ICD-11 criteria

• Recurrent attacks of severe anxiety not restricted to any particular situation or set of circumstances and therefore unpredictable
• Secondary fears of dying, losing control or going mad
• Attacks usually last for minutes; often there is a crescendo of fear and autonomic symptoms
• Comparative freedom from anxiety symptoms between attacks (but anticipatory anxiety is common)

Epidemiology:

• 1-2% in general population
• 2-3x more common in females
• Bimodal: peaks at 20yo and 50yo
• Agoraphobia occurs in 30-50%
• Risk of attempted suicide is raised when comorbid depression, alcohol misuse or substance misuse

PC

• Breathing difficulties
• Chest discomfort
• Palpitations
• Tingling or numbness in hands, feet or around the mouth: Hyperventilation blows off CO2, raising pH, Calcium binds to albumin leads to hypocalcaemia. If extreme, carpopedal spasm (curling of fingers and toes can occur)
• Shaking, sweating, dizziness
• Depersonalization/ derealisation