Diagnosis and Clinical Characteristics
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
PD is an anxiety disorder characterised by recurrent panic attacks involving intense fear/discomfort and accompanied by at least 4 of 13 somatic or cognitive symptoms which develop abruptly and reach a peak within 10 minutes, (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)).[2]
Attacks should not be substance-induced, nor related to a medical condition or as a consequence of another psychiatric disorder, and should be spontaneous in nature. Panic attacks that occur with fewer than 4 of the 13 panic symptoms are termed limited symptom attacks.[2] To make the diagnosis of PD, at least one of the attacks must be followed by a month or more of persistent concern regarding the possibility of a subsequent attack, worry about the implications of the attacks and/or behavioural change, e.g. avoidant behaviours such as agoraphobia – anxiety about being in places from which escape might be difficult or where help may not be available in the event of a panic attack.[2] PD may occur with or without agoraphobia.[2]
The disorder has been described as a ‘common, persistent and disabling’ condition.[3] Notwithstanding such a description, both pharmacological and psychotherapeutic interventions have established efficacy.