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New developments in panic disorder

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Abstract

Panic disorder is a distressing and disabling disorder characterized by recurring panic attacks; anticipatory anxiety about having additional attacks; and agoraphobic fear and avoidance of situations in which attacks have occurred, ready escape is difficult, or help is unavailable in the event of an attack. It is typically associated with impairment in social, emotional, and vocational functioning, as well as excessive utilization of the medical care system. A number of pharmacologic agents and cognitive-behavioral treatments have proven effective for the treatment of panic disorder. Selective serotonin reuptake inhibitors are becoming first-line pharmacotherapy because of their favorable side effect profile and greater spectrum of efficacy in comparison with older classes of agents. In this article, we provide an overview of the prevalence, associated health care utilization, impairment in quality of life, and treatment of panic disorder.

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References and Recommended Reading

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  2. Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51:8–19.

    PubMed  CAS  Google Scholar 

  3. Pollack MH, Smoller JW: The longitudinal course and outcome of panic disorder. InLongitudinal Perspectives on Anxiety Disorders. Psychiatric Clinics of North America. Edited byPollack MH, OttoMW. Philadelphia: WB Saunders; 1995: 785–801.

    Google Scholar 

  4. Klerman GL, Weissman MM, Ouellette R, et al.: Panic attacks in the community: social morbidity and health care utilization. JAMA 1991, 265:742–746.

    Article  PubMed  CAS  Google Scholar 

  5. Buller R, Winter P, Amering M, et al.: Center differences and cross-national invariance in help-seeking for panic disorder: a report from the cross-national collaborative panic study. Soc Psychiatry Epidemiol 1992, 27:135–141.

    CAS  Google Scholar 

  6. Katerndahl DA, Realini JP: Where do panic sufferers seek care? J Fam Pract 1995, 40:237–243.

    PubMed  CAS  Google Scholar 

  7. Orleans CT, George LK, Houpt JL: How primary physicians treat psychiatric disorders: a national survey of family practitioners. Arch Gen Psychiatry 1985, 42:52–57.

    Google Scholar 

  8. Borus JF, Howes MJ, Devins NP, et al.: Primary health care providers’ recognition and diagnosis of mental disorders in their patients. Gen Hosp Psychiatry 1988, 10:317–321.

    Article  PubMed  CAS  Google Scholar 

  9. Stewart AL, Hays RD, Ware JE: The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care 1988, 26:724–735.

    Article  PubMed  CAS  Google Scholar 

  10. Pollack MH, Kradin R, Otto MW, et al.: Prevalence of panic disorder in patients referred for pulmonary function testing at a major medical center. Am J Psychiatry 1996, 153:110–113.

    PubMed  CAS  Google Scholar 

  11. Barsky AJ, Clearly PD, Coeytaux RR, et al.: Psychiatric disorders in medical outpatients complaining of palpitations. J Gen Intern Med 1994, 9:306–313.

    Article  PubMed  CAS  Google Scholar 

  12. Stein MB, Asmundson GJG, Ireland D, et al.: Panic disorder in patients attending a clinic for vestibular disorders. Am J Psychiatr 1994, 151:1697–1700.

    PubMed  CAS  Google Scholar 

  13. Beitman BD, Mukerji V, Lamberti JW, et al.: Panic disorder in patients with chest pain in angiographically normal coronary arteries. Am J Cardiol 1989, 63:1399–1403.

    Article  PubMed  CAS  Google Scholar 

  14. Spitzer RL, Williams JB, Kroenke K, et al.: Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME MD 1000 Study. JAMA 1994, 272:1749–1756.

    Article  PubMed  CAS  Google Scholar 

  15. Sheehan DV, Ballenger JC, Jacobsen G: Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry 1980, 37:51–59.

    PubMed  CAS  Google Scholar 

  16. Carter C, Maddox R, Amsterdam E, et al.: Panic disorder and chest pain in the coronary care unit. Psychosomatics 1992, 33:302–310.

    PubMed  CAS  Google Scholar 

  17. Lydiard RB, Fossey MD, Marsh W, et al.: Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics 1993, 34:229–234.

    PubMed  CAS  Google Scholar 

  18. Bridges KW, Goldberg BP: Somatic presentation of DSM-III psychiatric disorders in primary care. J Psychosom Res 1985, 29:563–569.

    Article  PubMed  CAS  Google Scholar 

  19. Ormel J, Koeter MW, van denBrinkW, et al.: Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry 1991, 48:700–706.

    PubMed  CAS  Google Scholar 

  20. Roy-Byrne PP, Stein MB, Russo J: Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. J Clin Psychiatry 1999, 60:492–499. This paper presents issues related to the presentation of panic in medical setting and treatment issues.

