Screening for Panic Disorder

If you suspect that you might suffer from panic disorder, answer the questions below, print out the results and share them with your health care professional.

Are you troubled by the following?

Yes     No Repeated or unexpected “attacks” during which you suddenly are overcome by intense fear or discomfort for no apparent reason

If yes, during an attack did you experience any of these symptoms?

Yes   No Pounding heart
Yes   No Sweating
Yes   No Trembling or shaking
Yes   No Shortness of breath
Yes   No Choking
Yes   No Chest pain
Yes   No Nausea or abdominal discomfort
Yes   No "Jelly" legs
Yes   No Dizziness
Yes   No Fear of losing control or "going crazy"
Yes   No Fear of dying
Yes   No Numbness or tingling sensations
Yes   No Chills or hot flushes

As a result of these attacks, have you…

Yes   No experienced a fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge?
Yes   No felt unable to travel without a companion?

For at least one month following an attack, have you…

Yes   No felt persistent concern about having another one?
Yes   No worried about having a heart attack or “going crazy”?
Yes   No changed your behavior to accommodate the attack?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Depression and substance abuse are among the conditions that occasionally complicate panic disorder.

Yes   No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel…

Yes   No sad or depressed?
Yes   No disinterested in life?
Yes   No worthless or guilty?

During the last year, has the use of alcohol or drugs...

Yes   No resulted in your failure to fulfill responsibilities with work, school, or family?
Yes   No placed you in a dangerous situation, such as driving a car under the influence?
Yes   No gotten you arrested?
Yes   No continued despite causing problems for you or your loved ones?

Reference:
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.

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