Article1986

Panic disorder: epidemiology in primary care.

Wayne J. Katon · PETER PAUL VITALIANO · Joan E. Russo · Luc Cormier · Kathleen C. Anderson

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access Psychosomatic Disorders and Their Treatments

Abstract

One hundred ninety-five patients in a primary care practice were screened with the National Institute of Mental Health Diagnostic Interview Schedule, a structured psychiatric interview, so that the epidemiology of panic disorder could be studied. Thirteen percent of the patients met criteria described in the Diagnostic and Statistical Manual of Mental Disorders, ed 3 (DSM-III) for panic disorder (6.7 percent if the DSM-III exclusionary criteria are used). An additional 8.7 percent of patients, labeled in the study as having simple panic, had four or more autonomic symptoms of panic disorder but did not meet DSM-III criteria (three panic attacks in a three-week period). Compared with controls, patients with panic disorder or simple panic had a significantly higher lifetime risk of major depression, multiple phobias, and avoidance behavior and higher scores on their psychological distress scales. Patients with panic disorder and simple panic often misinterpreted their symptoms as being due to a physical illness and had significantly higher scores on the somatization scale of the SCL-90 and on a medical review of symptoms than did the controls with no panic disorder. It is important to diagnose panic disorder accurately because double-blind placebo-controlled studies have demonstrated the efficacy of psychopharmacologic treatments, including tricyclic antidepressants (notably imipramine and desipramine), the high-potency benzodiazepine (alprazolam) and monoamine oxidase inhibitors (phenelzine). Primary care physicians, by screening patients with complaints of tension and anxiety, as well as multiple unexplained somatic complaints for panic disorder, may be able to reduce somatic preoccupation and disease phobia by instituting effective therapy.

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References

1981National Institute of Mental Health Diagnostic Interview Schedule 1973SCL-90: an outpatient psychiatric rating scale--preliminary report.1972Screening Depressed Patients in Family Practice 1984Six-Month Prevalence of Psychiatric Disorders in Three Communities 1980Treatment of Endogenous Anxiety With Phobic, Hysterical, and Hypochondriacal Symptoms 1981Types of stressful life event and the onset of anxiety and depressive disorders 1983Panic Disorder and Major Depression 1984Major Depression in Patients With Agoraphobia and Panic Disorder

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1994Cost of anxiety disorders: Impact of comorbidity 1989The Recognition, Diagnosis, and Treatment of Mental Disorders by Primary Care Physicians 1998Panic disorder in the general medical setting 1990Panic disorder: Cognitive-behavioral treatment 2002Use of the Behavioral Model of Health Care Use to identify correlates of use of treatment for panic attacks in the community 1995

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