Unrecognized prevalence of panic disorder in primary care, internal medicine and cardiology

Research over the last 25 years has delineated the syndrome of panic disorder/agoraphobia from a myriad of medical, cardiologic and psychiatric diagnoses. This syndrome is characterized by the sudden onset of episodes of panic and terror, accompanied by extreme physiologic symptoms including palpitations, tachycardia, chest pain, shortness of breath, trembling, faintness, etc. These patients become quite anxious and hypochondriacal and begin to avoid certain situations in which they feel a recurrence of a panic attack would be dangerous or embarrassing. This avoidance (agoraphobia) typically involves malls, grocery stores, churches, crowds, bridges, planes, waiting in lines, visiting dentists, highways, etc., and rarely (5%) actually confines the patient to his home. With the prevalence of 3 to 7% in the general population, evidence suggests that many of these patients are currently unrecognized in primary care, internal medicine and cardiology practices. Over 90% believe they have a physical disorder and do not present to psychiatrists but instead to neurologists (44%), cardiologists (39%) and gastroenterologists (33%). Perhaps as many as one-third of patients with atypical chest pain, particularly if results of coronary angiograms are normal, have unrecognized panic disorder. Effective treatments in most patients are now available and are described. These include medications that block the panic attacks and reduce the anxiety and phobic fears and they are generally used in combination with behavioral treatments.