks.

The clinical presentation of panic attacks and PD can mimic the symptoms of coronary heart disease [2] and cardiomyopathies [2], making it difficult to differentiate between the conditions clinically [3]. For example, symptoms like chest pain, palpitations, sweating, discomfort, and dyspnea are common to PD as well as myocardial infarction (MI), angina pectoris and pulmonary embolism. Other somatic symptoms of PD include cold clammy hands, headache, diarrhea, insomnia, weakness, intrusive thoughts, and ruminations. The attacks in PD are often related to certain places or situations. Patients develop anxiety about the recurrence of the attack and start avoiding these situations and places resulting in agoraphobia [4]. This can further lead to the development of safety behaviors like dependence on anxiolytic medications and avoiding being alone [4].

Although no gender differences have been observed in the expression of PD symptoms in children and adolescents, a higher incidence of PD has been observed amongst girls. Children and adolescents experience somatic symptoms similar to those seen in adults and these include palpitations, dyspnea, sweating, chest pain, nausea, abdominal discomfort, dizziness, restlessness and a sense of losing control [5] [6] [7].

• Chills

  Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. [bu.edu]

  Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. [ncbi.nlm.nih.gov]

  Food Safety at Home Clean, cook, keep apart, chill: Follow these four easy rules to keep food from spoiling and causing people to get sick. Heart Health for Women Heart disease is a leading cause of death in the U.S. [pueblo.gsa.gov]

  You may also have physical symptoms, such as Fast heartbeat Chest or stomach pain Breathing difficulty Weakness or dizziness Sweating Feeling hot or a cold chill Tingly or numb hands Panic attacks can happen anytime, anywhere, and without warning. [medlineplus.gov]

• Fatigue

  In fact, panic disorder often coexists with unexplained medical problems, such as chest pain not associated with a heart attack or chronic fatigue. [web.archive.org]

  There may be symptoms like chest pain, difficulty breathing especially after exercise, fatigue, cough, palpitations etc. this needs to be ruled out. [news-medical.net]

  The long list of symptoms include everything from feelings of restlessness or having difficulty concentrating to muscle tension, fatigue, and sleep problems. [rd.com]

  It normally develops between the ages of 18-45 and commonly occurs with other illnesses like depression as well as: 1 Chronic obstructive pulmonary disorder (a lung disorder) Irritable bowel syndrome Migraine headache Restless leg syndrome Fatigue Heart [healthyplace.com]

• Dyspnea

  The DSM-V defines panic disorder (PD) as the recurrent onset of sudden fear accompanied by somatic symptoms like palpitations, excessive sweating, and dyspnea. [symptoma.com]

  A 34-year-old woman with a 9-year history of unprovoked attacks of anxiety and dyspnea associated with symptoms of depersonalization and derealization is presented. [ncbi.nlm.nih.gov]

  An episode of intense fear accompanied by symptoms such as heart palpitations, sweating and chills or hot flushes, a sensation of dyspnea, chest pain, abdominal distress, depersonalization, fear of going crazy, and fear of dying. [icd10data.com]

  Separation anxiety disorder was specifically associated with panic and dyspnea in response to CO 2. [doi.org]

• Nausea

  Some of the features of a panic attack do in fact mimic those of a heart attack: palpitations, chest pain, shortness of breath, sweating, dizziness and nausea. [healthychildren.org]

  Agoraphobia is not a component of this disorder An episode of intense fear and anxiety that may be accompanied by one or more of the following symptoms: heart palpitations, sweating, shortness of breath, chest pain, nausea, dizziness, and trembling. [icd9data.com]

  Tarbell, Vomiting and Nausea in the Pediatric Patient, Nausea and Vomiting, 10.1007/978-3-319-34076-0_13, (175-190), (2016). Andrea M. Victor, Alexandra D. Zagoloff and Gail A. [doi.org]

