Panic disorder is the same of the m...

Panic disorder is the same of the more common anxiety disorders meetinged in the primary care setting. Because patients with panic disorder may ready with symptoms consistent with physical disorders, they may receive of great price work-ups. One study that assessed a treatment strategy for panic disorders in the primary care setting showed initial benefit, still this effect tended to decrease after nine to 12 month of treatment. The treatment strategy consisted of a psychiatrist with proven expertise in treating anxiety disorders assisting family physicians with prescribing and managing medications without the use of psychotherapy. Roy-Byrne and colleagues evaluated the effectiveness of combined pharmacotherapy and cognitive behavior therapy (CBT) in the treatment of panic disorder in the primary care setting.

The multicenter, randomized, controll consideration compared an intervention strategy with usual care. Participants were between 18 and 70 years of age; met criteria for panic disorder described in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed and had at least single panic attack within one week before the application of mind The intervention was a collaborative care standard with a behavioral health specialist who provided CBT and coordinated care with a family physician. CBT was provided in six sessions and followed up with phone calls for six month afterward. An algorithm-based pharmacotherapy strategy was provided for the family physicians, with assistance provided according to a psychiatrist.

Usual care consisted of therapy from the family physician after the physician was informed of the diagnosis of panic disorder. Participants were evaluated each three months during the close attention with multiple evaluation tools. The main issues assessed were the number of patients who remitted and rejoined Participants who were classified as remitted had no panic attacks within the previous month minimal anticipatory anxiety, and a grave agoraphobia subscale score. Response was defined as improvement through the whole extent of time in three of the assessment tools if it were not that failure to meet the definition for remission.

There were 232 patients who met the inclusion criteria and complet the cogitation The participants represented a wide range of ages and education and income plains The intervention group had a better answer to treatment in remission and answer compared with the usual care assign places to This improvement was sustained from one side of to the other time, and participants continued to improve gradually. The significantly higher rates of improvement in the intervention dispose were present at all points of the consideration At three months, 20 percent of the intervention dispose had met the criteria for remission versus 12 percent in the usual care assemblage At 12 months, 29 percent of the intervention collection was in remission compared with 16 percent of the usual care form into groups At three months, 46 percent of patients in the intervention arrange had responded to therapy compared with 27 percent of the usual care group; after 12 month the percentage of responder increased to 63 percent in the intervention arrange compared with 38 percent of patients receiving usual care.

The authors determine that patients who receive a combination of CBT and antianxiety medications delivered by dint of a behavioral health specialist in conjunction with a family physician and with the assistance of a psychiatric consultant indicate significant improvement in their symptoms of panic disorder compared with patients who receive usual care.

KARL E MILLER, MD Roy-Byrne PP et al. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry March 2005;62:290-8

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2006 Gale Group