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Easing the Burden of Panic Disorder: Comorbidity, Diagnosis, and Implications for Treatment

Published online by Cambridge University Press:  07 November 2014

David Baldwin
David Baldwin*
Affiliation:
Dr. Baldwin is senior lecturer in psychiatry in the Clinical Neuroscience Division at the University of Southampton in the United Kingdom
*
David Baldwin, MS, BS, DM, FRCPsych, University Department of Psychiatry, Graham Rd, Southampton, S0140YG, United Kingdom; Tel: 44-2380-825-533; E-mail: D.S.Baldwin@soton.ac.uk.
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Abstract

Panic disorder (PD) is typically a distressing, chronic, and recurrent mental disorder associated with a high rate of comorbidity with other mood, anxiety, and substance abuse disorders, increased risk of medical morbidity and mortality, and marked impairment of functioning and reduced quality of life. Most patients with PD first seek treatment in emergency room or general practice settings. In the overwhelming majority of cases, PD patients present with primarily somatic symptoms, many of which are common to medical illnesses. It is, therefore, not surprising that PD is often misdiagnosed and that patients with this disorder often spend years seeking treatment and undergoing costly and unnecessary tests and medical consultations before receiving a correct diagnosis. Better diagnosis and treatment of PD to achieve remission and prevent relapse has the potential to reduce the burden of this illness to the individual and society.

Type
Research Article
Information
CNS Spectrums , Volume 10 , Issue S12 , September 2005 , pp. 5 - 11
Copyright
Copyright © Cambridge University Press 2005

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References

1.Hirschfeld, RM. Panic disorder: diagnosis, epidemiology, and clinical course. J Clin Psychiatry. 1996;57(suppl 10):3–8.Google Scholar
2.Pollack, MH, Allgulander, C, Bandelow, B, et al.WCA recommendations for the long-term treatment of panic disorder. CNS Spectr. 2003;8:17–30.Google Scholar
3.Pollack, MH, Marzol, PC. Panic: course, complications and treatment of panic disorder. J Psychopharmacol. 2000;14:25–30.CrossRefGoogle ScholarPubMed
4.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
5.Diagnostic and Statistical Manual of Mental Disorders: Primary Care Version. 4th ed. Washington, DC: American Psychiatric Publishing, Incorporated; 1995.Google Scholar
6.Barlow, DH, Brown, TA, Craske, MG. Definitions of panic attacks and panic disorder in the DSM-IV: implications for research. J Abnorm Psychol. 1994;103:553–564.Google Scholar
7.Shear, MK, Brown, TA, Barlow, DH, et al.Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154:1571–1575.Google Scholar
8.Klein, DR. Anxiety reconceptualized. In: Klein, DF, Rabkin, JG, eds. Anxiety: New Research and Changing Concepts. New York, NY: Raven Press; 1981.Google Scholar
9.Eaton, WW, Kessler, RC, Wittchen, HU, Magee, WJ. Panic and panic disorder in the United States. Am J Psychiatry. 1994;151:413–420.Google ScholarPubMed
10.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.Google Scholar
11.Wittchen, HU, Essau, CA, von Zerssen, D, Krieg, JC, Zaudig, M. Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. Eur Arch Psychiatry Clin Neurosci. 1992;241:247–58.Google Scholar
12.Weissman, MM, Bland, RC, Canino, GJ, et al.The cross-national epidemiology of panic disorder. Arch Gen Psychiatry. 1997;54:305–309.CrossRefGoogle ScholarPubMed
