The title above, taken from a National Institute of Mental Health public
service announcement, is an important message for physicians and for the public
because of the common occurrence of clinical situations exemplified by the
following prototypical scenario: A previously healthy young adult presents
for urgent evaluation because of the most recent episode of recurrent, spontaneous
attacks consisting of a rapid crescendo of intense anxiety accompanied by
frightening physical sensations of "pounding heart," chest pain, sweating,
shortness of breath, and dizziness, along with a fear of dying or losing control.
The patient's medical history, physical examination, and electrocardiogram
are otherwise unremarkable except for the presence of sinus tachycardia. The
likely diagnosis is panic disorder (PD).1
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The Rational Clinical Examination
A history of panic disorder should be explored.12 The details of a family history of...
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