Summary
The protocol describes panic disorder as recurrent, usually unexpected episodes of intense anxiety that are not tied to actual danger or one specific situation. A panic attack may include palpitations, breathlessness, sweating, trembling, dizziness, chest or abdominal discomfort, numbness, a sense of losing control, and fear of death. Attacks may be followed by anticipatory anxiety, persistent monitoring of bodily sensations, avoidance, and the development of agoraphobia.
Diagnosis examines the nature, frequency, context, and unexpected quality of attacks, their physical and cognitive symptoms, and the effect of avoidance on daily functioning. Suicide risk, other anxiety or mood disorders, medication exposure, and psychoactive-substance use are assessed. Physical and neurological examination, ECG, laboratory tests, and other investigations are used to exclude cardiovascular, endocrine, neurological, metabolic, and substance-related causes of similar episodes. Psychometric scales help document severity and progress but do not replace clinical assessment.
Treatment consists of psychotherapy and/or pharmacotherapy. The protocol presents SSRIs or venlafaxine as initial medication strategies; benzodiazepines may be used for limited periods with careful consideration of dependence and withdrawal risks. Response is judged by disappearance or reduction of attacks, lower overall anxiety, and restored functioning. Cognitive behavioral therapy includes correction of catastrophic interpretations of bodily sensations, interoceptive and real-life exposure, breathing work, and relaxation. Short-term psychodynamic and supportive approaches are also discussed. Rehabilitation focuses on reducing avoidance and restoring social participation. Frequent attacks, severe anxiety, marked agoraphobia, poor medication tolerability, or serious comorbidity may justify inpatient care. This text is a summary of the protocol and not an individual prescription or medical recommendation.