13.Goodwin, RD, Faravelli, C, Rosi, S, et al.The epidemiology of panic disorder and agoraphobia in Europe. Eur Neuropsychopharmacol. 2005;15(4):435–443.CrossRefGoogle ScholarPubMed
14.Katon, W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. J Clin Psychiatry. 1996;57(suppl 10):11–18.Google Scholar
15.Roy-Byrne, PP, Stein, MB, Russo, J, et al.Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. J Clin Psychiatry. 1999;60:492–499.Google Scholar
16.Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine, and placebo. Cross-National Collaborative Panic Study, Second Phase Investigators. Br J Psychiatry. 1992;160:191–202.Google Scholar
17.Klerman, GL, Weissman, MM, Ouellette, R, Johnson, J, Greenwald, S. Panic attacks in the community. Social morbidity and health care utilization. JAMA. 1991;265:742–746.Google Scholar
18.Uhde, TW. Anxiety disorders. In: Kryger, DH, Roth, T, Dement, WC, eds. Principles and Practice of Sleep Medicine. 2nd ed. Philadelphia, PA: WB Saunders; 1994:871–898.Google Scholar
19.Stein, MB, Tancer, ME, Uhde, TW. Major depression in patients with panic disorder: factors associated with course and recurrence. J Affect Disord. 1990;19:287–296.Google Scholar
20.Weissman, MM, Markowitz, JS, Ouellette, R, Greenwald, S, Kahn, JP. Panic disorder and cardiovascular/cerebrovascular problems: results from a community survey. Am J Psychiatry. 1990;147:1504–1508.Google ScholarPubMed
21.Katschnig, H, Amering, M. The long-term course of panic disorder and its predictors. J Clin Psychopharmacol. 1998;18:6S–11S.CrossRefGoogle ScholarPubMed
22.Regier, DA, Narrow, WE, Rae, DS. The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience. J Psychiatr Res. 1990;24(suppl 2):3–14.Google Scholar
23.Warshaw, MG, Massion, AO, Shea, MT, Allsworth, J, Keller, MB. Predictors of remission in patients with panic with and without agoraphobia: prospective 5-year follow-up data. J Nerv Ment Dis. 1997;185:517–519.CrossRefGoogle ScholarPubMed
24.Yonkers, KA, Zlotnick, C, Allsworth, J, Warshaw, M, Shea, T, Keller, MB. Is the course of panic disorder the same in women and men? Am J Psychiatry. 1998;155:596–602.Google Scholar
25.Keller, MB, Baker, LA. The clinical course of panic disorder and depression. J Clin Psychiatry. 1992;53(suppl):5–8.Google Scholar
26.Toni, C, Perugi, G, Frare, F, et al.A prospective naturalistic study of 326 panic-agoraphobic patients treated with antidepressants. Pharmacopsychiatry. 2000;33:121–131.Google Scholar
27.Simon, NM, Safren, SA, Otto, MW, Sharma, SG, Lanka, GD, Pollack, MH. Longitudinal outcome with pharmacotherapy in a naturalistic study of panic disorder. J Affect Disord. 2002;69:201–208.Google Scholar
28.Bruce, SE, Yonkers, KA, Otto, MW, et al.Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162:1179–1187.Google Scholar
29.Keller, MB, Lavori, PW, Mueller, TI, et al.Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry. 1992;49:809–816.Google Scholar
30.Roy-Byrne, PP, Stang, P, Wittchen, HU, Ustun, B, Walters, EE, Kessler, RC. Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking. Br J Psychiatry. 2000;176:229–235.Google Scholar
31.Kessler, RC, Stang, PE, Wittchen, HU, Ustun, TB, Roy-Burne, PP, Walters, EE. Lifetime panic-depression comorbidity in the National Comorbidity Survey. Arch Gen Psychiatry. 1998;55:801–808.Google Scholar
32.Lecrubier, Y. The impact of comorbidity on the treatment of panic disorder. J Clin Psychiatry. 1998;59(suppl 8):11–14.Google ScholarPubMed
