Can Nurse Practitioners Diagnose Panic Disorder?
Yes, nurse practitioners can diagnose panic disorder in adults within their scope of practice, as they are trained to screen, evaluate, and initiate diagnostic assessments for anxiety disorders including panic disorder.
Scope of Practice for Diagnosis
The National Association of Nurse Practitioners in Women's Health explicitly recognizes nurse practitioners as qualified providers who can identify and initiate diagnostic evaluations for anxiety disorders through standardized screening in routine clinical practice 1.
Multiple professional organizations, including the American College of Nurse-Midwives and the Association of Women's Health, Obstetric and Neonatal Nurses, endorse nurse practitioners' role in screening and diagnostic evaluation of anxiety disorders 1.
Diagnostic Approach for Panic Disorder
Initial screening and assessment:
Use validated screening tools such as the GAD-7 (which screens for generalized anxiety but helps identify anxiety disorders broadly) or the Patient Health Questionnaire for panic disorder to aid in diagnosis and assessment 2.
Conduct focused history taking to identify recurrent, unexpected panic attacks characterized by abrupt surges of intense fear with physical symptoms (palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, or fear of dying) 3, 2.
Determine if panic attacks are accompanied by persistent concern about additional attacks, worry about implications of attacks, or significant maladaptive behavioral changes related to the attacks 3.
Critical differential diagnosis considerations:
Rule out cardiac, pulmonary, endocrine (especially thyroid), and neurological conditions that can mimic panic symptoms through targeted history and selective testing based on clinical presentation 4, 5.
Screen for comorbid major depressive disorder using PHQ-9, as depression commonly co-occurs with panic disorder 6, 2.
Assess for substance use disorders (including caffeine, stimulants, and alcohol withdrawal), which frequently complicate anxiety disorders and must be treated concurrently 6, 2.
Safety Assessment Requirements
Immediately screen for suicidal ideation, self-harm thoughts, or intent to harm others, with any positive response requiring immediate psychiatric referral or emergency evaluation 6.
Evaluate functional impairment by determining how panic symptoms interfere with work, home responsibilities, and relationships 6.
Treatment Initiation Within NP Scope
Nurse practitioners can initiate first-line treatments:
Prescribe selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line pharmacotherapy, as these are equally effective and superior to benzodiazepines for long-term management 3, 2.
Provide patient education about panic disorder, which is a vital step in management 4.
Refer to cognitive behavioral therapy (CBT), which has strong evidence for effectiveness and can be used alone or combined with antidepressants 3, 7, 2.
Avoid benzodiazepines as first-line therapy due to adverse reactions, risk of dependence, and higher mortality despite their effectiveness in treating acute panic symptoms 2.
Collaboration and Referral Indications
Refer to psychiatry or psychology for complex cases, treatment-resistant panic disorder, significant comorbidities (bipolar disorder, psychotic symptoms, substance use disorders), or when specialized psychotherapy like CBT is needed but not available 6, 8.
Consider psychiatric consultation for patients with severe functional impairment, suicidal ideation, or diagnostic uncertainty 6.
Common Pitfalls to Avoid
Do not miss comorbid depression by failing to screen with PHQ-9 or direct questioning about depressive symptoms 6.
Do not overlook substance use disorders, particularly alcohol or stimulant use, which require concurrent treatment 6, 2.
Do not order extensive unnecessary cardiac or other medical testing before making a positive diagnosis of panic disorder based on careful history taking, as this increases costs and delays appropriate treatment 5.
Do not prescribe benzodiazepines for long-term management despite patient requests, as they are less effective than antidepressants and CBT for sustained improvement 3, 2.