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Panic disorder (with or without agoraphobia) is one of the most common — and, for patients, disabling—psychiatric disorders encountered in general medical settings. From a recent study in a primary care practice setting, investigators estimated that the 1-month prevalence of panic disorder among primary care patients is 1.4 percent (Von Korffet al. 1987). The estimate from the community-based Epidemiological Catchment Area Study is that in any month 0.5 percent of the population will have this diagnosis (Regier et al. 1988). Because a number of medical and mental disorders may mimic symptoms similar to panic disorder, an accurate differential diagnosis is essential—but often difficult.
During the past two decades, enormous strides have been made in elucidating the dysfunctional brain mechanisms underlying panic disorder, specifying empirically based diagnostic criteria, and developing effective treatments. All of these developments have given knowledgeable primary care physicians and psychiatric specialists alike newfound power to recognize and ameliorate the course of this once-daunting disorder. However, many practitioners, especially those trained before these developments occurred, may have had little opportunity to stay abreast of all these advances. Further, only a limited amount of the recent psychiatric research literature related to panic disorder has been translated into practical advice for primary care physicians.
This volume was written to fill that knowledge gap by providing busy primary care practitioners (and their mental health consultants) with practical, state-of-the-art diagnostic and treatment techniques for panic disorder. It is intended to aid clinicians in recognizing and treating patients with this common mental disorder and in identifying when psychiatric consultation or referral is required.
This volume includes up-to-date information on the natural course, clinical characteristics, epidemiology, psychobiology, and treatment of panic disorder. Dr. Katon cogently discusses the challenge of diagnosing panic disorder, the medical illnesses associated with it, and the bases for making a differential diagnosis. In addition, he suggests ways to provide followup care for these patients in primary care settings and offers guidelines for psychiatric referral. He has also thoughtfully included a list of articles and books related to panic disorder that should prove particularly useful for patients and physicians.
For the National Institute of Mental Health, which sponsored the development of this volume, it represents an important aspect of our research mission: closing the gap between the research laboratory and the clinician's office.
Because primary care practitioners are the main source of ambulatory care for the mentally ill, we are particularly eager to assure that clinically relevant results of mental health research reach such clinicians quickly, in a form they will find readily accessible and useful in day-to-day practice. I believe that these goals are admirably met in this volume.