PANIC DISORDER - HISTORY AND EPIDEMIOLOGY

Panic has not always been recognised as an exclusively psychiatric con dition. Research in this area continued along separate medical and psy chological axes until 1980, when the development of Diagnostic and Sta tistical Manual (DSM)-III criteria established the overall concept of panic disorder. The lifetime prevalence of DSM-III panic disorder and repeated panic attacks, defined as the average of individual estimates from six studies, are 2.7% and 7.1% of the general population respect ively. Females are almost twice as likely as males to suffer panic dis order, and about seven times as likely to suffer repeated panic attack s. Overall, panic disorder or panic attacks occur in up to one in ten of the general population. The prevalence of panic disorder and panic attacks, their associations with other conditions, and their time cour ses have been investigated in a prospective epidemiological study in Z urich, Switzerland, in which 591 individuals were followed for IS year s. The validity of panic disorder and panic attacks as genuine psychol ogical phenomena are attested to by their positive associations with a family history of panic disorder, elevated risk of suicide, lifetime treatment for psychiatric disorders, and especially treatment with pre scribed medication and substantial work and social impairment. Strong comorbidity exists between panic states and other psychiatric conditio ns, including depression (major depression, hi polar disorder and recu rrent brief depress ion), agoraphobia social phobia specific phobia, a nd obsessive-compulsive disease. A lower degree of comorbidity is seen with alcohol and tobacco dependence. Comorbid conditions usually prec ede panic, except for alcohol abuse, which is usually secondary to epi sodes of panic. The prognosis of panic states is often optimistic, and chronic disease is present in less than half of sufferers. Both panic disorder and repeated panic attacks are common, serious and disabling conditions. Effective diagnosis and treatment of repeated panic attac ks and panic disorder are of equal importance. (C) 1998, Elsevier, Par is.