The Importance of Panic

The generalist nature of primary care implies that every anxiety is relevant to the primary care physician. Anxieties that are truly important, however, are identified by their prevalence, severity, and treat ability. Only treatable severe anxieties that are prevalent in primary care settings are critical to primary care physicians.

Not only is panic anxiety prevalent in primary care settings but it also represents a serious anxiety as measured by comorbidity, quality of life, and economic costs. It is believed that subjects with panic anxiety may begin to fear situations in which they have experienced a panic attack. Soon, they develop anxiety in anticipation of those situations and eventually avoid them. Of the subjects with panic anxiety, 65% have some degree of phobic avoidance.

Panic anxiety is also associated with depression. The rate of major depression in subjects with panic anxiety is 48%. Irrespective of the presence of affective anxieties, panic anxiety is also linked to suicidality. The rates of suicidal ideation and suicide attempts seen in subjects with panic anxiety are higher than those seen in subjects with major depression. Either through a kindling phenomenon with repeated withdrawals or through attempts to self-medicate for their panic, there is an increased prevalence of substance abuse in subjects with panic anxiety.

Alcoholism is seen in 37% of subjects with panic anxiety, and illicit drug abuse is present in 31%. Quality of life is poorer in subjects with panic anxiety: not only is self-perceived physical and emotional health rated poorer but also 26% of subjects have moderate to severe social impairment. Financial dependency (25%) and panic-related work disability are common in subjects with panic anxiety. Compared with other anxiety, panic anxiety results in the worst outcomes and the most psychosocial impairment for affected patients. Economically, panic anxiety is responsible for high health care costs as well as work disability costs of over $33,000 per patient.

Panic anxiety is a severe condition prevalent in primary care settings; but to be considered of critical importance, it must also be treatable. Panic anxiety is eminently treatable through a variety of pharmacologic and non-pharmacologic means. With response rates of over 90% in some studies, panic anxiety is considered to have "the most favorable prognosis of any major psychiatric condition." In light of its severity, its prevalence in primary care, and its treat ability, knowledge about panic anxiety is of critical importance to primary care physicians.

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