Friday, August 14, 2009

Psychiatric Treatment Received by Primary Care Patients With Panic Disorder With and Without Agoraphobia

Panic disorder is fairly common, with a 12-month prevalence rate of 2.7% and a lifetime prevalence rate of 4.7% (1,2). The course of panic disorder tends to be chronic, with high rates of recurrence after remission, particularly for panic disorder with agoraphobia (3–5). Furthermore, individuals with panic disorder experience considerable impairment and disability, including occupational difficulties (6–9), impaired well-being (10–12), and reduced quality of life (9–14). They also have higher rates of health care use, with a greater number of outpatient visits, emergency room visits, and hospitalizations compared with those without the disorder (8,10,15).

Individuals with panic disorder typically present to the primary care setting, with estimates suggesting that as many as 80% of cases first present to primary care (16). Thus the rate of the disorder is higher in primary care settings, with a reported median prevalence of 4% to 6% (8). Furthermore, the majority of individuals with panic disorder obtain their mental health treatment in the primary care setting (17,18). Despite these findings, research suggests that panic disorder often goes unrecognized (19, 20) and is inadequately treated in both primary care (8,21–23) and psychiatric settings (24–26). A number of effective pharmacologic treatments for panic disorder exist, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (27–30). Likewise, psychosocial treatments, namely cognitive-behavioral therapy (30,31) and possibly a specific form of psychoanalytic treatment (32), have been found to be effective. Despite this, estimates suggest that over 40% of individuals with panic disorder go untreated (33). Certain demographic characteristics. (for example, gender, education, and race) and clinical variables (for example, comorbid diagnoses) appear to be related to mental health service use in general (34–36). Additionally, there may be other factors that have an impact on service use, such as not perceiving oneself in need of treatment (37). For individuals with panic disorder who do receive treatment, little is known about the treatment typically received, and no studies have examined whether there are differences in treatment between persons with panic disorder with agoraphobia and those with panic disorder without agoraphobia. Brook A. Marcks, Ph.D.
Risa B. Weisberg, Ph.D. Martin B. Keller, M.D.


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