© 2004 Psychiatric Times. All rights reserved.

Treating Panic Disorder and Agoraphobia Without 'Pushing t

by Arline Kaplan

Psychiatric Times October 1998 Vol. XV Issue 10

A middle-aged woman presents to a hospital emergency room complaining of severe chest pains, a
reveals she is having a panic attack rather than a heart attack.

To assist physicians in caring for patients with panic disorder, the American Psychiatric Associatio
Disorder (American Psychiatric Association, 1998).

Co-chairing the guideline work group were Katherine Shear, M.D., professor of psychiatry at the U
Jack Gorman, M.D., professor and vice chairman for research for the department of psychiatry at C
M.D.; John March, M.D.; Walton Roth, M.D.; and Michael Shehi, M.D.

"A typical panic attack is a sudden onset of...fear or apprehension which is accompanied by somat
heart, chest pain, dizziness or light-headedness, weakness, hot or cold flashes, shakiness and some
are caused by what we think of as activation of the sympathetic or autonomic nervous system are v

Because of the very prominent physical symptoms of panic disorder, those affected believe there is
or a specialist, such as a pulmonologist, first.

For any patients who present with chest pains and/or heart palpitations, Shear urged physicians to
disorder are often misdiagnosed, resulting in repeated visits to emergency rooms. The timing of th

"Panic attacks tend to occur at rest, and most anginal chest pain more likely occurs during exercise
think some of the symptoms of panic may relate to low blood bicarbonate. Panic patients show som
episodes."

Prior to the initiation of any treatment, the practice guideline recommends "a comprehensive gener
substance-induced conditions may be causing the panic symptoms, complicating treatment or requ
addition, the assessment of developmental factors, psychosocial stressors and conflicts, social supp

Natural History and Epidemiology

Several different types of panic attacks may occur, according to the guideline. The most common i
individuals also may experience panic attacks linked to certain situations or particular emotional c
related to agoraphobia.

"Agoraphobia technically is feeling trapped or unable to escape, or all alone or unable to get help i