DIAGNOSTIC PROFILE

Panic Disorder
300.01 (F41.0)
I. INTRODUCTION

A. Client’s Demographics
Joe is a 76 years old man who married to his wife Florence, as a child he was
basically a happy one despite his family was not stable financially. His father was a
laborer and work hard in his job until they were able to open a small hardware store.
But due to their financial difficulties Joe was not able to complete his education and
was helping with the store instead. He work for 9 years in the store then drafted for
Vietnam War at the age of 23. Years after returning from the war, Joe focused
himself in working for the store until it became successful. At age 45 he met his wife,
he was reluctant at first because of his educational background but then Florence
was really amazed of Joe’s intelligence and wisdom despite his educational
background. A year after he married Florence and have a daughter. They worked
hard in establishing the store until his retirement at the age of 70.

B. Reason for Referral

The client was presented to the therapist as he was experiencing a frequent panic
attack and was confused of what is wrong with himself. He was experiencing difficulty
in breathing, he felt that his heart was beating faster as if he could hear it, and he
also experienced chest pain and was even brought to the hospital thinking it was a
heart attack but according to the cardiologist there nothing wrong with his heart. The
symptoms was continuous for many weeks.

II. JUSTIFICATION
This psychologist in training was able to come up with a diagnosis on Panic
Disorder 300.01 (F41.0). This is due to the fact that diagnostic criteria for this disorder have
been fully satisfied and met. Presented below is the detailed diagnosis.

Diagnostic Criteria Given Facts

CRITERION A CRITERION A
Recurrent unexpected panic attacks. A Eight out of the following symptoms was
panic attack is an abrupt surge of intense evident with Joe’s case of recurrent
fear
or intense discomfort that reaches a peak
within minutes, and during which time four
(or more) of the following symptoms occur:
unexpected panic attacks. In which he
experienced an uncomfortable symptoms
that would wake him up from his sleep and
made him uncomfortable in going outside
his house.

1. Palpitations, pounding heart, or 1. Joe experienced a heart palpitations

accelerated heart rate. during his first attack during his flight
as he describe that his heart was
racing furiously. And few days after
the attack he woke at 2am in the
midnight feeling that his heart could
leap out from his chest and was
having difficulty in breathing.
Thinking he was having a heart
attack he was brought to the
hospital but the result came our as
negative as the cardiologist was
pointed out that he was having an
anxiety attack.

2. Sweating. 2. Joe does not describe any sweating

in his symptoms during the attack.

3. Trembling or shaking. 3. Joe experienced the symptoms as

he was going out in the morning and
was walking to the store when
suddenly felt that his heart was
pounding rapidly, he was breathing
difficulty, feeling dizzy, and was not
able to stop from trembling.

4. Sensations of shortness of breath or 4. Joe was symptoms shows difficulty

smothering. in breathing in most of his attack,
during his flight he felt difficult to
breathe and he woke up in the
 midnight feeling difficult to breath
and the day after during his walk he
felt the same symptoms, the
symptoms also continue for weeks.

5. Feelings of choking. 5. He does not experienced any

symptoms of feelings that he was
choked although he felt difficulty in
breathing in most attack.

6. Chest pain or discomfort. 6. Joe experienced a lot of chest pain

during his attack was even brought
to the hospital in thinking that he
was experiencing a heart attack
however the cardiologist mentioned
there was nothing wrong with his
heart and he was just having an
anxiety attack.

7. Nausea or abdominal distress. 7. He does not experienced any

nausea and any abdominal distress.

8. Feeling dizzy, unsteady, light- 8. During his walk in the morning after
headed, or faint. he was brought to the hospital
because of an attack, he
experienced the feeling of dizziness
and other symptoms such difficulty
in breathing, chest pain, and
trembling.

9. Chills or heat sensations. 9. Joe did not described any

experienced of chills or heat
sensations.

10. Paresthesias (numbness or tingling 10. His symptoms does not includes any
sensations). feeling of paresthesias.
11. Derealization (feelings of unreality) 11. Joe experienced during his attack as
or depersonalization (being he was walking for his routine trip to
detached from oneself). the store he was experiencing some
symptom related to his attack and
he was looking for safe place but
then realized that everything was
like he was in a dreamland as he
described, that everything around
him seemed unreal.

12. Fear of losing control or “going 12. Joe thought that if he goes outside
crazy.” after experiencing an attack while
walking in a busy street he was
reminded by the cardiologist words
that he was having an anxiety
thinking that he was afraid of having
a nervous breakdown. When his
arrived an asking about him he was
barely manage follow what she was
saying and he was thinking that he
was losing a grip.

13. Fear of dying 13. Joe experienced his first attack

during his flight and because of the
difficulty in breathing he felt like he
needs to open the plane’s door and
was frightened by the thought,
during his attack in the midnight also
he was scared of opening the
window thinking about the previous
thoughts during the flight as if for
him he was having a suicide
ideation which made him stay away
 from his window. When he was
walking also he experienced an
attack and forced himself back to his
apartment, as his suggested that
they would take a walk outside he
was terrified by the idea thinking he
will have other attack and he was
very uncomfortable by the thought.

CRITERION B CRITERION B
At least one of the attacks has been Both of the following was observed with
followed by 1 month (or more) of one or case of Joe.
both of the following:

1. Persistent concern or worry about 1. Joe felt if he will go outside as his

additional panic attacks or their wife suggested he will experienced
consequences (e.g., losing control, another attack and would not able to
having a heart attack, “going crazy”). find a safe space to help him calm
down.

2. A significant maladaptive change in 2. Joe become afraid and

behavior related to the attacks (e.g.,
behaviors designed to avoid having
panic attacks, such as avoidance of
exercise or unfamiliar situations).
uncomfortable with going outside
due to thinking that he might not
able to find a place that could help
him if the symptoms will appear
again.

CRITERION C CRITERION C
The disturbance is not attributable to the Joe’s condition was not attributed with any
physiological effects of a substance (e.g., a physiological effects of a substance or other
drug of abuse, a medication) or another medical condition as he was examine by a
medical condition (e.g., hyperthyroidism, cardiologist and appeared negative in
cardiopulmonary disorders). results.
 CRITERION D CRITERION D
The disturbance is not better explained by His conditions cannot be better explained in
another mental disorder (e.g., the panic any other mental disorder as his symptoms
attacks do not occur only in response to appear unexpectedly even during his
feared social situations, as in social anxiety sleeps.
disorder; in response to circumscribed
phobic objects or situations, as in specific
phobia; in response to obsessions, as in
obsessive-compulsive disorder; in response
to reminders of traumatic events, as in
posttraumatic stress disorder; or in
response to separation from attachment
figures, as in separation anxiety disorder).

III. TREATMENT RECOMMENDATION

Panic disorder respond effectively with psychotherapy and medication. Psychotherapy
particular Cognitive Behavioral Therapy (CBT) can help Joe with the way his thinking,
behaving, and reacting to the feelings of the attacks that he experienced. This therapy will
help the client deal with his symptoms and eventually treat him completely, other treatment
is through medication such as Selective serotonin reuptake inhibitors (SSRIs) and Serotonin-
norepinephrine reuptake inhibitors (SNRIs) in which it could help with the symptoms that the
client is having, although side effects could be present in which it needed a proper guidance
from a psychiatrist.

IV. COMORBIDITY
There are several mental disorder that greatly comorbid with Panic disorder however with
the case of Joe he does not shows any symptoms that could explain any comorbidity with
other disorders as his symptoms only in lined with his diagnosis.