  Nausea and tiredness were more common with fluvoxamine (p = 0.02 and p = 0.01, respectively). Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. [ncbi.nlm.nih.gov]

• Choking

  ’ or ‘going mad’ increased heart rate difficulty breathing (feeling that there is not enough air) feeling choked excessive perspiration dizziness, light-headedness or feeling faint. [beyondblue.org.au]

  […] dizziness, or feeling faint or unsteady fear of dying fear of losing control feelings of choking feelings of not being part of your environment flushing or chills nausea, stomach ache, or diarrhea numbness or tingling racing heart sweating trembling [medbroadcast.com]

  Symptoms may include trembling, shortness of breath, heart palpitations, chest pain (or chest tightness), sweating, nausea, dizziness (or slight vertigo), hyperventilation, paresthesias (tingling sensations), vomiting, and sensations of choking or smothering [sciencedaily.com]

  Symptoms may include: racing heart sweating shortness of breath or feelings of choking dizziness feeling numb or tingling sensations fear of going crazy fear of dying queasy stomach feeling detached from oneself. [au.reachout.com]

• Abdominal Pain

  Fast or pounding heartbeat Sweating, trembling, or shaking Shortness of breath or trouble breathing Feeling of choking or having a lump in your throat Chest pain or discomfort Nausea or abdominal pain Feeling dizzy, unsteady, lightheaded, or faint Feeling [drugs.com]

  Common side effects of SSRIs include: nausea headaches low sex drive (loss of libido) blurred vision diarrhoea or constipation dizziness dry mouth loss of appetite sweating feeling agitated insomnia (sleep problems) abdominal pain When you first start [nhsinform.scot]

  which may feel like a heart attack Feeling lightheaded, dizzy, or as if one is about to faint Feeling as if one is going to choke, having abdominal pain, or being extremely nauseous Feeling detached, feeling as if one is about to die, or just feeling [americanaddictioncenters.org]

  These symptoms include rapid heart rate, sweating, shaking, shortness of breath, hot flashes, and lightheadedness—as well as a sense of impending doom, chills, nausea, abdominal pain, chest pain, headache, and numbness or tingling. [psycom.net]

• Chest Pain

  CONCLUSIONS: The prevalence of panic disorder was low in patients presenting to an Australian ED with chest pain. [ncbi.nlm.nih.gov]

  For example, symptoms like chest pain, palpitations, sweating, discomfort, and dyspnea are common to PD as well as myocardial infarction (MI), angina pectoris and pulmonary embolism. [symptoma.com]

  In fact, panic disorder often coexists with unexplained medical problems, such as chest pain not associated with a heart attack or chronic fatigue. [web.archive.org]

• Palpitations

  The DSM-V defines panic disorder (PD) as the recurrent onset of sudden fear accompanied by somatic symptoms like palpitations, excessive sweating, and dyspnea. [symptoma.com]

  Some of the features of a panic attack do in fact mimic those of a heart attack: palpitations, chest pain, shortness of breath, sweating, dizziness and nausea. [healthychildren.org]

  Palpitations, chest pain, faintness, and trembling/shaking were the most frequent PD symptoms. In comparison with the other groups, youths with PD were significantly slightly older, Caucasian, and have more comorbid bipolar disorder. [ncbi.nlm.nih.gov]

  Koenig, The Teenager with Palpitations, Pediatric Clinics of North America, 61, 1, (63), (2014). [doi.org]

• Tachycardia

  The event started suddenly and was associated with diaphoresis, chest pain, tachycardia, and tachypnea. Troponins and ECG are within normal limits. [step2.medbullets.com]

  […] flashes Visual disturbances Fear of dying Fear of losing control or impending doom [1] [2] [4] [6] [13] [14] [15] Effects of symptoms Symptoms of panic disorder have physical, behavioral and cognitive effects: [13] Physical: Tachycardia Palpitations [physio-pedia.com]

