Panic Disorder (Attack)


Article Author:
Curt Cackovic
Saad Nazir


Article Editor:
Raman Marwaha


Editors In Chief:
David Wood
Andrew Wilt
Hajira Basit


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
7/3/2019 10:59:45 PM

Introduction

Thirty years ago panic disorder was officially recognized as a distinct psychiatric condition. Since then it has become extensively studied compared to other anxiety disorders.

Panic disorder is fairly common in the general population. Among all anxiety disorders, it has the highest number of medical visits and serves as a very costly mental health condition.

Panic disorder is characterized by recurrent, unexpected panic attacks. Panic attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an abrupt surge of intense fear or discomfort” reaching a peak within minutes. Four or more of a specific set of physical symptoms accompany a panic attack.  Panic attacks occur as often as several times per day or as infrequent as only a few attacks per year. A hallmark feature of panic disorder is that attacks occur without warning. There is often not a specific trigger for the panic attack. Patients suffering from these attacks self-perceive a lack of control.

Panic attacks, however, are not limited to panic disorder. They can occur alongside other anxiety, mood, psychotic, substance use, and even medical disorders. Panic attacks can be associated with increased symptom severity of various disorders, suicidal ideation and behavior, and diminished treatment response in patients with concomitant anxiety and mental disorders.

Making an accurate diagnosis of panic disorder is not possible without a thorough understanding of what constitutes panic attacks. It is important to differentiate symptoms experienced during or in association with an actual alarm situation, such as a physical threat, from a true panic attack. According to DSM V (Fifth Edition) criteria, at least one panic attack must be followed by one month or more of persistent concern over having more attacks, worry about the consequences of the attacks, or maladaptive behavior such as avoidance of work or school activities. Although panic attacks may originate from the direct effects of substance use, medications, or a general medical condition like hyperthyroidism or vestibular dysfunction, they must not derive solely from these.

Panic disorder is not diagnosed when the symptoms are attributable to another disorder.  For example, when panic attacks occur in the presence of a social anxiety disorder in which the attacks are triggered by social situations like public speaking, this is not considered a panic disorder. Certain culturally specific symptoms such as neck soreness or uncontrollable crying are not considered core symptoms of a panic attack.

For patients with panic disorder, the fear and anxiety symptoms that they experience primarily manifest themselves in a physical manner as opposed to a cognitive one. This is a distinctive finding.[1][2][3]

Etiology

Multiple theories and models exist which speak to the possible etiology. Most indicate the potential role of chemical imbalance as a major factor, including abnormalities in gamma-aminobutyric acid, cortisol, and serotonin. Additional studies have also implicated genetic factors as significant contributors.[4] There is believed to be some genetic vulnerability. 

Epidemiology

Panic disorder has a relatively high lifetime prevalence, ranking behind only social anxiety disorder, posttraumatic stress disorder, and generalized anxiety disorder. Notably, patients suffering from panic disorder have much higher lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems compared to the general population. European Americans are more likely to suffer from panic disorder than African Americans, Asian Americans, or Latinos. Females are more affected than men. Panic disorder peaks in adolescense and early adulthood, with low prevalence in children below age 14 and another decline in later adulthood. [4][5][6]

Pathophysiology

Many neurotransmitters and peptides within the central nervous system appear to play a major role in the physical manifestations. Results of brain imaging studies have shown characteristic changes, including increased flow and receptor activity, in specific geographic regions including the limbic and frontal region. The amygdala is proposed as the main area of dysfunction. From a pathophysiological and psychological standpoint, medical illness and panic disorder are highly correlated.   

There are two main theories which attempt to explain why patients are more likely to experience panic attacks. The first hypothesizes that susceptible patients lack the appropriate neurochemical mechanisms which would normally inhibit serotonin. The causes alterations in the fear network model of the autonomic nervous system. The second theorizes that a deficiency in endogenous opioids results in separation anxiety and an increased awareness to suffocation. [7][8]

History and Physical

The vast majority of patients with panic disorder complain of chest pain, palpitations, or dyspnea. Other common symptoms may include diaphoresis, tremor, a choking sensation, nausea, chills, paresthesias, or feelings of depersonalization. Because most patients complain of physical symptoms, they often inquire about alternative explanations of their symptoms not related to mental health. They frequently shy away from care by mental health professionals and instead seek reassurance from specialty medical consultants. A good example of this is a patient requesting a referral to a cardiologist for further evaluation. This is due in part because there is significant overlap between symptoms of panic disorder and those of acute cardiac events. It is important to remember that conditions such as irritable bowel syndrome, asthma, and vocal cord dysfunction also have many symptoms attributable to panic disorder.

