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Panic disorders treatable, often misdiagnosed


BETHESDA -- Most Americans who suffer from panic disorder aren't receiving promising treatments, in part because of doctors who are ignorant about the problem and fail to recognize its symptoms, a panel of mental health authorities said yesterday.

The disorder is marked by episodes of intense fear accompanied by physical symptoms such as a racing heart, dizziness, nausea, abdominal pain and shortness of breath. The bouts usually occur without any realistic threat, although the person may feel threatened by particular environments, such as a crowded elevator, a busy street or a shopping mall.

The panel, assembled by the National Institutes of Health to assess what is known about panic disorders, estimated that three-quarters of the people who suffer from episodes of paralyzing fear known as panic attacks never get appropriate treatment.

The condition will affect one in 75 Americans during their lifetime, the panel said in a "consensus statement" issued at the end of a three-day conference here. The statement was issued after the panel heard testimony from a variety of specialists.

Economic barriers such as poor insurance coverage prevent some patients from getting help, the panel said. But some patients see 10 or more doctors before they are accurately diagnosed.

Experts described patients who check into emergency room after emergency room thinking they are in the throes of a heart attack. Doctors seeking a physical cause run batteries of tests that show nothing; symptoms disappear, and the patients get sent home.

"Most primary-care physicians are not aware of this illness," Dr. Carl I. Margolis, an internist and psychiatrist from Rockville, said during a briefing that followed the conference. "I think primary-care physicians don't know how to treat this."

Knowledge about panic disorders is relatively new. Specialists began to recognize "panic" as a distinct type of anxiety disorder in the 1960s, but it wasn't until 1980 that the problem was recognized in the standard reference book of the American Psychiatric Association.

Despite this, the panel said, a growing body of research has shown that certain medications and a "talk" approach known as cognitive therapy have shown impressive records in treating panic. The medications include certain anti-depressants and benzodiazepines, a class of anti-anxiety drugs that includes Xanax and Valium.

The specialists appeared even more enthusiastic about cognitive therapy because patients tend to relapse less often once they end treatment. In the cognitive approach, the patient and therapist explore the distorted thoughts that may cause the patient to be overcome with fear.

To analyze the thought patterns, the therapist may take the patient to the threatening place or re-create a fearful scene in the office. The goal is to develop more rational ways of thinking about situations that actually pose little danger.

Any treatment that fails to produce a beneficial effect within eight weeks should be reassessed, the panel recommended. The patient may then require a referral or consultation with another specialist.

At the Sheppard and Enoch Pratt Hospital in Towson, therapists assess which method is best for each patient -- prescribing medication or cognitive therapy or a combination of the two.

Dr. Sally Winston, director of the anxiety disorders program there, said improvements may occur gradually over several weeks or months. But she added: "In one session, just receiving the diagnosis can have a massive effect. It can make huge differences in a person's life."

At least one-third of "panic" patients develop agoraphobia, an intense fear of open spaces or public places that can keep a person housebound.

Many patients also develop drug or alcohol problems while groping for ways to ease their tension.

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