Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Reason for Visit:
Initial evaluation for suspected panic disorder
Follow-up for diagnosed panic disorder (monitoring response to
treatment, symptoms)
Evaluation of recent panic attack or worsening anxiety symptoms
Chief Complaint:
Recurrent episodes of sudden, intense anxiety (panic attacks)
May describe physical symptoms during panic attacks (e.g.,
palpitations, chest pain, shortness of breath, dizziness, sweating,
nausea, paresthesias (tingling or numbness), feeling of detachment
(derealization), fear of losing control or going crazy (depersonalization))
Fear of situations or activities that might trigger panic attacks
(agoraphobia – may or may not be present)
History of Present Illness:
Onset, frequency, and duration of panic attacks.
Triggers identified for panic attacks (if any).
Impact of panic attacks on daily life (work, social activities).
Development of agoraphobic behaviors (avoidance of certain
situations or places due to fear of panic attacks).
Past Medical History:
Underlying medical conditions (e.g., thyroid disorders,
cardiovascular disease).
Previous psychiatric diagnoses (e.g., depression, other anxiety
disorders).
Substance use history (alcohol, drugs – can worsen anxiety symptoms).
Family History:
Family history of anxiety disorders or panic disorder (increased risk).
Social History:
Stressful life events (may trigger or worsen panic disorder).
Social support system (important for coping with anxiety).
Mental Status Examination:
Appearance: Assess for signs of anxiety (e.g., restlessness,
tremor).
Mood and affect: Evaluate for anxiety, depression, or other
mood disorders.
Speech: Normal rate and volume or rapid and pressured?
Thought content: Presence of intrusive thoughts or preoccupations
related to panic attacks.
Sensorium and cognition: Intact or any concerns about orientation,
memory, concentration?
Insight and judgment: Awareness of the nature of the problem and
ability to make sound decisions.
Assessment:
Panic disorder: Based on clinical presentation (history of
recurrent panic attacks and associated features) meeting diagnostic criteria
(DSM-5).
Severity of panic disorder: Consider frequency and intensity of panic attacks, level of impairment in daily life, and presence of
agoraphobia.
Comorbid conditions: Identify any other mental health conditions
that may be co-occurring with panic disorder (e.g., depression,
generalized anxiety disorder).
Differential Diagnoses:
Consider other conditions that may present with similar symptoms:
Medical conditions causing physical symptoms that mimic panic
attacks (e.g., hyperthyroidism, arrhythmias)
Substance-induced anxiety disorder (due to alcohol or drug use)
Phobias (intense fear of specific objects or situations)
Obsessive-compulsive disorder (OCD)
Plan:
Treatment plan: A combination of psychotherapy and medication
is usually recommended for panic disorder.
Psychotherapy: Cognitive behavioral therapy (CBT) is the
first-line psychotherapy for panic disorder. CBT helps
individuals identify and challenge negative thoughts and
behaviors associated with panic attacks. Exposure therapy may
also be used to gradually expose patients to feared situations.
Medication: Selective serotonin reuptake inhibitors (SSRIs)
are the first-line medications for panic disorder. Other
medications like benzodiazepines may be used in specific situations,
but due to dependence risk, they are typically not a long-term
solution.
Patient education: Educate the patient about panic disorder,
symptoms, treatment options, and coping strategies.
Follow-up: Schedule regular follow-up appointments to monitor
response to treatment and adjust the plan as needed.
Prognosis:
Panic disorder is a highly treatable condition. Most people with panic disorder experience significant improvement with proper treatment.