Differential Diagnosis of Panic Attacks

Medical Conditions That Mimic Panic Attacks

Hyperthyroidism can cause anxiety symptoms, including palpitations, tremor, and sweating, and should be excluded before confirming a psychiatric diagnosis, according to the American College of Physicians 1
Hypoglycemia/Diabetes can trigger panic-like symptoms with autonomic activation, and thyroid function tests and glucose levels should be ordered if clinical presentation suggests these conditions, as recommended by the Endocrine Society 2
Cardiac arrhythmias can initiate or mimic panic attacks, and should be distinguished from panic by ECG findings, relationship to exertion, and absence of psychological triggers, according to the European Society of Cardiology 3

Panic Disorder is characterized by recurrent unexpected panic attacks with abrupt surge of intense fear, physical manifestations, and anticipatory anxiety about future attacks, and is diagnosed based on criteria from the American Psychiatric Association 4
Generalized Anxiety Disorder (GAD) is a chronic, pervasive worry about multiple topics with physical symptoms, but lacks discrete panic attacks, and is diagnosed based on criteria from the American Psychiatric Association 4

Sexual harassment, assault, and trauma are common underlying triggers for panic attacks, particularly in women, and should be assessed as part of a comprehensive diagnostic evaluation, according to the American College of Obstetricians and Gynecologists 2
Stressful life events can directly precipitate anxiety episodes, and insecure attachment patterns can increase vulnerability to panic attacks, as noted by the American Academy of Child and Adolescent Psychiatry 2

Suicidal ideation or self-harm behaviors require immediate attention and intervention, and should be assessed in all patients with panic disorder, according to the National Institute of Mental Health 4
Comorbid depression, especially GAD with depression, is a significant risk factor for suicide and should be carefully evaluated and treated, as recommended by the American Psychiatric Association 5

The GAD-7 is a validated screening tool for generalized anxiety in patients ≥8 years, and can be used to identify patients who require further evaluation and treatment, according to the American Academy of Family Physicians 4

Initiate an SSRI as first-line medication for panic disorder, and consider concurrent cognitive-behavioral therapy (CBT) for optimal treatment outcomes, as recommended by the American Psychiatric Association 1
Benzodiazepines are not recommended for first-line or long-term use due to dependence risk and higher mortality, but may be used for short-term bridging while SSRIs take effect, according to the National Institute of Mental Health 6
CBT should be initiated concurrently with medication, and provides durable skills that may prevent relapse after medication discontinuation, as noted by the American Psychological Association 1