Diagnosis

A panic attack is characterised by all of the following:

• a discrete episode of fear
• abrupt onset of symptoms
• maximal intensity within minutes
• lasts several minutes
• four or more associated symptoms including at least one autonomic symptom

The diagnosis of panic disorder is excluded by:

• the consistent association of attacks with:
  • situations or objects
  • exertion
  • danger
• physical disease which explains the symptoms
• organic mental disorder
• schizophrenia
• affective disorder
• somatoform disorder

Notes:

• the diagnostic process should elicit necessary relevant information such as personal history, any self-medication, and cultural or other individual characteristics that may be important considerations in subsequent care
• according to the DSM-IV-TR , a fundamental characteristic of panic disorder is the presence of recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another panic attack and concern about the consequences of a panic attack, or a significant change in behaviour related to the attacks
  • at least two unexpected panic attacks are necessary for diagnosis and the attacks should not be accounted for by the use of a substance, a general medical condition or another psychological problem
• panic disorder can be diagnosed with or without agoraphobia.

Reference:

• 1) American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington DC: American Psychiatric Association.
• 2) NICE (January 2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults