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Am Fam Physician. 2002;65(7):1453-1457

Panic disorder is a disabling condition and a common diagnosis in the primary care physician's office. The initial presentation may feature various physical complaints, including cardiovascular, gastrointestinal, and neurologic symptoms. Persons with panic disorder tend to visit physicians' offices at much higher rates than the general population. Despite these frequent visits, panic disorder tends to be under-diagnosed. In addition, studies have shown that even after diagnosis, patients with this disorder tend to receive less than adequate pharmacotherapy or psychotherapy. Collaborative care between primary care physicians and psychiatrists has been shown to be an effective management strategy in treating depression, but no studies have examined this treatment model for effectiveness in panic disorder. Roy-Byrne and associates studied the effectiveness of collaborative care in the treatment of patients with panic disorder.

Patients who were seen at three primary care sites, met criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) for panic disorder, and had at least one panic attack in the past month were eligible for the study. The participants were randomly assigned to receive usual care or collaborative care. Usual care consisted of the primary care physician providing pharmacotherapy and management after an initial diagnostic telephone evaluation. In the collaborative care model, participants received educational videotapes and pamphlets, pharmacotherapy, two psychiatrist visits, and two telephone follow-ups during the first eight weeks of the study. Both groups were treated with the same medication unless participants were unable to tolerate the selected agent. Patients were assessed multiple times during the 12-month study. The assessment included panic, anxiety sensitivity, depression, and disability variables, along with pharmacotherapy response.

Patients in the collaborative care group were more likely to receive an adequate dosage and duration of medication. In addition, these patients were more likely to still be compliant with their medication at three and six months. Patients in the collaborative care group improved more significantly in measures of anxiety, depression, and disability than did the patients in the usual care group.

The authors conclude that the collaborative care model for the treatment of panic disorder was more effective than treatment by a primary care physician alone. The greater effectiveness included improvement in compliance with medication regimens and better clinical and functional outcomes. The authors also note that future studies should examine the stepped-care approach, where primary care physicians care for patients who do respond, and those who do not respond, or have an incomplete response, are referred for collaborative care.

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Copyright © 2002 by the American Academy of Family Physicians.

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