[Panic attacks and panic syndrome--diagnosis and therapy]

Paroxysmal states of anxiety that cannot be traced back to somatic causes have been called panic attacks since the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) of the American Psychiatric Association. This term has since been accepted as part of psychiatric everyday language in many countries. The present review discusses initially the diagnostic and differential diagnostic aspects against the background of nosological classifications as practised to date, with particular emphasis on the requirements of the practising psychiatrist. The authors of this review hold the opinion that whereas the phenomenon of panic attack is a valid concept, the conceptualisation of a panic disorder is still largely hypothetical. The often observed "natural history"--after panic attacks, anticipatory anxiety, coupling of attacks to certain situations, avoidance of these situations, as well as agoraphobia, depressivity, self-medication with tranquilisers and alcohol, hypochondriacal fears with increased consultation of doctors, and family conflicts may develop--requires early therapeutic intervention. Hence, the second part of this article presents the pharmacological and psychotherapeutical treatment methods for panic attacks and their complications as developed and successfully tried out during the past few years. The efficacy has been proven of drug therapy on the one hand of prophylactic treatment using tricyclic antidepressives, MAO-inhibitors and alprazolam or clonazepam, and on the other hand also of a non-continuous attack-related treatment strategy. Of the more recent psychotherapeutic methods, relaxation methods and the cognitive treatment of panic attacks are discussed. This direct focus on panic attacks seems to be more promising than the conventional treatment methods centered on secondary symptoms such as anticipatory anxiety or agoraphobia.