Abstract
Under-recognition of somatic symptoms associated with panic in primary care settings results in unnecessary and costly diagnostic procedures and inappropriate referrals to cardiologists, gastroenterologists, and neurologists. In the current study specialists’ knowledge regarding the nature and treatment of panic were examined. One-hundred and fourteen specialists completed a questionnaire assessing their knowledge about panic attacks, including their perceptions of psychologists’ role in treating panic. Respondents answered 51% of knowledge items correctly. Although most knew the definition of a panic attack, they knew less about clinical features of panic and its treatment. Specifically, whereas 97.4% believed medication effectively relieves panic symptoms, only 32.5% knew that cognitive-behavioral therapy (CBT) is a first-line treatment. Only 6% reported knowing how to implement CBT, and only 56.1% recognized that psychologists could effectively treat panic. These findings demonstrate significant gaps in specialists’ knowledge about panic and the need to enhance physician knowledge about panic attacks and their treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association. (2006, May). Practice guideline for the treatment of patients with panic disorder. doi:10.1176/appi.books.9780890423363.51396. Retrieved September 15, 2008, from Psychiatry online: http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=Panic_05-15-06.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders-text revision. Washington, DC: Author.
Ballenger, J. C. (1998). Treatment of panic disorder in the general medical setting. Journal of Psychosomatic Research, 44, 5–15.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.
Barlow, D. H., & Craske, M. (1994). Mastery of your anxiety and panic II (MAP II). Albany, NY: Graywind.
Barsky, A. J., Delamater, B. A., Clancy, S. A., Antman, E. M., & Ahern, D. K. (1996). Somatized psychiatric disorder presenting as palpitations. Archives of Internal Medicine, 156, 1102–1108.
Carter, C. S., Servan-Schreiber, D., & Perlstein, W. M. (1997). Anxiety disorders and the syndrome of chest pain with normal coronary arteries: Prevalence and pathophysiology. Journal of Clinical Psychiatry, 58(Suppl 3), 70–73. discussion 4–5.
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.
Craske, M. G., Roy-Byrne, P., Stein, M. B., Donald-Sherbourne, C., Bystritsky, A., Katon, W., et al. (2002). Treating panic disorder in primary care: A collaborative care intervention. General Hospital Psychiatry, 24, 148–155.
Deehan, A., Templeton, L., Taylor, C., Drummond, C., & Strang, J. (1997). The effect of cash and other financial inducements on the response rate of general practitioners in a national postal study. British Journal of General Practice, 47, 87–90.
Fleet, R. P., Dupuis, G., Marchand, A., Burelle, D., & Beitman, B. D. (1997). Detecting panic disorder in emergency department chest pain patients: A validated model to improve recognition. Annals of Behavioral Medicine, 19, 124–131.
Goldstein, A. J., & Chambless, D. L. (1978). A reanalysis of agoraphobia. Behavioral Therapy, 9, 947–959.
Hicks, T. V., Leitenberg, H., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2005). Physical, mental, and social catastrophic cognitions as prognostic factors in cognitive-behavioral and pharmacological treatments for panic disorder. Journal of Consulting and Clinical Psychology, 73, 506–514.
Katerndahl, D. A. (1988). The sequence of panic symptoms. Journal of Family Practitioners, 26, 49–52.
Katerndahl, D. A., & Ferrer, R. L. (2004). Knowledge about recommended treatment and management of major depressive disorder, panic disorder, and generalized anxiety disorder among family physicians. Primary Care Companion to the Journal of Clinical Psychiatry, 6, 147–151.
Katerndahl, D. A., & Realini, J. P. (1995). Where do panic attack sufferers seek care? Journal of Family Practice, 40, 237–243.
Katon, W. (1992). Panic disorder: Somatization, medical utilization, and treatment. American Journal of Medicine, 92(1A), 1–2.
Katon, W. (1996). Panic disorder: Relationship to high medical utilization, unexplained physical symptoms, and medical costs. Journal of Clinical Psychiatry, 57(Suppl 10), 11–18. discussion 9–22.
Katon, W. J., Von Korff, M., & Lin, E. (1992). Panic disorder: Relationship to high medical utilization. American Journal of Medicine, 92(1A), 7S–11S.
Kawachi, G. A., Colditz, A., Ascherio, E. B., Rimm, E., Giovannucci, M. J., & Stampfer, W. C. (1994). Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation, 89, 1992–1997.