33.Ball, SG, Otto, MW, Pollack, MH, Rosenbaum, JF. Predicting prospective episodes of depression in patients with panic disorder: a longitudinal study. J Consult Clin Psychol. 1994;62:359–365.CrossRefGoogle ScholarPubMed
34.Cowley, DS, Flick, SN, Roy-Byrne, PP. Long-term course and outcome in panic disorder: a naturalistic follow-up study. Anxiety. 1996;2:13–21.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
35.Swinson, RP, Cox, BJ, Woszczyna, CB. Use of medical services and treatment for panic disorder with agoraphobia and for social phobia. CMAJ. 1992;147:878–883.Google ScholarPubMed
36.Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110:585–599.Google Scholar
37.Klerman, GL. Treatments for panic disorder. J Clin Psychiatry. 1992;53(suppl):14–19.Google Scholar
38.Coryell, W, Noyes, R, Clancy, J. Excess mortality in panic disorder. A comparison with primary unipolar depression. Arch Gen Psychiatry. 1982;39:701–703.Google Scholar
39.Johnson, J, Weissman, MM, Klerman, GL. Panic disorder, comorbidity, and suicide attempts. Arch Gen Psychiatry. 1990;47:805–808.Google Scholar
40.Weissman, MM, Klerman, GL, Markowitz, JS, Ouellette, R. Suicidal ideation and suicide attempts in panic disorder and attacks. N Engl J Med. 1989;321:1209–1214.Google Scholar
41.Cox, BJ, Direnfeld, DM, Swinson, RP, Norton, GR. Suicidal ideation and suicide attempts in panic disorder and social phobia. Am J Psychiatry. 1994;151:882–887.Google Scholar
42.Vickers, K, McNally, RJ. Panic disorder and suicide attempt in the National Comorbidity Survey. J Abnorm Psychol. 2004;113:582–591.Google Scholar
43.Fleet, R, Lavoie, K, Beitman, BD. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res. 2000;48:347–356.Google Scholar
44.Pollack, MH, Kradin, R, Otto, MWet al.Prevalence of panic in patients referred for pulmonary function testing at a major medical center. Am J Psychiatry. 1996;153:110–113.Google Scholar
45.Goodwin, RD, Eaton, WW. Asthma and the risk of panic attacks among adults in the community. Psychol Med. 2003;33:879–885.Google Scholar
46.Hasler, G, Gergen, PJ, Kleinbaum, DG, et al.Asthma and panic in young adults: a 20-year prospective community study. Am J Respir Crit Care Med. 2005;171:1224–1230.Google Scholar
47.Jacob, RG, Furman, JM, Durrant, JD, Turner, SM. Panic, agoraphobia, and vestibular dysfunction. Am J Psychiatry. 1996;153:503–512.Google Scholar
48.Marazziti, D, Toni, C, Pedri, S, et al.Prevalence of headache syndromes in panic disorder. Int Clin Psychopharmacol. 1999;14:247–251.Google Scholar
49.Garakani, A, Win, T, Virk, S, Gupta, S, Kaplan, D, Masand, PS. Comorbidity of irritable bowel syndrome in psychiatric patients: a review. Am J Ther. 2003;10:61–67.CrossRefGoogle ScholarPubMed
50.Simon, NM, Blacker, D, Korbly, NB, et al.Hypothyroidism and hyperthyroidism in anxiety disorders revisited: new data and literature review. J Affect Disord. 2002;69:209–217.Google Scholar
51.Katon, W. Panic disorder and somatization. Review of 55 cases. Am J Med. 1984;77:101–106.Google Scholar
52.Sheehan, DV, Ballenger, J, Jacobsen, G. Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms. Arch Gen Psychiatry. 1980;37:51–59.Google Scholar
53.Katerndahl, DA, Realini, JP. Where do panic attack sufferers seek care? J Fam Pract. 1995;40:237–243.Google Scholar
54.Huffman, JC, Pollack, MH, Stern, TA. Panic disorder and chest pain: mechanisms, morbidity, and management. Prim Care Companion J Clin Psychiatry. 2002;4:54–62.Google ScholarPubMed
55.Huffman, JC, Pollack, MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics. 2003;44:222–236.Google Scholar
