Panic disorder prevalence

The lifetime prevalence rate for panic disorder is about 1.7%, divided into 2.4% in women,... 

With a lifetime prevalence of 28.8%, anxiety disorders collectively represent the most prevalent Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR)2 class of disorders, with specific phobia (12.5%) and social anxiety disorder (12.1%) being the most common.3 Recent reports from the National Comorbidity Survey Revised (NCS-R) estimate the lifetime and 1-year prevalence of generalized anxiety disorder (GAD) for those 18 years of age and older to be 5.7% and 3.1%, respectively.3,4 Rates for panic disorder (PD) are slightly lower, with an estimated 12-month prevalence of 2.7% and lifetime prevalence of 4.7%. 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

The prevalence of panic disorder in the United States has been placed between 1.5% and 3.5%. Most of these cases are found in young adults, and panic disorder is very rare in the elderly. In addition, panic disorder tends to affect twice as many women as men, with more than 70% of panic disorder diagnoses occurring in women. 

SRls are currently the most prevalent pharmacological treatment used for panic disorder [see Westenberg and Den Boer, Chapter 24, in this volume], even though tricyclic antidepressants, monoamine oxidase inhibitors [MAOls], and benzodiazepines are also effective. The efficacy of the SRI antidepressants and the observation that initially they may induce deterioration of symptoms [which is usually not the case with treatment of depressed patients with the same medications] raise issues related to the pathobiology of anxiety and its comorbidity with depression. 

The presence of comorbid depression in patients with panic disorder is associated with an increased prevalence of agoraphobia and suicide attempts. 

Panic disorder affects up to 2% of the population, but less than one-third receive treatment. Panic disorder typically begins in late adolescence or early adulthood but can present in childhood. Onset is rare after age 45. Panic disorder is more prevalent in women, who have perhaps twice the rate in men. Genetic studies demonstrate a 15 to 20% rate of panic disorder in relatives of patients with panic disorder, including a 40% concordance rate for panic disorder in monozygotic twins. 

Panic disorder is one of the most prevalent psychiatric disorders in industrialized countries. It is often associated with agoraphobia and has an estimated prevalence of between 1% and 6%. The use of imipramine in the treatment of anxiety by Klein and Fink, and the discovery by William Sargant that monoamine oxidase inhibitors (MAOIs) were effective in the treatment of "atypical depression" over 30 years ago led to the investigation of the efficacy of such treatments in patients with panic disorder. Since that time, such drugs have been shown to attenuate the symptoms of panic in addition to those of phobic avoidance and anticipatory anxiety. As both the... 

As with several other drugs, for example marijuana, PCP, and LSD, cocaine can precipitate panic disorder, which continues long after drug withdrawal (177). Among 280 patients in a methadone maintenance clinic, the prevalence of panic disorder increased from 1% to 6% over a decade (178). A marked rise in the frequency of cocaine abuse coincided with this outbreak. The authors suggested that episodes of panic occurring in cocaine users can result in hospitalization for either psychiatric or medical illnesses. 

The mood and anxiety disorders in their various permutations constitute a major source of personal suffering and impaired ability to engage in productive Avork and interpersonal relationships. Between 5 and 9% of women and between 2 and 3% of men meet the diagnostic criteria for major depression at any time 10-25% of all women suffer major depression sometime in their lives, while 5-10% of men will develop major depressive disorder (American Psychiatric Association, 1994). The anxiety disorders obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, and generalized anxiety disorder (GAD) show lifetime prevalence rates of approximately 2.5%, 7%, 2.5%, and 5% respectively. Between 3 and 13% of individuals in community samples are regarded to meet the diagnostic criteria for social phobia. Mood and anxiety disorders are common comorbidities (American Psychiatric Association, 1994) and the most common antidepressant medications including the serotonin reuptake inhibitors, the mixed serotonin-catecholamine reuptake inhibitors, the tricyclic antidepressants, and the monoamine oxidase inhibitors, are all effective treatments for anxiety and panic attacks. 

Generalized anxiety disorder (GAD) (6) is defined as excessive anxiety and worry occurring more days than not for a period of at least 6 months. The anxiety is accompanied by at least three of the following symptoms restlessness, fatigue, impaired concentration, irritability, muscle tension, and sleep disturbance. The anxiety is uncontrollable and causes clinically significant distress. GAD has a lifetime prevalence of 6-10% (7), and the NCS study (3) indicates a high comorbidity with other psychiatric disorders, especially depression and panic disorder. 

The essential feature of panic disorder (PD)(13)is the occurrence of repeated, unexpected panic attacks. There is a marked worry about the consequences of the attack and the possibility of having a future attack. The persistent anxiety evoked by the panic attacks causes major behavioral changes and intrusion into normal life. Around 50% of panic disorder patients also suffer from agoraphobia. A lifetime prevalence of 3.5%has beenestimated (3), and a high comorbidity with depression and other anxiety disorders is observed. 

United States, the 1-year prevalence rate for anxiety disorders was 13.3% in persons aged 18 to 54 years and 10.6% in those over age 55 years. Specific phobias were the most common anxiety disorder, with a 12-month prevalence of 8% however, patients were not seriously impaired in terms of daily functioning, and few persons sought treatment. The 1-year prevalence of generalized anxiety disorder (GAD) was 2.8%, that of panic disorder was 1.7%, and that of social anxiety disorder (SAD) was 3.7%. ... 

Opponents of MCS argue that behavioral and stress-mediated mechanisms control the symptoms. They claim that MCS most likely represents the overlapping of primary psychiatric disorders, misdiagnosed medical disorders, and classical conditioning. One study found significantly increased prevalence of the panic disorder-associated cholecystokinin B receptor allele 7 in subjects with MCS (Binkley et al. 2001). Three opposing interpretations of MCS are that... 

Binkley K, King N, Poonai N, et al Idiopathic environmental intolerance increased prevalence of panic-disorder-associated cholecystokinin B receptor allele 7. J Allergy Clin Immunol 107 887-890, 2001... 

Fyer AJ, Liebowitz MR, Gorman JM, et al Effects of clonidine on alprazolam discontinuation in panic patients a pilot study. J Clin Psychopharmacol 8 270—274,1988 Garvey MJ, Tollefson GD Prevalence of misuse of prescribed benzodiazepines in patients with primary anxiety disorder or major depression. Am J Psychiatry 143 1601-1603, 1986... 

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Wittchen HU, Zhao S, Kessler RC, Eaton WW (1994) DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 51 355-364 Wittchen HU, Nelson CB, Lachner G (1998a) Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med 28 109-126 Wittchen HU, Reed V, Kessler RC (1998b) The relationship of agoraphobia and panic in a community sample of adolescents and yoimg adults. Arch Gen Psychiatry 55 1017-1024... 

Cross-situational anxiety differs from the situation-specific anxiety described in the previous chapter, in that it involves multiple anxieties and worries that affect performance across a wide range of work and non-work-related situations and tasks. Examples of cross-situational anxiety include disorders such as uncued panic attacks, agoraphobia, generalized social phobia and generalized anxiety disorder (American Psychiatric Association [APA] 2000). The treatment of panic attacks and phobias was discussed in the previous chapter. This chapter thus focuses on the formulation and treatment of generalized anxiety disorder (GAD). GAD warrants specific attention since it requires quite a different CBT treatment approach from the other forms of anxiety already mentioned. Two other anxiety syndromes which have been found to be particularly prevalent among health workers, namely post-traumatic stress disorder (PTSD) and health anxiety, are also discussed in this chapter. 

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