Article Surfing Archive

Most people with panic attack disorder are treated in their primary care setting, which is not surprising, since the physical symptoms of a panic disorder can cause people to seek care for what they perceive as a physical ailment.

Difficulties in the diagnosis of panic attack disorder in this setting argue for the possible value of population based screening for the disorder in primary care, which is currently recommended for major depression. Panic disorder is associated with severe disability and work impairment in people receiving primary care, even if the effects of comorbid physical and depressive illness are accounted for. The quality of primary care given to people with panic disorder (and other anxiety/agoraphobia disorders) is not the best; only 19-40% of people are estimated to receive the minium standards accepeted for evidence based treatment. In addition to detection and diagnosis difficulties, many other barriers exist, including uncertainty about where to seek help, insufficient organization of primary care to treat chronic disease and problems with insurance coverage and concerns about cost of care (especially in the USA)

New approaches are needed to overcome these barriers and to improve delivery of health care for people with panic attack disorder. Other promising approaches that could supplement care provided by primary-care physicians, or that might be used alone for some patients, include self-help treatments for which computer (internet-based) delivery approaches are being increasingly proposed.

Because the onset of panic disorder peaks late in adolescence, prevention efforts could be best directed at or before this critical developmental period. In a study, 150 individuals presenting to the emergency room with panic attacks were assigned to 1 h of contact with a clinician from whom they received reassurance or exposure instruction. The exposure group improved on all measures of anxiety and panic after 6 months, compared with controls. 40% of the sample group met criteria for panic disorder, so this investigation was not a pure prevention study. In another study, 151 university students with at least one panic attack in the past year and moderate anxiety sensitivity were assigned to be put on a waiting list or to undergo a 5-h, cognitive-behavioral workshop.148 6 months later, 13'6% of controls developed panic disorder, compared with 1'8% of individuals in the workshop group. Increased research into methods for the detection and identification of individuals at risk of panic disorder (e.g., children of patients with the disorder or behaviorally inhibited children) will be crucial.