    Article  PubMed  CAS  Google Scholar 

  21. Candilis P, McLean R, Otto M, et al.: Quality of life in patients with panic disorder. J Nerv Ment Dis 1999, 187:429–434. This paper documents impaired quality of life associated with panic disorder.

    Article  PubMed  CAS  Google Scholar 

  22. Markowitz JS, Weissman MM, Ouellette R, et al.: Quality of life in panic disorder. Arch Gen Psychiatry 1989, 46:984–992.

    PubMed  CAS  Google Scholar 

  23. Weissman MM: Panic disorder: impact on quality of life. J Clin Psychiatry 1991, 52(Suppl):6–9.

    PubMed  Google Scholar 

  24. Pohl R, Wolkow R, Clary C: Sertraline in the treatment of panic disorder: a double-blind multicenter trial. Am J Psychiatry 1998, 155:1189–1195.

    PubMed  CAS  Google Scholar 

  25. Pollack MH, Otto MW, Worthington JJ, et al.: Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Arch Gen Psychiatry 1998, 55:1010–1016.

    Article  PubMed  CAS  Google Scholar 

  26. Endicott J, Nee J, Harrison W, Blamenthal R: Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull 1993, 29:321–326.

    PubMed  CAS  Google Scholar 

  27. Rapaport MH, Pollack M, Wolkow R, et al.: Is placebo response the same as drug response in panic disorder? Am J Psychiatry 2000, 157:1014–1016.

    Article  PubMed  CAS  Google Scholar 

  28. Goddard AW, Charney DS: SSRIs in the treatment of panic disorder. Depress Anxiety 1998, 8(Suppl 1):114–120. This paper reviews treatment data examining efficacy of SSRIs for the treatment of panic disorder.

    Article  PubMed  Google Scholar 

  29. Breier A, Charney D, Heninger G: Major depression in patients with agoraphobia and panic disorder. Arch Gen Psychiatry 1984, 41:1129–1135.

    PubMed  CAS  Google Scholar 

  30. Naranjo CA, Kadlec KE, Sanhuenza P, et al.: Fluoxetine differentially alters alcohol intake and other consummatory behaviors in problem drinkers. Clin Pharmacol Ther 1990, 47:490–498.

    Article  PubMed  CAS  Google Scholar 

  31. Pollack MH, Rosenbaum JF: Fluoxetine for the treatment of cocaine abuse in intravenous drug users. J Clin Psychiatry 1991, 52:31–33.

    PubMed  CAS  Google Scholar 

  32. Steiner M, Oakes R, Gergel IP, et al.:A fixed dose study of paroxetine and placebo in the treatment in panic disorder. 148th Annual Meeting of the American Psychiatric Association. New Research Abstracts. Miami, FL, May 20–25, 1995.

  33. Londborg PD, Wolkow R, Smith WT, et al.: Sertraline in the treatment of panic disorder. Br J Psychiatry 1988, 173:54–60.

    Google Scholar 

  34. Ballenger JC, Burrow GD, DuPont RL, et al.: Alprazolam in panic disorder and agoraphobia: results from a multicenter trial; efficacy in short-term treatment. Arch Gen Psychiatry 1988, 45:413–422.

    PubMed  CAS  Google Scholar 

  35. Tesar GE, Rosenbaum JF, Pollack MH, et al.: Double blind, placebo controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry 1991, 52:69–76.

    PubMed  CAS  Google Scholar 

  36. Noyes R, Garvey MJ, Cook B, et al.: Controlled discontinuation of benzodiazepine treatment for patients with panic disorder. Am J Psychiatry 1991, 148:517–523.

    PubMed  Google Scholar 

  37. Simon NM, Pollack MH: The current status of panic disorder treatment: pharmacotherapy and cognitive-behavioral therapy. Psychiatr Ann 2000, in press.

  38. Modigh K, Westberg P, Eriksson E: Superiority of clomipramine over imipramine in the treatment of panic disorder: a placebo-controlled trial. J Clin Psychopharmacol 1992, 12:251–261.

    Article  PubMed  CAS  Google Scholar 

  39. Otto MW, Pollack MH, Jenike MA, et al.: Anxiety disorders and their treatment. In The Harvard Guide to Psychiatry, edn 3. Edited byNicholiAM. Cambridge: The Belknap Press of Harvard University Press; 1999:220–239. This chapter is a great overview of the epidemiology, presentation, and treatment of the anxiety disorders.

