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Characteristics and Course of Panic Disorder and Panic Disorder With Agoraphobia in Primary Care Patients

Jennifer Francis · Risa B. Wiesberg · INGRID R. DYCK · Larry Culpepper · Kevin W Smith · Maria Orlando Edelen +1 more

34 citations0/0 files storedThe Primary Care Companion to The Journal of Clinical Psychiatry

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access Personality Disorders and Psychopathology

Abstract

OBJECTIVE: To examine the course of panic disorder (PD) and panic disorder with agoraphobia (PDA) in 235 primary care patients during a 3-year period. METHOD: Patients were recruited from primary care waiting rooms and diagnosed using the Structured Clinical Interview for DSM-IV. They were reassessed at 6 months, 1 year, and annually thereafter for diagnosis, treatment, and other clinical and demographic variables. Recruitment occurred between July 1997 and May 2001. RESULTS: At intake, 85 patients were diagnosed with PD and 150 were diagnosed with PDA. Patients with PD were significantly more likely to achieve recovery (probability estimate, 0.75) from their disorder than patients with PDA (0.22) at the end of 3-year follow-up (p < .0001). There was no difference in recurrence rates between the 2 disorders. Women were more likely to recover from PD (p = .001). At intake, comorbid generalized anxiety disorder (p = .004), higher Global Assessment of Functioning score (p = .0003), and older age at panic onset (p = .05) were related to recovery from PDA, and comorbid major depressive disorder (p = .05) and psychosocial treatment (p = .002) predicted remaining in an episode of PDA. The relationship between psychosocial treatment and poor recovery must be interpreted with caution and is most likely due to the treatment bias effect. CONCLUSION: Primary care patients with PDA have a chronic course of illness, whereas those with PD have a more relapsing course. Given the significant burden of PD and PDA in primary care, attention to factors relevant to the course of these disorders is important for recognition and for continued improvement of treatment interventions in this setting.

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References

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2013Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder in a longitudinal sample of African American adults.2010Characteristics and predictors of social phobia course in a longitudinal study of primary-care patients 2009Psychiatric Treatment Received by Primary Care Patients With Panic Disorder With and Without Agoraphobia

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