Panic attacks in patients with panic disorder are more often characterized by severe dizziness, episodes of irregular breathing, and fears of losing control or "going crazy." Although physical examination of these patients is often normal, nonspecific findings may include elevated heart rate, elevated blood pressure, mildly elevated respiratory rate without increased work of breathing, mild tremors, and cool, diaphoretic skin to palpation.

Evaluation

There are no specific laboratory, radiographic, or other tests required to diagnose panic disorder. Be mindful, however, that health care providers often disregard the possibility of alternative diagnoses; in these cases, more extensive testing may be useful to exclude other medical conditions. Panic disorder occurs in the absence of another medical or psychiatric condition that can better explain the symptoms[9]

Treatment / Management

The main approaches to the treatment of panic disorder include both psychological and pharmacological interventions.

Psychological interventions may consist of cognitive behavioral therapy. As an added benefit in patients with a panic disorder that also has concomitant comorbid medical conditions, there are components of their therapeutic regimens which may also secondarily improve their respective medical illnesses. Breathing training is a method of reducing panic symptomatology by utilizing capnometry biofeedback to decrease the number of episodes of hyperventilation. Several of these slow breathing techniques have been shown to benefit patients with asthma and hypertension.

Hyperventilation reduction can help patients with cardiovascular disease. Anxiety and stress-reduction techniques can lower adverse outcomes in cardiovascular illness by decreasing sympathetic activity. Relaxation and stress-reduction interventions can reduce anxiety and blood pressure.  

Antidepressants and benzodiazepines are the mainstays of pharmacologic treatment. Among the different classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) are recommended over monoamine oxidase inhibitors and tricyclic antidepressants. SSRIs are considered first line treatment. Some authors have proposed that if first-line pharmacologic treatment is unsuccessful, consideration should be given to the use of antiepileptic drugs. There also exists a potential for atypical antipsychotics to be used in select circumstances. There should be careful weighing of risks vs benefits of benzodiazepine use. Treatment of any co-occuring anxiety, depressive, or substance use disorders should take precedent. [10][11][12]

Differential Diagnosis

  • Angina
  • Asthma
  • Congestive heart failure
  • Mitral valve prolapse
  • Pulmonary embolism
  • Substance use diosrder
  • other mental health disorders associated with panic attacks

Prognosis

Prognosis can be guarded. The presence of panic disorder without other psychopathology is rare. Most people will have recurrence of panic symptoms even after a period of having no attacks. 

Complications

Panic disorder is associated with a higher risk of suicidal ideation. It is also associated with an increased risk of comorbid medical conditions and smoking. 

Pearls and Other Issues

 

 

 

Enhancing Healthcare Team Outcomes

There is no cure for panic disorder, and it can present in a number of ways, thus making the diagnosis difficult. The majority of patients with panic disorder present to the emergency room and hence the role of the nurse and emergency room physician cannot be overemphasized. The patient needs a thorough education on the disorder and understands that the symptoms are not life-threatening. The patient needs to be told about the different treatments available and the need for compliance. Plus, the pharmacist should caution the patient against the use of alcohol or recreational drugs. The patient should be taught to recognize the triggers and avoid them. Before starting any drug therapy, the patient should be informed about the side effects and benefits. In addition, the family should be educated in helping the patient overcome unrealistic fears and other behaviors. Finally, the patient should be educated on a healthy lifestyle by adopting good sleep hygiene, exercise, and a healthy diet. The patient should be advised against any herbal supplements without first speaking to the primary care provider. [13][14](Level V)

