Panic disorder

Panic disorder (PD) is a new diagnostic category characterized by recurrent attacks of panic and by secondary development of generalized anxiety, phobias and restriction of activity. The life prevalence of uncomplicated PD is 1.4% and of PD with secondary syndromes 2.5%. PD clusters in families. Its prevalence in first degree relatives is 17.3% and in indentical twins 40-60%. No increase in other types of psychiatric disorders was found in these families. In spite of their clinical similarities, PD and mitral valve prolapse are independent entities. Patients with PD react to lactate infusion and isoproterenol challenge by developing an acute panic attack. This would attest that the pathogenesis of PD is correlated with CNS and sympathetic system hypersensitivity. Dysfunction of the locus coeruleus has been suggested as a possible explanation. With its rapid advances, the biomedical explanatory model overrides previous psychodynamic hypotheses. The shortcomings of the biological model in explaining the role of specific circumstances in triggering attacks of panic leaves a place for an explanatory model of PD which integrates CNS hypersensitivity and learning theory.