Panic disorder in primary care: Comorbid psychiatric disorders and their persistence

Objective

Although 70–80% of panic disorder patients use primary care to obtain mental health services, relatively few studies have examined panic patients in this setting. This study aimed to examine both the lifetime and current comorbid psychiatric disorders associated with panic disorder in primary care, the duration and severity of the disorder, and the sociodemographic factors associated with it.

Design

Patients were screened for panic disorder. Panic disorder and the comorbid disorders were determined using the Structured Clinical Interview for DSM-IV Axis I and II.

Setting

Eight different health care centers in primary care in the city of Espoo.

Subjects

Finnish-speaking, between 18 and 65 years of age.

Main outcome measures

Comorbid psychiatric disorders, the duration and severity of the disorder, and the sociodemographic factors.

Results

A sample of 49 panic disorder patients and 44 patients with no current psychiatric diagnosis were identified; 98% of panic disorder patients had at least one comorbid lifetime DSM-IV Axis I disorder. Major depressive disorder and other anxiety disorders were most common comorbid disorders. Lifetime alcohol use disorders also showed marked frequency. Interestingly, the remission rates of alcohol use disorders were notable. The panic symptoms appeared to persist for years. Panic disorder was associated with low education and relatively low probability of working full time.

Conclusions

Also in primary care panic disorder is comorbid, chronic, and disabling. It is important to recognize the comorbid disorders. High remission rates of comorbid alcohol use disorders encourage active treatment of patients also suffering from these disorders.Key Words: Comorbid disorders, Finland, general practice, panic disorder, primary careThere are only a few studies considering the comorbid psychiatric disorders associated with panic disorder in primary care and no earlier study had examined the prevalence of all other psychiatric disorders, both lifetime and current, using a structured diagnostic interview method.

• In this study 98% of panic disorder patients had at least one comorbid lifetime psychiatric disorder.
• Major depressive disorder, other anxiety disorders, and alcohol use disorders were the most common comorbid disorders.
• The panic symptoms appeared to persist for years.