Outcomes 

Panic disorder has no cure, and its course is unpredictable. The currently available pharmacological therapy and cognitive behavior therapy do work in about 80% of patients, but relapses are common. About 20% of patients continue to have symptoms that lead to a poor quality of life. About two third of treated patients have a good prognosis, achieving remissions for about six months at a time. If the trigger factors like stress, alcohol, financial problems, divorce are not controlled, the symptoms can create havoc. More important, there is a high risk of coronary artery disease in patients with panic disorder and the risk of sudden death is increased compared to the general population. Finally, the suicide rate is much higher in patients with panic disorder. There is a high association of social, occupational, and phsyical disability caused by panic disorder. [15][16][17](Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Panic Disorder (Attack) - Questions

Take a quiz of the questions on this article.

Take Quiz
Which of the following drugs is used to treat acute panic disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In a patient with anxiety, which finding would suggest the presence of an organic disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is diagnosed with panic disorder and prescribed an anxiolytic drug. What is the most important reason for short-term follow-up?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Panic disorder often is treated with which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
During an anxiety attack, which segment of the nervous system is activated?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 33 year old patient with panic disorder suddenly becomes quite anxious, frightened, and cannot catch her breath during a unit group session. What is the best initial action?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What intervention is required for a patient having an acute panic attack?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is an unlikely presentation of a panic disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is diagnosed with panic disorder. Which of the following is not a manifestation of this condition?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What drug typically is used as a first-line agent to treat panic disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient on the psychiatric inpatient unit has been complaining of recurrent episodes of shortness of breath, a feeling of doom, diaphoresis, a choking sensation, lightheadedness, and palpitations. These episodes have been occurring on a weekly basis. Work up so far has not revealed an organic cause. The psychiatrist believes it be a mental health disorder. What is a key hallmark feature of this disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is the most prominent symptom during a panic attack?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following symptoms is most likely to be seen in panic disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
At what point does the average panic attack peak?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following symptoms is not classically observed in panic disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An adult with a history of panic attacks presents to the emergency room with chest pain, palpitations, and dyspnea. What is the most appropriate initial management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 24-year-old female with no past medical history presents to the emergency department with an overwhelming sense of doom, palpitations, dyspnea, and dizziness for the past 20 minutes. She describes multiple similar previous episodes in which her hands get sweaty. Attacks occur one to two times weekly. She cannot identify any triggers. She denies any excessive caffeine use or illicit drug use. What is the most appropriate pharmacologic agent for her clinical condition from the options listed below?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 65-year-old male presents to the emergency department with complaints of excessive sweating, shortness of breath, and choking for the past 2 hours. He is accompanied by his wife, who describes the patient as being overconcerned about the things that are happening in his life. On physical examination, the blood pressure is 130/80 mmHg, the pulse is 78/min, and the respiratory rate is 12/min. He is fearful of receiving any medication as he previously stopped taking a prescription after his symptoms worsened upon its initiation. Which of the following is the most appropriate treatment for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 17-year-old patient presents to the emergency department with the complaint of shortness of breath and chest tightness. He has had these symptoms for the third time in the past two months, and he keeps on shouting, "I think I will die." On physical examination, his blood pressure is 130/80 mmHg, the pulse is 90/min, and respiratory rate is 16/min. His EKG and lab findings are unremarkable. He is prescribed the appropriate medication and therapy for his condition. During the treatment of the condition, which of the following would be recommended for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following are common symptoms of a panic attack? Select all that apply.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A client has been diagnosed with panic disorder. What teaching points will be included in educating the client and family about this disorder? Select all that apply.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 30-year-old man presents from work with a complaint of an episode of chest pain, breathing difficulty, and a racing heart that lasted 15 minutes. He currently feels better. However, he is concerned as he has had several episodes of these symptoms for the past three months. The symptoms usually last 20-30 minutes. He has recently started a job where he is not doing well and feels stressed because of it. His family history is significant for coronary artery disease in his father, diagnosed at the age of 60. He denies smoking or the use of any other illicit substance. On physical examination, his heart rate is 100/min, respiratory rate is 14/min, and the blood pressure is 125/80 mmHg. Which of the following is the most appropriate step in diagnosing the condition?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Panic Disorder (Attack) - References

