[Stress, anxiety, panic. Panic attack and panic disorder. A new psychiatric concept]

Pathological anxiety--painful and incapacitating--can be defined as perception of stress with cognitive distortion. The traditional unitary model of anxiety neurosis is replaced by the american model (DSM III) with "panic disorder" and "panic attacks" representing the cornerstone of the new construct, based on the evidence (by Donald Klein) of the efficacy of so-called antidepressant drugs. Behavioral and cognitive treatments are useful, mainly in anxiety with agoraphobia. "General anxiety disorder" is now considered as a "residual category". Clinical aspects, differential diagnosis, circumstances of onset, pharmacological induction of panic attacks (specially by lactate and caffeine), and treatments, are reviewed.