  Definition (CSP) specific psychological phenomenon characterized by sudden onset of anxiety (often unrelated to objective events), accompanied by autonomic symptoms such as tachycardia, paresthesia, flushing, and sweating. [fpnotebook.com]

  Specific psychological phenomenon characterized by sudden onset of anxiety (often unrelated to objective events), accompanied by autonomic symptoms such as tachycardia, paresthesia, flushing, and sweating. [icd10data.com]

• Skin Patch

  The development of a new MAOI skin patch may decrease these risks. MAOIs can also react with SSRIs to produce a serious condition called “ serotonin syndrome ”. [web.archive.org]

• Tinnitus

  Sex Age Original indication for benzodiazepines Years on regular benzodiazepines Daily benzodiazepine dose at presentation (mg) Months since withdrawal Outcome* 1 F 34 Menorrhagia 14 Nitrazepam 10 Diazepam 12.5 - Relapsed 2 M 31 Tinnitus 3 Lorazepam 3 [benzo.org.uk]

• Fear

  Fear of heights and fear of crossing bridges are examples of simple phobias. [web.archive.org]

  A therapeutic focus on fear of death and dying via cognitive interventions and exposure is recommended. [ncbi.nlm.nih.gov]

• Depersonalization

  A 34-year-old woman with a 9-year history of unprovoked attacks of anxiety and dyspnea associated with symptoms of depersonalization and derealization is presented. [ncbi.nlm.nih.gov]

  Depersonalization is a feeling of being outside your own body while derealization is a feeling that the world is not real. [study.com]

  Panic Disorder At least four of the following symptoms: palpitations sweating trembling and shaking shortness of breath choking sensation chest pain or discomfort nausea or abdominal distress dizziness, lightheadedness feeling detached from oneself ( depersonalization [healthychildren.org]

• Obsessive Thoughts

  Some OCD sufferers may only have obsessive thoughts without the related rituals. [uhs.umich.edu]

  […] known and predictable situations There is no symptoms of anxiety between seizures (although anxiety may be common) Psychological or vegetative symptoms are primary manifestations of anxiety, and not secondary to other symptoms, such as crazy ideas or obsessive [intechopen.com]

  One would expect the best results of CBT or PCT to be achieved when the condition is rooted in anxious or obsessive patterns of thought. However, it is not always easy to distinguish such cases. [panic411.com]

• Low Self-Esteem

  It can cause: Low self-esteem Poor school performance Problems with peer and family relationships Social isolation Sleep problems Depression Drug or alcohol use Agoraphobia (fear of visiting crowded places) What causes panic attacks and panic disorder [youngmenshealthsite.org]

  self-esteem, frustration, and resentment prior to PD onset. [scielo.br]

  HeartSpeak - a novel method for reducing stress and other stress-related conditions such as anxiousness, depression, and low self-esteem.[69] Depending on the situation, all of these coping mechanisms may be adaptive, or maladaptive. [en.wikipedia.org]

• Hot Flushes

  Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. [ncbi.nlm.nih.gov]

  flushes If these symptoms seem relevant to you, we can help. [bu.edu]

  flushes or cold chills numbness, or tingling sensations Panic attacks develop suddenly and increase in intensity within about 10 minutes. [psychology-tools.com]

• Dizziness

  Dizziness is one of the most frequent complaints in both primary and specialized medical care facilities. Many dizzy patients, without a known organic cause, considered as having idiopathic dizziness, may have a psychiatric disorder. [ncbi.nlm.nih.gov]

  Some of the features of a panic attack do in fact mimic those of a heart attack: palpitations, chest pain, shortness of breath, sweating, dizziness and nausea. [healthychildren.org]

  Agoraphobia is not a component of this disorder An episode of intense fear and anxiety that may be accompanied by one or more of the following symptoms: heart palpitations, sweating, shortness of breath, chest pain, nausea, dizziness, and trembling. [icd9data.com]

