Topic: Panic Disorder Case scenario: Debbie is a 28-year-old woman who presents to an outpatient psychiatry clinic with a 1-month history of panic attacks. She has a past history of major depressive disorder

Topic: Panic Disorder

Case scenario:

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Debbie is a 28-year-old woman who presents to an outpatient psychiatry clinic with a 1-month history of panic attacks. She has a past history of major depressive disorder (MDD) and is taking a low-dose serotonin norepinephrine reuptake inhibitor (SNRI). During the panic attacks, she experiences severe anxiety with the following symptoms: lightheadedness, accelerated heart rate, chest pain, shortness of breath, and nausea. The symptoms last between 2 and 20 minutes. She cannot identify any triggers for the panic attacks.

Debbie has been worrying about when the next panic attack will occur, and the symptoms are affecting her ability to function. She was previously effectively treated with venlafaxine and until now had experienced infrequent panic attacks. The patient reports numerous stressors at home, including conflicts with her husband, having a 7-month-old son, and recently taking in a friend who is homeless. She was restarted on venlafaxine 75 mg daily 5 months ago for depressive symptoms that reemerged after giving birth to her son. The venlafaxine had been stopped during her pregnancy to reduce the risk of teratogenicity. Psychiatric review of systems is positive for depression and generalized anxiety. Debbie does not have any medical history or symptoms that would suggest a medical cause for her panic attacks. She denies any history of alcohol use or substance use, and the toxicology screen was negative for illicit substances.

• What history is essential to obtain from Debbie when you suspect a panic attack?
• What questions will you ask to exclude other possible diagnoses in a client with panic attack?
• What is the possible differential diagnosis?
• What are the classical signs and symptoms of panic attack?
• How will you differentiate panic attacks from specific phobia?
• What laboratory tests would you recommend for Debbie?
• As a PMHNP, what are your treatment recommendations for Debbie? What is the prognosis for panic disorder?

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