Book Review

Panic Disorder and Its Treatment

N Engl J Med 1998; 339:1483-1484November 12, 1998

Article

Panic Disorder and Its Treatment
(Medical Psychiatry.) Edited by Jerrold F. Rosenbaum and Mark H. Pollack. 353 pp. New York, Marcel Dekker, 1998. $99.75. ISBN: 0-8247-0216-6

A 60-year-old man who had endured panic disorder during an earlier period of his life awoke with crushing substernal chest pain radiating down his arm and up to his jaw. Observing him diaphoretic, nauseated, and in pain, his wife called an ambulance. On his arrival at the Massachusetts General Hospital emergency ward, he suffered cardiac arrest. Resuscitated and admitted to the coronary care unit, he was informed by the house officer that he had survived a myocardial infarction. He sighed with relief, and his first words were, “Thank goodness — I thought my panic attacks were coming back.”

ANIC attacks are associated with an array of physical symptoms, including palpitations, diaphoresis, trembling, shortness of breath, nausea, choking, dizziness, and paresthesias. More than 10 percent of persons in community samples have occasional panic attacks, and approximately 3 percent have persistent worries about these attacks and how they affect their lives. These people have panic disorder. The majority of patients with panic disorder are seen in the emergency department or in primary care settings where the signs and symptoms are often not recognized. Undiagnosed and untreated panic disorder is frightening and demoralizing for the patient. It uses a substantial portion of medical services and expensive and unnecessary laboratory procedures, and it can culminate in marked social dysfunction and disability. Panic disorder affects the life not only of the patients but also of all the patients' loved ones and the health care professionals who take care of them.

Panic Disorder and Its Treatment presents a concise yet thorough review of the epidemiology of panic disorder, its clinical presentation, the genetics and biology of panic disorder, and the influence of environmental factors on the genesis of the condition. These initial chapters thoughtfully develop the groundwork for later sections on the complex relation between coexisting alcohol and drug disorders and panic disorder and on the state of the art of pharmacotherapy and psychotherapy of panic disorder.

Two important topics covered in this book are particularly relevant to students and clinicians: the chapter on the course and treatment of panic disorder during pregnancy and the postpartum period and the chapter about quality of life, cost effectiveness, and the effect of managed care on the treatment of panic disorder. Since women of childbearing age constitute the largest group of patients with panic disorder, this book's practical review and guidelines for treatment are critically important, especially because the subject has been ignored in most other books. As the authors discuss, there are distressingly few data on the long-term effects of psychotropic medications on the fetus, and there is a tremendous need for more research in this area.

The chapter on quality of life and managed care clearly outlines the tremendous social consequences of untreated panic disorder. It succinctly reviews the studies demonstrating that effective treatment of panic disorder markedly improves quality of life and decreases use of medical services. This chapter is important not only for clinicians but also for anyone who has an interest in cost-effective treatment of patients.

This is a well-written book. The individual chapters can serve as independent summaries of specific topics, yet when read as a whole the book presents a clear and impressive review of panic disorder and its treatment. It is an important addition to the library of any primary care clinician.

Mark Hyman Rapaport, M.D.
University of California at San Diego School of Medicine, La Jolla, CA 92037