• Headache

  N Engl J Med 327:1109–1114 PubMed Google Scholar Sjaastad O, Bakketeig LS (2004) Caffeine-withdrawal headache: the Vaga study of headache epidemiology. [doi.org]

  Common side effects of SSRIs include: nausea headaches low sex drive (loss of libido) blurred vision diarrhoea or constipation dizziness dry mouth loss of appetite sweating feeling agitated insomnia (sleep problems) abdominal pain When you first start [nhsinform.scot]

  Other somatic symptoms of PD include cold clammy hands, headache, diarrhea, insomnia, weakness, intrusive thoughts, and ruminations. The attacks in PD are often related to certain places or situations. [symptoma.com]

  Headaches, discomfort and lightheadedness are also common. When the panic-related anxiety becomes a chronic issue, the person starts to experience detrimental long-term effects. [psychguides.com]

• Paresthesia

  Symptoms may include trembling, shortness of breath, heart palpitations, chest pain (or chest tightness), sweating, nausea, dizziness (or slight vertigo), hyperventilation, paresthesias (tingling sensations), vomiting, and sensations of choking or smothering [sciencedaily.com]

  Definition (CSP) specific psychological phenomenon characterized by sudden onset of anxiety (often unrelated to objective events), accompanied by autonomic symptoms such as tachycardia, paresthesia, flushing, and sweating. [fpnotebook.com]

  Specific psychological phenomenon characterized by sudden onset of anxiety (often unrelated to objective events), accompanied by autonomic symptoms such as tachycardia, paresthesia, flushing, and sweating. [icd10data.com]

  […] accelerated heart rate Sweating Trembling or shaking Sensations of shortness of breath or smothering Feelings of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, light-headed, or faint Chills or heat sensations Paresthesia [adaa.org]

• Tremor

  These can include: intense fear or discomfort; nausea; feeling short of breath; choking sensations; chest pain or discomfort; dizziness or light-headedness; rapid ‘thumping’ heartbeat; sweating; numbness or tingling sensations; tremor (shaking); and fear [mydr.com.au]

  Signs There are no specific physical signs associated with the condition, unless the patient is seen during a panic attack, when increased sympathetic outflow may manifest as tachycardia, hypertension, tremors, sweating, etc. [patient.info]

  […] disorders, and dysfunction of the mitral valve of the heart can mimic anxiety while medications such as codeine, calcium channel blockers, ACE inhibitors, statins, and benzodiazepines can cause anxiety-like symptoms such as agitation, dizziness, flushing, tremors [rd.com]

• Average Intelligence

  Women are twice as likely as men to develop panic disorder and it occurs far more often in people with above average intelligence.[97] Panic disorder can continue for months or years, depending on how and when treatment is sought. [en.wikipedia.org]

Diagnosis of PD can be challenging as its clinical presentation resembles that of several serious acute conditions. Therefore the diagnosis is often based on the exclusion. History, physical examination and mental status examination are the pillars of PD diagnosis. An electrocardiography (ECG) should be obtained early during the workup to rule out myocardial ischemia and conduction abnormalities in all patients presenting with palpitations, chest pain, dyspnea, and sweating. Pulse oximetry will usually show either normal or slightly higher oxygen levels. Arterial blood gas analysis is performed to exclude metabolic acidosis and hypoxemia. In patients with a history of a syncopal event, ambulatory Holter monitoring should be considered. A D-dimer test, spiral computed tomography (CT scan), lower limb Doppler or ventilation-perfusion (V/Q) scanning is indicated to exclude pulmonary embolism especially in those at risk. Electroencephalography may be required to differentiate PD from partial complex seizures.

Laboratory studies should be performed to exclude substance abuse and other medical conditions. These include complete blood count, hemoglobin, urine toxicology, serum electrolytes, serum glucose, cardiac enzymes and, thyroid-stimulating hormone.

Orexin or hypocretin has been shown to play a role in the pathogenesis of panic in rats [8] and elevated levels have been observed in the cerebrospinal fluid of individuals with panic attacks.

