[Panic attack: viewpoint of the internist]

The first part of this paper presents the history of a panic attack occurring during an acute hypertensive crisis, which led to the discovery of a left adrenal phaeochromocytoma. The second part of the paper presents a discussion of conditions that can simulate panic attacks. Accounts are given of: acute hypertensive crises, the post-ictal phase of epilepsy, overt tetany, certain forms of hypercalcaemia, hyperventilation syndromes, and lastly, paroxysmal dysrhythmias. The third part of the paper discusses panic reactions occurring in a variety of clinical conditions, in particular, once again, hypertensive attacks, profuse external haemorrhage, dyspnoeic attacks and hypoglycaemic attacks. These different manifestations demonstrate that failure to recognise a clinical sub-stratum responsible for, or co-existing with, a panic attack leads to the risk that treatment of a neuro-psychological nature may be inappropriate.