Clinical Review

Panic disorder

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7547.951 (Published 20 April 2006) Cite this as: BMJ 2006;332:951
  1. C Barr Taylor, professor (btaylor@stanford.edu)
  1. Department of Psychiatry, Stanford University School of Medicine, CA 94305-5722, USA
  • Accepted 8 March 2006

Introduction

Panic disorder, with or without agoraphobia, is one of the most common and important anxiety disorders in the general population in the Western world with a prevalence in one year of 2-3% in Europe.1 Agoraphobia without panic occurs in another 1% of the population. Patients with panic disorder have a high use of medical services, an impaired social and work life, and an overall reduced quality of life.2 3 The good news is that short term, psychological interventions can improve the lives of most patients. Protocols and resources to help general practitioners implement such techniques, with and without drugs, are available.

Sources and selection criteria

This review is based on searches in PubMed for meta-analyses of the efficacy of treatment of panic disorder, including the National Institute for Health and Clinical Excellence (NICE) clinical guideline for anxiety and panic disorder (guideline 22).4

What is panic disorder?

The main feature of panic disorder is recurrent, unexpected panic attacks. Most patients with the disorder avoid situations where they think a panic attack may occur, and avoidance may severely limit their life. Agoraphobia can occur without panic attacks, although patients may have episodes such as gastrointestinal distress and diarrhoea that are equivalent to panic attacks. Most of the evidence based studies on panic disorder and agoraphobia use the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria (box). However, many practitioners use ICD-10 (International Classification of Diseases, 10th revision), which states that the “essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.”

What other psychiatric conditions are associated with panic?

Panic disorder is associated with several psychiatric conditions, such as depression and other anxiety disorders.5 About a third of patients with depression present with panic disorder. Over a lifetime, about half of patients with panic disorder …

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