Functional magnetic resonance imaging is not routinely recommended in the workup of PD although increased flow in the right parahippocampal region with decreased serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients with panic disorder has been noticed on positron emission tomography (PET) scanning [9]. Patients with PD have also been observed to have smaller temporal lobe volume on magnetic resonance imaging [10].

In addition to treatment efficacy, other factors should be considered when recommending treatment, including patient preference, treatment history, severity of illness, and presence of comorbid disorders. [web.archive.org]

Articles were identified through PsycLIT, PsyINFO, and MEDLINE (1985 to 2006) using the terms panic disorder, psychotherapy, psychosocial treatment, treatment, and pharmacotherapy. [ncbi.nlm.nih.gov]

Prognosis is good with treatment. Without treatment, adolescents may drop out of school, withdraw from society, and become reclusive and suicidal. Panic disorder often waxes and wanes in severity without any discernible reason. [merckmanuals.com]

Prognosis Patients with panic disorder have a poor prognosis particularly if untreated. Patients often relapse when they attempt to discontinue treatment. [minddisorders.com]

Prognosis The literature is contradictory about prognosis. In one study the panic disorder had a long course lasting several years [ 9 ]. [patient.info]

Sarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. [ncbi.nlm.nih.gov]

This anxiogenic effect is hypothesized to be more important in the etiology of some cases of panic disorder. [doi.org]

Considering alcohol and drug dependence, 14% met the criteria for only alcohol dependence, and 11% for drug dependence.12 ETIOLOGY Several factors have been identified as part of the etiology of PD, and both genetic and environmental factors seem to contribute [scielo.br]

METHODS: Analysis was conducted on data from 2 epidemiologic studies, the Epidemiologic Study of Young Adults in southeast Michigan (N = 1007) and the National Comorbidity Survey Tobacco Supplement (n = 4411). [ncbi.nlm.nih.gov]

Although accumulating evidence suggests that some inflammatory processes play a role in the pathophysiology of mental disorders, very few studies have evaluated cytokine levels in patients with PD. [ncbi.nlm.nih.gov]

This study points out the need of early antidepressant treatment for panic disorder to prevent further ED. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. KEYWORDS: Antidepressants; Erectile dysfunction; Panic disorder; Taiwan [ncbi.nlm.nih.gov]

Prevent Relapse Finally, the last step of the CBT treatment for panic disorder is preventing relapse after treatment is complete. [newharbinger.com]

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
2. Tully PJ. A good time to panic? Premorbid and postmorbid panic disorder in heart failure affects cardiac and psychiatric cause admissions. Australas Psychiatry. 2015;23:124 –7.
3. Tully PJ, Cosh SM, Baumeister H. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease.J Psychosom Rese. 2014;77:439 –48.
4. Roy-Byrne PP, Craske MG, Stein MB. Panic disorder. Lancet. 2006;16:1023-32
5. Masi G, Favilla L, Mucci M, Millepiedi S. Panic disorder in clinically referred children and adolescents. Child Psychiatry Hum Dev. 2000;31:139-51.
6. Ehlers A. Somatic symptoms and panic attacks: a retrospective study of learning experiences. Behav Res Ther. 1993;31:269-78.
7. Diler RS, Birmaher B, Brent DA, et al. Phenomenology of panic disorder in youth. Depress Anxiety. 2004;20:39-43.
8. Johnson PL, Truitt W, Fitz SD, et al. A key role for orexin in panic anxiety. Nat Med. Jan 2010; 16(1):111-5.
9. Neumeister A, Bain E, Nugent AC, et al. Reduced serotonin type 1A receptor binding in panic disorder. J Neurosci. Jan 21 2004; 24(3):589-91.
10. Vythilingam M, Anderson ER, Goddard A, et al. Temporal lobe volume in panic disorder--a quantitative magnetic resonance imaging study. Psychiatry Res. Aug 28 2000; 99(2):75-82