A Randomized Effectiveness Trial of Collaborative Care for Patients With Panic Disorder in Primary Care

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Abstract
PANIC DISORDER (PD) is a prevalent1 and disabling2 psychiatric condition affecting 3% of the US population at some point during a lifetime. Because the dramatic physical manifestations of a panic attack often mimic a variety of cardiorespiratory,3 gastrointestinal,4 and otoneurologic5 illnesses, a large proportion of PD patients (80% according to one estimate6) initially receive treatment in the general medical setting.7,8 The current prevalence of PD in primary care is estimated at 4% to 6%.9 These patients use primary care services at several times the rate of other patients, including those with depression10 and those with comparable medical illness severity,11 and are overrepresented among cohorts of distressed patients who frequently use health care services.12 Despite this pattern of frequent utilization and expensive health care cost, PD is often not recognized9 by primary care physicians and, even when recognized, is inadequately treated. The few available studies suggest that fewer than 1 in 4 patients receives adequate pharmacotherapy, and only 1 in 8 receives adequate psychotherapy.13,14 These rates are lower than rates recently reported for depressed patients in primary care.15,16