References

Berenz EC,York TP,Bing-Canar H,Amstadter AB,Mezuk B,Gardner CO,Roberson-Nay R, Time course of panic disorder and posttraumatic stress disorder onsets. Social psychiatry and psychiatric epidemiology. 2018 Jul 12     [PubMed]
Indranada AM,Mullen SA,Duncan R,Berlowitz DJ,Kanaan RAA, The association of panic and hyperventilation with psychogenic non-epileptic seizures: A systematic review and meta-analysis. Seizure. 2018 Jul     [PubMed]
Perna G,Caldirola D, Is panic disorder a disorder of physical fitness? A heuristic proposal. F1000Research. 2018     [PubMed]
Sivolap YP, [Panic disorder: clinical phenomena and treatment options]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2017     [PubMed]
Farris SG,Robinson JD,Zvolensky MJ,Hogan J,Rabius V,Cinciripini PM,Karam-Hage M,Blalock JA, Panic attacks and smoking cessation among cancer patients receiving smoking cessation treatment. Addictive behaviors. 2016 Oct     [PubMed]
Foldes-Busque G,Fleet RP,Denis I,Poitras J,Chauny JM,Diodati JG,Marchand A, Nonfearful Panic Attacks in Patients With Noncardiac Chest Pain. Psychosomatics. 2015 Sep-Oct     [PubMed]
Lai CH, Fear Network Model in Panic Disorder: The Past and the Future. Psychiatry investigation. 2018 Sep 5     [PubMed]
Quagliato LA,Freire RC,Nardi AE, Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines. Expert opinion on drug safety. 2018 Mar     [PubMed]
Blackwelder R,Bragg S, Anxiety disorders: A blended treatment approach. International journal of psychiatry in medicine. 2016     [PubMed]
Ströhle A,Fydrich T, [Anxiety disorders: which psychotherapy for whom?] Der Nervenarzt. 2018 Mar     [PubMed]
Tanguay Bernard MM,Luc M,Carrier JD,Fournier L,Duhoux A,Côté E,Lessard O,Gibeault C,Bocti C,Roberge P, Patterns of benzodiazepines use in primary care adults with anxiety disorders. Heliyon. 2018 Jul     [PubMed]
Thibaut F, Anxiety disorders: a review of current literature. Dialogues in clinical neuroscience. 2017 Jun     [PubMed]
Legey S,Aquino F,Lamego MK,Paes F,Nardi AE,Neto GM,Mura G,Sancassiani F,Rocha N,Murillo-Rodriguez E,Machado S, Relationship Among Physical Activity Level, Mood and Anxiety States and Quality of Life in Physical Education Students. Clinical practice and epidemiology in mental health : CP     [PubMed]
Spijker J,van Vliet IM,Meeuwissen JA,van Balkom AJ, [Update of the multidisciplinary guidelines for anxiety and depression]. Tijdschrift voor psychiatrie. 2010     [PubMed]
Apolinário-Hagen J, Internet-Delivered Psychological Treatment Options for Panic Disorder: A Review on Their Efficacy and Acceptability. Psychiatry investigation. 2018 Aug 20     [PubMed]
Caldirola D,Alciati A,Riva A,Perna G, Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years. Expert opinion on pharmacotherapy. 2018 Aug     [PubMed]
Schwartz RA,Chambless DL,McCarthy KS,Milrod B,Barber JP, Client resistance predicts outcomes in cognitive-behavioral therapy for panic disorder. Psychotherapy research : journal of the Society for Psychotherapy Research. 2018 Jul 26     [PubMed]
2016 Jun;     [PubMed]
Santos M,D'Amico D,Spadoni O,Amador-Arjona A,Stork O,Dierssen M, Hippocampal hyperexcitability underlies enhanced fear memories in TgNTRK3, a panic disorder mouse model. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2013 Sep 18;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Pediatrics-Medical Student. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Pediatrics-Medical Student, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Pediatrics-Medical Student, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Pediatrics-Medical Student. When it is time for the Pediatrics-Medical Student board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Pediatrics-Medical Student.