| Panic Assessment Inventory Dr. Kracke & Associates Name:______________________ Date:__________________ If you suspect panic disorder, complete the following self-test by clicking the `yes' or `no' boxes next to each question, print out the test and show the results to your health care professional. HOW CAN I TELL IF IT'S PANIC DISORDER? Are you troubled by: Yes No Repeated, unexpected "attacks" during which you suddenly are overcome by intense fear or discomfort, for no apparent reason? During this attack, did you experience any of these symptoms? Yes No pounding heart Yes No "jelly" legs Yes No sweating Yes No dizziness Yes No trembling or shaking Yes No feelings of unreality or being detached from yourself Yes No shortness of breath Yes No fear of losing control, going crazy Yes No choking Yes No fear of dying Yes No chest pain Yes No numbness or tingling sensations Yes No nausea or abdominal discomfort Yes No chills or hot flashes Yes No Do you experience a fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge? Yes No Are you troubled by being unable to travel without a companion? For at least one month following an attack, have you: Yes No felt persistent concern about having another one? Yes No worried about having a heart attack or going "crazy"? Yes No changed your behavior to accommodate the attack? Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate an anxiety disorder include depression and substance abuse. With this in mind, please take a minute to answer the following questions: Yes No Have you experienced changes in sleeping or eating habits? More days than not, do you feel: Yes No sad or depressed? Yes No disinterested in life? Yes No worthless or guilty? During the last year, has the use of alcohol or drugs: Yes No resulted in your failure to fulfill responsibilities with work, school, or family? Yes No placed you in a dangerous situation, such as driving a car under the influence? Yes No gotten you arrested? Yes No continued despite causing problems for you and/or your loved ones? |