Identification and treatment of panic attacks with or without agoraphobia

OBJECTIVE To describe for family physicians screening, diagnosis, and treatment of panic disorder with or without agoraphobia (PD/A). QUALITY OF EVIDENCE Articles were identified through PsycLIT, PsyINFO, and MEDLINE (1985 to 2006) using the terms panic disorder, psychotherapy, psychosocial treatment, treatment, and pharmacotherapy. Recommendations on treatment choices and guidelines are based on data from high-quality studies only. information about assessment and diagnosis of PD/A is supported by the most recent epidemiologic studies, as well as expert consensus and opinion. MAIN MESSAGE Panic disorder with or without agoraphobia is a psychiatric disease frequently encountered in primary care. It appears to be underdiagnosed and undertreated in this medical setting. Early successful screening requires a focus on unexplained symptoms and specific questions aimed at identifying panic attacks and their meaning for patients. The treatment of choice for PD/A is cognitive-behavioral therapy administered by a specialized psychologist or psychiatrist. When such therapy is hard to come by or unavailable, family physicians can prescribe drug therapy. CONCLUSION Family physicians can contribute greatly to early detection and treatment of PD/A.