Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Panic Disorder

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In one line

·Panic attacks keep coming back, and the fear of the next one takes over your life.

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Normal physiology

·In a healthy brain, the amygdala (the alarm center deep inside) watches for real threats, the prefrontal cortex (the front part that thinks things through) keeps the alarm from going off for small things, and GABA (the main calming signal) and serotonin (a messenger that steadies mood and keeps worry in check) keep the whole system balanced and smooth.

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What goes wrong

·The amygdala becomes hair-trigger sensitive and starts firing the alarm for no real danger—a crowded room, a flutter in your chest, even the memory of a past panic attack can set it off. At the same time, the prefrontal cortex (the part that should calm things down) gets worn out by chronic stress and loses its ability to pump the brakes. GABA (the calming signal) drops, and serotonin (the mood-and-worry steadier) runs low, so there is nothing left to turn the alarm off once it starts. The result: a full-blown panic attack triggered by nothing.

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Hallmark signs

·Sudden racing heart (palpitations)
·Chest pain or tightness
·Shortness of breath or feeling smothered
·Dizziness or feeling faint
·Sweating or chills
·Trembling or shaking
·Feeling detached from yourself or reality (depersonalization or derealization)
·Fear of dying or losing control

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Red flags · escalate now

·Chest pain with new shortness of breath, arm pain, jaw pain, or sweating (could be a real heart attack, not panic—get emergency help)
·Attack happens only during physical effort or always in the same specific situation (may point to a heart or lung problem, not pure panic)
·New confusion, slurred speech, one-sided weakness, or severe headache during an attack (could be stroke or another brain emergency)
·Symptoms that don't peak within 10 minutes or last many hours without relief (classic panic attacks surge fast and fade within 20–30 minutes; longer episodes suggest another cause)
·First panic-like episode ever in someone over age 45 with heart disease risk factors (higher chance it's cardiac, not psychiatric)

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Workup

·Electrocardiogram (ECG or EKG, a tracing of the heart's electrical activity)
·Troponin I or T (blood test that rises when heart muscle is damaged)
·Thyroid-stimulating hormone (TSH, a blood test that checks thyroid function)
·Complete blood count (CBC, counts red cells, white cells, and platelets)
·Basic metabolic panel (BMP, checks sodium, potassium, glucose, kidney function)
·Urine drug screen (tests for stimulants like cocaine, amphetamines, or other drugs)
·Chest X-ray (imaging of the lungs and heart)

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Treatment

·Selective serotonin reuptake inhibitor (SSRI) such as sertraline (Zoloft) 25 mg daily or paroxetine (Paxil) 10 mg daily, started low and increased slowly over 4 to 6 weeks to a target dose (sertraline 50–200 mg, paroxetine 20–60 mg)
·Cognitive behavioral therapy (CBT) with interoceptive exposure: learning to trigger panic sensations on purpose (spinning to get dizzy, breathing through a straw to feel short of breath, running in place to make your heart race) in a safe setting, then sitting with those feelings without fear
·Short-term benzodiazepine (lorazepam 0.5–1 mg as needed, or clonazepam 0.25–0.5 mg as needed) for acute panic attacks only, used for 2 to 4 weeks while the SSRI is building up
·Remove or cut down caffeine (coffee, energy drinks, soda, pre-workout supplements) and fix sleep (7 to 9 hours per night, same bedtime and wake time every day, dark quiet room)
·One complete medical workup (ECG, troponin, TSH, chest X-ray if symptoms suggest heart or lung disease), then clear reassurance from the doctor: 'Your heart is healthy. This is panic, not a heart attack.'
·Psychosocial support: stable housing, workplace or school accommodations (flexible schedule, quiet space during attacks), social connection (family, friends, support groups), and addressing trauma, job stress, or major life stressors

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NCLEX trap

·Panic Disorder is when you have panic attacks over and over AND spend weeks worrying that the next one will hit. Generalized Anxiety Disorder (GAD) is a steady hum of worry about everyday things — money, health, work — that lasts all day, most days. They use different brain circuits. Panic is a sudden, sharp spike in the amygdala (the brain's alarm bell) and the sympathetic nervous system (the body's gas pedal). GAD is the prefrontal cortex (the brain's worry center) running nonstop on low power.
·Normal tests make Panic Disorder more likely, but the chest pain is still real — the patient's nervous system is firing pain signals even though the heart is healthy. Treat the pain seriously and explain the mechanism kindly. Also stay alert: a person can have both Panic Disorder and real heart disease at the same time. Check cardiac risk factors (age, family history, smoking, diabetes, high cholesterol) and use your clinical judgment.
·SSRIs (like sertraline or escitalopram) or SNRIs (like venlafaxine) PLUS cognitive-behavioral therapy (CBT) with interoceptive exposure (practicing the body sensations on purpose so they lose their power) are first-line for Panic Disorder. Benzodiazepines (like lorazepam or alprazolam) are only a short bridge — 2 to 4 weeks max — while you wait for the SSRI to kick in (which takes 4 to 6 weeks). Long-term benzodiazepines make Panic Disorder worse because the brain gets used to them, and stopping causes rebound panic and physical dependence.
·In Panic Disorder, avoidance of places (stores, highways, crowds, being alone) is part of the same condition — the brain learned to connect the panic attack with the place where it happened, so now the place triggers fear. You code it as 'Panic Disorder with agoraphobia' if the avoidance is bad enough. Treat the Panic Disorder (SSRI plus CBT) and the avoidance shrinks together because the patient learns the place is not dangerous.
·Panic Disorder comes from a broken alarm circuit in the brain — the amygdala (the danger sensor) fires too easily, and the prefrontal cortex (the brake pedal that calms things down) does not shut it off fast enough. The connections between them are overactive. Stress, past trauma, and big life changes can make it worse, but panic attacks often strike out of nowhere — even during sleep or calm moments. You have to fix both the biology (medication to calm the circuit) and the thinking (CBT to retrain the brain's fear response). If you only fix one, the other keeps the problem alive.
·Hyperventilation during a panic attack is not a lung problem — it is the nervous system misfiring and telling the person to breathe fast even though their oxygen is fine (usually 98% or higher). High-flow oxygen does not help and can make the patient believe something is truly wrong with their lungs, which feeds the panic. Instead, guide them through slow breathing (breathe in for 4 seconds, hold for 2, breathe out for 6) or use a grounding technique (name 5 things you see, 4 things you can touch, 3 sounds you hear). This calms the sympathetic nervous system and stops the spiral.

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