The long-term course of panic disorder and its predictors

Whereas Lifetime prevalence rates of panic disorder-as established in epide miologic surveys-range between 1.6 and 3.5%, 1-month rates usually amount t o much less than one half of the lifetime rates. This finding indicates tha t a substantial proportion of patients who had panic disorder at some stage in their Life must have remitted. In contrast to these results, clinicians tend to regard panic disorder as a chronic condition because, as a rule, t hey see panic patients only several years after onset of the disorder. A nu mber of small, prospective, long-term studies of such clinical populations indicate that after several years, between 17 and 70% of patients still hav e panic attacks, and between 36 and 82% have phobic avoidance. In the large st and longest follow-up study published to date, 45% of all patients showe d an unremitting-although in a certain proportion waxing and waning-course, 24% followed a pattern of remissions and relapses, whereas 31% went back i nto a stable remission. The evidence of factors predicting the course of pa nic disorder in clinical populations suggests that long duration and agorap hobia at baseline-not the severity and frequency of panic attacks-are predi ctors of an unfavorable course. Additional studies are needed to determine whether personality factors, depression, and other variables are also of pr edictive relevance. Also, factors working during follow-up, such as positiv e and negative life events, coping behaviors, and treatment, should be cons idered in future studies.