Panic disorder and agoraphobia

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Target exams

Red flags

• First or atypical late-onset panic-like episode with chest pain, hypoxia, focal neurology, fever, or haemodynamic instability — exclude ACS, PE, arrhythmia, anaphylaxis, thyrotoxicosis, and other medical emergencies before attributing to panic
• Active suicidal ideation with depression comorbidity — full risk assessment, means restriction, and escalated care; do not treat as 'just anxiety'
• Severe housebound agoraphobia with inability to access food, care, or safety — escalate supports and intensity of care
• Chronic high-dose benzodiazepine dependence with failed self-tapers — planned withdrawal with CBT support, not abrupt cessation
• New or worsening agitation/activation after starting an SSRI — reassess early, review dose escalation pace, and recheck suicide risk if mood is low
• Substance intoxication or withdrawal (stimulants, cannabis, alcohol, benzodiazepines) presenting as panic — treat the substance pathway in parallel