College Women's Gynecological Health Care Practices and Preferences

Abstract

Panic disorder is characterized by recurrent, sudden, often unprovoked attacks of intense, diffuse autonomic discharge accompanied by severe anxiety as distinguished from ordinary generalized anxiety. Recent research indicates a biochemical abnormality that predisposes some individuals to the disorder, which generally begins in young adulthood and affects women twice as frequently as men. Untreated panic disorder follows a chronic, fluctuating course. Complications include hypochondriasis, anticipatory anxiety, phobic avoidance and agoraphobia, abuse of alcohol and sedative drugs, and depression.

Diagnosis is complicated by patients' complaints of physical rather than emotional symptoms. Workups can be avoided if the physician considers the diagnosis in apparently healthy young adults who present with episodic cardiac, gastrointestinal, neurologic, and/or respiratory symptoms. The physician needs to be able to distinguish the symptoms of panic disorder from those of ordinary anxiety and also to rule out medical conditions that mimic panic disorder.

Neither conventional benzodiazepines nor psychotherapy alone is very effective in stopping panic attacks, but alprazolam, imipramine, and phenelzine are all highly effective. Alprazolam has fewer troublesome side effects, but patience and perseverance are necessary to reach therapeutic levels with all three drugs. Inadequate dosage is the most common cause of treatment failure. Most patients do well once their attacks are controlled and do not require close follow-up. Patient education is an important part of long-term management because relapses are common.