Postpanic anxiety disorder: diagnosis and treatment

Patients with a postpanic anxiety disorder (PPAD) have panic attacks less frequently than patients with a panic disorder. A PPAD must be suspected when a physician notes the following: persistent somatic complaints despite repeatedly normal results of physical examinations and laboratory tests, reluctance to engage in certain activities or avoidance of activities because the patient fears the precipitation of panic or aggravation of symptoms, and history of one or more panic attacks. Three different groups of medication are effective in the treatment of PPAD: alprazolam (a triazolobenzodiazepine), imipramine (a tricyclic antidepressant), and phenelzine (a monoamine oxidase inhibitor). Relaxation training, desensitization, and family conferences assist in lowering anxiety and in improving the prognosis. An early diagnosis of PPAD reduces the patient's discomfort and morbidity and lowers the cost of medical care.