Panic disorder: epidemiology in primary care.

One hundred ninety-five patients in a primary care practice were screened with the National Institute of Mental Health Diagnostic Interview Schedule, a structured psychiatric interview, so that the epidemiology of panic disorder could be studied. Thirteen percent of the patients met criteria described in the Diagnostic and Statistical Manual of Mental Disorders, ed 3 (DSM-III) for panic disorder (6.7 percent if the DSM-III exclusionary criteria are used). An additional 8.7 percent of patients, labeled in the study as having simple panic, had four or more autonomic symptoms of panic disorder but did not meet DSM-III criteria (three panic attacks in a three-week period). Compared with controls, patients with panic disorder or simple panic had a significantly higher lifetime risk of major depression, multiple phobias, and avoidance behavior and higher scores on their psychological distress scales. Patients with panic disorder and simple panic often misinterpreted their symptoms as being due to a physical illness and had significantly higher scores on the somatization scale of the SCL-90 and on a medical review of symptoms than did the controls with no panic disorder. It is important to diagnose panic disorder accurately because double-blind placebo-controlled studies have demonstrated the efficacy of psychopharmacologic treatments, including tricyclic antidepressants (notably imipramine and desipramine), the high-potency benzodiazepine (alprazolam) and monoamine oxidase inhibitors (phenelzine). Primary care physicians, by screening patients with complaints of tension and anxiety, as well as multiple unexplained somatic complaints for panic disorder, may be able to reduce somatic preoccupation and disease phobia by instituting effective therapy.