18 year old girl presented with breathlessness, anxiety, palpitation & tingling around lips. There is similar history in past. Diagnosis is -

Ans. is 'a' i.e., Panic attack o Hyperventilation syndrome with chest pain and a tingling sensation in the fingertips and around the mouth (paresthesia) and may accompany a panic attack.o Panic disorder is characterized by intermittent sever anxiety (Panic) unrelated to any particular situation or object. A panic attack has following characterisitics:-i) Discrete episode of intense fearii) Abrupt onset (sudden onset)iii) Reaches as maximum within few minutes and lasts for some minutes.iv) At least four of the following symptoms:-1) Palpitation8) Dizziness, unsteady, tainting2) Sweating9) Derealization or depersonalization3) Shortness of breath (Breathlessness)10) Fear of losing control4) Feeling of choking11) Fear of dying (impending doom)5) Chest pain or discomfort (chest constriction)12) Paresthesias6) Nausea or abdominal distress13) Chills or hot flushes7) Trembling or shaking v) At least one of the attack is followed by 1 month (or more) of one (or more) of the following:-a) Persistent concern of future attacks.b) Worry about the consequences of attacks (Heart attack, Stroke)c) Significant change in behavior related to attack.o Patients with panic disorder present with a number of comorbid conditions, most commonly agoraphobia. So, panic disorders may be classified as either Panic disorder with agoraphobia or panic disorder without agoraphobiao Important differential diagnosis of Panic disorder1) CVS:- Anemia, Angina, CHF, Hypertension, Mitral valve prolapse.2) Pulmonary:- Asthma.3) Endocrine:- Pheochromocytoma, Hyperthyroidism, Carcinoid syndrome, Cushing's syndrome, Addison's disease, Diabetes, Hypoparathyroidism.4) Neurological:- CVA, Epilepsy, infection, Migraine, Tumor, Multiple sclerosis, Huntington's disease, Meniere's disease.5) Amphetamine, Cocaine, Theophylline, Nicotine, Marijuana, Anticholinergics.6) Drug withdrawal:- Alcohol, Opioids, Antihypertensives.7) Other:- Anaphylaxis, Vit-B 12 deficiency, SLE, Uremiao Major neurotransmitters involved in panic disorder are norepinephrine, Serotonin and GABA. Other neurotransmitters involved are dopamine and cholecystokinine.