Understanding and Treating Panic Disorder in the Primary Care Setting
J Clin Psychiatry 2005;66(suppl 4):16-22
© Copyright 2014 Physicians Postgraduate Press, Inc.
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According to studies, the median prevalence of panic disorder in the primary care setting is 4%.
Rates are higher among certain patient populations, such as those with cardiac (20% to 50%) or gastrointestinal
presentations (28% to 40%). Consequently, patients with panic disorder are high utilizers
of medical services and are heavily represented among patients classified as high health care utilizers,
compared with other psychiatric or non-psychiatric groups. Despite its frequency in the primary care
setting, panic disorder is significantly under-recognized by medical providers. Corresponding with
inadequate recognition is the substantial proportion of these patients who fail to receive appropriate
treatment (pharmacotherapy and psychotherapy). Most experts have concluded that panic disorder
is poorly managed in the primary care setting because of the process of care and patient engagement.
In terms of process of care, primary care practice still operates on an acute disease model (leaving
no time for initial patient education or follow-up), which is a poor fit for the management of chronic
diseases. Insufficient patient engagement in treatment (i.e., being involved in the treatment process,
"buying into" rationale for treatment, and being willing to collaborate with clinician and adhere to recommendations)
is the second important contributor to inadequate treatment. Use of a chronic disease
self-management approach would enhance treatment of panic disorder. This model requires that
patients, in collaboration with the health care provider/system, take day-to-day responsibility for managing
their illness by doing 3 things: adhering to recommended medical management, adopting
improved health habits/coping skills, and assisting in ongoing monitoring of illness status/change.
Future approaches to treating panic disorder in primary care would be enhanced by including
assessments of patient beliefs and preferences, spending more time in preparing the patient for treatment,
utilizing a simple pharmacotherapy algorithm, utilizing simple rating scales to monitor outcomes,
and training providers in brief CBT interventions.