    Google Scholar 

  40. Tiffon L, Coplan JD, Papp LA, et al.: Augmentation strategies with tricyclic or fluoxetine treatment in seven partially responsive panic disorder patients. J Clin Psychiatry 1994, 55:66–69.

    PubMed  CAS  Google Scholar 

  41. Gastfriend DR, Rosenbaum JF: Adjunctive buspirone in benzodiazepine treatment of four patients with panic disorder. Am J Psychiatr 1989, 146:914–916.

    PubMed  CAS  Google Scholar 

  42. DeMartinis NA, Schweizer E, Rickels K: An open-label trial of nefazodone in high comorbidity panic disorder. J Clin Psychiatry 1996, 57:245–248.

    PubMed  CAS  Google Scholar 

  43. Pollack MH, Worthington JJ, Otto MW, et al.: Venlafaxine for panic disorder: results from a double-blind, placebo controlled study. Psychopharmacol Bull 1996, 32:667–670.

    PubMed  CAS  Google Scholar 

  44. GeraciotiT Jr: Venlafaxine treatment of panic disorder: a case series. J Clin Psychiatr 1995, 56:408–410.

    Google Scholar 

  45. Keck PE, McElroy SL, Tugrul KC, et al.: Antiepileptic drugs for the treatment of panic disorder. Neuropsychiatry 1993, 27:150–153.

    Google Scholar 

  46. Pollack MH, Scott EL: Gabapentin and lamotrigine: novel treatments for mood and anxiety disorders. CNS Spectrums 1997, 2:56–61.

    Google Scholar 

  47. Pollack MH, Matthews J, Scott EL: Gabapentin for refractory anxiety. Am J Psychiatr 1998, 155:992–993.

    PubMed  CAS  Google Scholar 

  48. Pande AC, Pollack MH, Crockatt J, et al.: Placebo-controlled study of gabapentin treatment in panic disorder. J Clin Psychopharm 2000, in press.

  49. Barlow DH, Gorman JM, Shear MK, et al.: A randomized controlled trial of cognitive-behavioral treatment versus imipramine and their combination for panic disorder: Primary outcome results. JAMA 2000, 283:2529–2536.

    Article  PubMed  CAS  Google Scholar 

  50. Clark DM, Salkvskis PM, Hackman A, et al.: A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry 1994, 164:759–769.

    Article  PubMed  CAS  Google Scholar 

  51. Gould RA, Otto MW, Pollack MH: A meta-analysis of treatment outcome for panic disorder. Clin Psychology Rev 1995, 15:819–844.

    Article  Google Scholar 

  52. Otto MW, Pollack MH, Gould RA: Access to empiricallysupported treatment for panic disorder: costs, benefits, and managed care. Paper presented at the Anxiety Disorders Association of America 17th National Conference. New Orleans, LA: March 20–23, 1997.

  53. Barlow DH, Craske MD: Mastery of your anxiety and panic (Client Workbook), edn 2. San Antonio, TX: Psychological Corporation; 1995.

    Google Scholar 

  54. Otto MW, Deckersbach T: Cognitive-behavioral therapy for panic disorder: theory, strategies, and outcome. InPanic Disorder and Its Treatment. Edited byJFRosenbaum MHPollack. New York: Marcel Dekker; 1998:181–204.

    Google Scholar 

  55. Penava SJ, Otto MW, Maki KM, et al.: Rate of improvement during cognitive-behavioral group treatment for panic disorder. Behav Res Ther 1998, 36:665–673.

    Article  PubMed  CAS  Google Scholar 

  56. Otto MW, Pollack MH, Maki KM: Empirically-supported treatments for panic disorder: costs, benefits, and stepped care.J Consult Clin Psychol 2000, in press.

  57. Pollack MH, Otto MW, Kaspi SP, et al.: Cognitive-behavioral therapy for medication-refractory panic disorder. J Clin Psychiatry 1994, 55:200–205.

    PubMed  CAS  Google Scholar 

  58. Otto MW, Pollack MH, Penava SJ, et al.: Group cognitivebehavior therapy for patients failing to respond to pharmacotherapy for panic disorder: a clinical case series. Behav Res Ther 1999, 37:763–770.

    Article  PubMed  CAS  Google Scholar 

  59. Otto MW, Pollack MH, Sachs GS, et al.: Discontinuation of benzodiazepine treatment: Efficacy of cognitive-behavior therapy for patients with panic disorder. Am J Psychiatry 1993, 150:1485–1490.

    PubMed  CAS  Google Scholar 

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Marzol, P.C., Pollack, M.H. New developments in panic disorder. Curr Psychiatry Rep 2, 353–357 (2000). https://doi.org/10.1007/s11920-000-0081-8

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