Panic disorder in primary care: Patients' attributions of illness causes and willingness to accept psychiatric treatment

Objective: This study assessed the causes that primary care patients with p anic disorder (PD) attribute to their panic symptoms, and their acceptance of various psychiatric treatment options. Methods: In a cross-sectional ass essment of 306 patients treated at two primary care clinics, 42 met criteri a for DSM-IV PD in the past year. The authors classified these 42 PD-positi ve patients to one of two groups: those receiving both primary and speciali ty mental health care (PC+MH; n=19) and those receiving only primary care ( PC-only; n=23). Patients rated the probability of four possible causes of t heir panic symptoms, and level of acceptability of three psychiatric and tw o medical treatments for PD. To place primary care patients' ratings into a broader context, a third contrast group of PD-positive patients, recruited from clinical trials of investigational PD pharmacotherapies (n=31), also rated causes and treatment acceptability. Results: Participants of the thre e treatment groups attributed psychiatric causes for their panic symptoms i n approximately the same proportion (78 percent to 90 percent; p=ns). PC-on ly participants attributed medical causes for panic symptoms more frequentl y than PC+MH and PD Clinical Trials participants (48 percent vs. 5 percent and 32 percent; p=.01). Remarkably, the great majority of patients across a ll groups expressed willingness to see psychiatrists (84 percent to 94 perc ent) and psychotherapists (95 percent to 100 percent), and to take psychotr opic medications (87 percent to 100 percent). Conclusions: In this study mo st patients attributed a psychiatric cause for panic symptoms and communica ted strong acceptance of psychiatric treatment. Thus, we recommended that p rimary care clinicians more assertively inform their patients of PD diagnos is and recommend psychiatric treatments with less fear about stigmatizing a nd alienating them.