56.Markowitz, JS, Weissman, MM, Ouellette, R, Lish, JD, Klerman, GL. Quality of life in panic disorder. Arch Gen Psychiatry. 1989;46:984–992.Google Scholar
57.Simon, GE, VonKorff, M. Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. Am J Psychiatry. 1991;148:1494–1500.Google Scholar
58.Simpson, RJ, Kazmierczak, T, Power, KG, Sharp, DM. Controlled comparison of the characteristics of patients with panic disorder. Br J Gen Pract. 1994;44:352–356.Google Scholar
59.Diagnostic and Statistical Manual of Mental Disorders. 3rd ed rev. Washington, DC: American Psychiatric Association; 1987.Google Scholar
60.White, KS, Barlow, DH. Panic disorder and agoraphobia. In: Barlow, DH, ed. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. 2nd ed. New York, NY: The Guilford Press; 2002:328–379.Google Scholar
61.Candilis, PJ, McLean, RY, Otto, MW, et al.Quality of life in patients with panic disorder. J Nerv Ment Dis. 1999;187:429–434.Google Scholar
62.Katschnig, H, Amering, M, Stolk, JM, Ballenger, JC. Predictors of quality of life in a long-term followup study in panic disorder patients after a clinical drug trial. Psychopharmacol Bull. 1996;32:149–155.Google Scholar
63.Hollifield, M, Katon, W, Skipper, B, et al.Panic disorder and quality of life: variables predictive of functional impairment. Am J Psychiatry. 1997;154:766–72.Google Scholar
64.Katerndahl, DA, Realini, JP. Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder. J Clin Psychiatry. 1997;58:153–158.CrossRefGoogle ScholarPubMed
65.Mendlowicz, MV, Stein, MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157:669–682.Google Scholar
66.Rubin, HC, Rapaport, MH, Levine, B, et al.Quality of well being in panic disorder: the assessment of psychiatric and general disability. J Affect Disord. 2000;57:217–221.Google Scholar
67.Cramer, V, Torgersen, S, Kringlen, E. Quality of life and anxiety disorders: a population study. J Nerv Ment Dis. 2005;193:196–202.Google Scholar
68.Leon, AC, Portera, L, Weissman, MM. The social costs of anxiety disorders. Br J Psychiatry. 1995;166(suppl 27):19–22.Google Scholar
69.Greenberg, PE, Sisitsky, T, Kessler, RC, et al.The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60:427–435.Google Scholar
70.Salvador-Carulla, L, Segui, J, Fernandez-Cano, P, Canet, J. Costs and offset effect in panic disorders. Br J Psychiatry Suppl. 1995;23–28.Google Scholar
71.Roy-Byrne, PP, Clary, CM, Miceli, RJ, Colucci, SV, Xu, Y, Grudzinski, AN. The effect of selective serotonin reuptake inhibitor treatment of panic disorder on emergency room and laboratory resource utilization. J Clin Psychiatry. 2001;62:678–682.Google Scholar
72.International Classification of Diseases. 9th ed-CM. Hyattsville, MD: Health and Human Services Department, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services; 2005.Google Scholar
73.Goodwin, RD, Lieb, R, Hoefler, M, et al.Panic attack as a risk factor for severe psychopathology. Am J Psychiatry. 2004;161:2207–2214.Google Scholar
74.Tsao, JC, Lewin, MR, Craske, MG. The effects of cognitive-behavior therapy for panic disorder on comorbid conditions. J Anxiety Disord. 1998;12:357–371.Google Scholar
75.Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. American Psychiatric Association. Am J Psychiatry. 1998;155:1–34.Google Scholar
76.Ballenger, JC, Davidson, JR, Lecrubier, Y, et al.Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 1998;59:47–54.Google Scholar
77.Bruce, SE, Vasile, RG, Goisman, RM, et al.Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? Am J Psychiatry. 2003;160:1432–1438.CrossRefGoogle ScholarPubMed