Klosko, J. S., Barlow, D. H., Tassinari, R., & Cerny, J. A. (1990). A comparison of alprazolam and behavior therapy in treatment of panic disorder. Journal of Consulting and Clinical Psychology, 58, 77–84.
Leon, A. C., Olfson, M., & Portera, L. (1997). Service utilization and expenditures for the treatment of panic disorder. General Hospital Psychiatry, 19, 82–88.
Lydiard, R. B., Fossey, M. D., Marsh, W., & Ballenger, J. C. (1993). Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics, 34, 229–234.
Marcks, B. A., Woods, D. W., Teng, E. J., & Twohig, M. P. (2004). What do those who know, know? Investigating providers’ knowledge about Tourette’s syndrome and its treatment. Cognitive and Behavioral Practice, 11, 298–305.
Otto, M. W., & Deveney, C. (2005). Cognitive-behavioral therapy and the treatment of panic disorder: Efficacy and strategies. Journal of Clinical Psychiatry, 66(Suppl 4), 28–32.
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.
Roy-Byrne, P. P., Craske, M. G., Stein, M. B., Sullivan, G., Bystritsky, A., Katon, W., et al. (2005). A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Archives of General Psychiatry, 62, 290–298.
Roy-Byrne, P. P., & Katon, W. (2000). Anxiety management in the medical setting: Rationale, barriers to diagnosis and treatment, and proposed solutions. In D. Mostofsky & D. Barlow (Eds.), The management of stress and anxiety in medical disorders (p. 114). Boston: Allyn & Bacon.
Salkovskis, P. M. (1988). Phenomenology, assessment, and the cognitive model of panic. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 111–136). Hillsdale, NJ: Erlbaum.
Sartorius, N., Ustun, T. B., Costa e Silva, J. A., Goldberg, D., Lecrubier, Y., Ormel, J., et al. (1993). An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on ‘Psychological Problems in General Health Care’. Archives of General Psychiatry, 50, 819–824.
Siegel, L., Jones, W. C., & Wilson, J. O. (1990). Economic and life consequences experienced by a group of individuals with panic disorder. Journal of Anxiety Disorders, 4, 201–211.
Simon, G. E., & VonKorff, M. (1991). Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. American Journal of Psychiatry, 148, 1494–1500.
Simpson, R. J., Kazmierczak, T., Power, K. G., & Sharp, D. M. (1994). Controlled comparison of the characteristics of patients with panic disorder. British Journal of General Practice, 44, 352–356.
Smoller, J. W., Pollack, M. H., Wassertheil-Smoller, S., Jackson, R. D., Oberman, A., Wong, N. D., et al. (2007). Panic attacks and risk of incident cardiovascular events among postmenopausal women in the women’s health initiative observational study. Archives of General Psychiatry, 64, 1153–1160.
Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., de Gruy, F. V., 3rd, Hahn, S. R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. Journal of the American Medical Association, 272, 1749–1756.
Stewart, W. F., Shechter, A., & Liberman, J. (1992). Physician consultation for headache pain and history of panic: Results from a population-based study. American Journal of Medicine, 92(1A), 35S–40S.
Svensson, T. H. (1987). Peripheral, autonomic regulation of locus coeruleus noradrenergic neurons in brain: Putative implications for psychiatry and psychopharmacology. Psychopharmacology, 92, 1–7.
Zaubler, T. S., & Katon, W. (1998). Panic disorder in the general medical setting. Journal of Psychosomatic Research, 44, 25–42.
Acknowledgements
This material is based in part upon work supported by the Office of Academic Affiliations, VA Special MIRECC Fellowship Program in Advanced Psychiatry and Psychology, Department of Veterans Affairs and South Central MIRECC Fellowship start-up funds. This material is also based upon work supported in part by the Houston VA HSR&D Center of Excellence (Houston Center for Quality of Care & Utilization Studies [HFP90-020]).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Teng, E.J., Chaison, A.D., Bailey, S.D. et al. When Anxiety Symptoms Masquerade as Medical Symptoms: What Medical Specialists Know about Panic Disorder and Available Psychological Treatments. J Clin Psychol Med Settings 15, 314–321 (2008). https://doi.org/10.1007/s10880-008-9129-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-008-9129-4