Diagnosis of Panic Anxiety

Panic Anxiety is generally unrecognized by clinicians. Recognition of panic anxiety was linked with increased use of general medical settings. Physicians in these settings were more likely to recognize panic if
• panic symptoms were severe,
• phobic avoidance was present, or
• Panic reduced work capacity.

It is important that physicians distinguish between panic anxiety and hyperventilation syndrome. Although hyperventilation may be important in panic anxiety, hyperventilation syndrome lacks the clear-cut diagnostic criteria that characterize panic anxiety. Hyperventilation provocation tests using room air are poor inducers of panic attacks, and hyperventilation syndrome fails to respond to anxiolytics or antidepressants.

The significance of subsyndromal panic, either infrequent panic attacks or limited-symptom attacks, is still unclear. Although little research has been done on limited-symptom attacks, studies comparing panic disorder with infrequent panic suggest that the prevalence of comorbid psychiatric conditions is similar in both panic groups. With respect to disability and quality-of-life measures, however, subjects with infrequent panic tend to be intermediate between controls and those with panic disorder. Thus, recognition of infrequent panic is important, and may represent management implications similar to those of panic disorder.

Below mentioned is a list of medical conditions thought to be associated with panic or panic-like attacks. These conditions must be considered with a thorough history and physical examination before instituting a management plan. Routine laboratory testing is unnecessary and may actually be detrimental, despite patients' tendency to believe that in a somatic cause for their attacks. Although panic disorder is associated with mitral valve prolapse, the presence of the latter in patients with panic anxiety does not alter either the clinical course or the treatment response. A drug screen, however, is appropriate in any patient in whom substance abuse is suspected.

Conditions Associated with Panic Symptoms

1) Psychiatric Disorders
• Major depression
• Agoraphobia
• Simple phobia
• Social phobia
• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Substance abuse
• Posttraumatic stress disorder

2) Cardiovascular Disorders
• Mitral valve prolapse
• Paroxysmal supraventricular tachycardia

3) Endocrine Disorders
• Hyperthyroidism
• Hypoglycemia
• Menopause
• Pheochromocytoma
• Carcinoid syndrome

4) Neurologic Disorders
• Temporal lobe epilepsy
• Cerebral tumor
• Parkinson's disease

5) Sleep Disorders
• Narcolepsy
• Sleep apnea

6) Drug-related Disorders
• Antidepressant withdrawal
• Sedative-tranquilizer withdrawal
• Stimulant (cocaine, cannabis, PCP) use
• Metronidazole use
• L-dopa use
• Neuroleptic use
• Organic solvent exposure

7) Miscellaneous
• Wilson's disease
• Acute intermittent porphyria
• Hyperventilation syndrome


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