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Panic disorder
Short Text
Introduction
This pathway covers the management of panic disorder (with or without agoraphobia) in adults in primary, secondary and community care.
Panic disorder is characterised by recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another attack and concern about its consequences, or a significant change in behaviour related to panic attacks. Panic disorder can be diagnosed with or without agoraphobia.
Panic disorder varies in severity and complexity, and can follow chronic or remitting courses. Where possible, the goal of an intervention should be complete relief of symptoms (remission), which is associated with better functioning and a lower likelihood of relapse.
Source guidance
The NICE guidance that was used to create the pathway.
Anxiety. NICE clinical guideline 113 (2011)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on:
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
15 February 2013 Minor maintenance updates
Supporting information
Glossary
Cognitive behavioural therapy
Selective serotonin reuptake inhibitor
Person with suspected panic disorder (with or without agoraphobia)
Person with suspected panic disorder (with or without agoraphobia)
Principles of care
Principles of care
Principles of care
Shared decision making and information provision
Shared decision making between the individual and healthcare professionals should take place during diagnosis and all phases of care.
To facilitate shared decision making:
- provide evidence-based information about treatment
- provide information on the nature, course and treatment of panic disorder, including the use and likely side-effect profile of medication
- discuss concerns about taking medication, such as fears of addiction
- consider the person's preference and experience and outcome of previous treatments
- offer information about self-help groups and support groups for people with panic disorder, their families and carers
- encourage participation in self-help and support groups.
Language
Use everyday, jargon-free language, and explain any technical terms.
Where appropriate, provide written material in the language of the person, and seek interpreters for people whose first language is not English.
Where available, consider providing psychotherapies in the person's own language if this is not English.
NICE has written information for the public explaining its guidance on generalised anxiety disorder and panic disorder in adults.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeStep 1: Recognition and diagnosis
Step 1: Recognition and diagnosis
Step 1: Recognition and diagnosis
Consultation skills
A high standard of consultation skills is needed so that a structured approach can be taken to the diagnosis and management plan.
Diagnosis
Ask about relevant information such as personal history, any self-medication, and cultural or other individual characteristics that may be important considerations in subsequent care.
Comorbidities
Be alert to comorbidity, which is common.
Identify the main problems through discussion with the person.
Clarify the sequence of the problems to determine the priorities of the comorbidities – drawing up a timeline to show when different problems developed can help with this.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePresentation with a panic attack in accident and emergency departments or other settings
Presentation with a panic attack in accident and emergency departments or other settings
Presentation with a panic attack in accident and emergency departments or other settings
If a person presents with a panic attack, he or she should:
- be asked if they are already receiving treatment for panic disorder
- undergo the minimum investigations necessary to exclude acute physical problems
- not usually be admitted to a medical or psychiatric bed
- be referred to primary care for subsequent care, even if assessment has been undertaken in the accident and emergency department
- be given appropriate written information about panic attacks and why they are being referred to primary are
- be offered appropriate written information about sources of support, including local and national voluntary and self-help groups.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeStep 2: Treatment for panic disorder in primary care
View the 'Step 2: Treatment for panic disorder in primary care' pathStep 3: Review and reassess the panic disorder, and consider trying another intervention
Step 3: Review and reassess the panic disorder, and consider trying another intervention
Step 4: Review and offer referral to specialist mental health services if appropriate and the person still has significant symptoms
Step 4: Review and offer referral to specialist mental health services if appropriate and the person still has significant symptoms
Step 5: Care for panic disorder in specialist mental health services
Step 5: Care for panic disorder in specialist mental health services
Step 5: Care for panic disorder in specialist mental health services
Reassess the person's panic disorder, their environment and their social circumstances. Evaluate:
- previous treatments, including effectiveness and concordance
- any substance use, including nicotine, alcohol, caffeine and recreational drugs
- comorbidities
- day-to-day functioning
- social networks
- continuing chronic stressors
- the role of agoraphobic and other avoidant symptoms.
Undertake a comprehensive risk assessment.
Develop an appropriate risk management plan.
To carry out these evaluations, and to develop and share a full formulation, more than one session may be required and should be available.
Consider:
- treatment of comorbid conditions
- CBT with an experienced therapist if not offered already, including home-based CBT if attendance at clinic is difficult
- structured problem solving
- full exploration of pharmacotherapy
- day support to relieve carers and family members
- referral for advice, assessment or management to tertiary centres.
Ensure accurate and effective communication between all healthcare professionals – particularly between primary care clinicians (GP and teams) and secondary care clinicians (community mental health teams) if there are existing physical health conditions that also require active management.
Implementation tools
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-singleSource guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeGeneralised anxiety disorder pathway
View the 'generalised anxiety disorder overview' pathPaths in this pathway
- Step 2: Treatment for panic disorder in primary care
- Psychological treatment for panic disorder
- Drug treatment for panic disorder
- Self-help for panic disorder
Pathway created: March 2012 Last updated: February 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.