14th February 2025

A 17-year-old woman with a background of depression, asthma and anorexia nervosa frequently attends A&E with acute severe anxiety, headaches, and the feeling that she is going to die.

A 17-year-old woman with a background of depression, asthma and anorexia nervosa frequently attends A&E with acute severe anxiety, headaches, and the feeling that she is going to die. 

Observations – RR 24, Sa02 98% on room air, BP 145/100, HR 97, T 36.6 

The SHO (senior house officer) speaks with his consultant who advises him to refer her to endocrinology to rule out a physical cause of her episodic symptoms. 

The following investigations are ordered in the endocrinology clinic:

Urine metanephrines: 0.7 µmol (<1.5 µmol/24 hrs)

Urine normetanephrines: 2 µmol (<3.5 µmol/24 hrs)

TSH 4.0 mU/L² (0.4-4)

Free T4 20.7 pmol/L (9-24)

The A&E SHO wonders whether she is suffering from panic attacks. 

What differentiates panic attacks from panic disorder?

Select the SINGLE most appropriate option from the list below. Select ONE option only.