Panic Disorder as an organ disorder

Research Offers Hope to Patients with Anxiety Disorders

By Denise Mann

[Medical Tribune: Family Physician Edition 37(21): 1996.

NEW YORK--Research on the inner workings of the brain is paving the way for new
treatments that may offer hope to the millions of Americans who suffer from a
spectrum of anxiety disorders, including obsessive-compulsive and panic
disorder, mental-health experts announced here.

Primary-care physicians can make a difference in delivering cost-efficient care
to patients with mental-health disorders, experts said.

"All mental disorders are disorders of an organ--the brain--just as hepatitis is
a disorder of an organ--the liver," said Steven E. Hyman, M.D., director of the
National Institute of Mental Health in Bethesda, Md., at a meeting here last
month sponsored by the American Medical Association.

"Anxiety disorders are real brain disorders that can be diagnosed very clearly
by behavioral criteria, and it is worth making a diagnosis because increasingly
effective treatments are available," Dr. Hyman stressed.

In fact, "not to make a diagnosis is condemning [a patient] to rather severe
disability," he said.

Although primary-care physicians cannot yet prevent the onset of an anxiety
disorder, they must become more aware of what symptoms such as intrusive
thoughts and recurrent panic attacks might mean, especially if they are
interfering with a patient's life, Dr. Hyman noted.

Ongoing research suggests that obsessive-compulsive disorder (OCD) may be rooted
in the striatum, Dr. Hyman reported. Some cases of obsessive-compulsive disorder
that begin during childhood may stem from a hostile immune-system reaction to
common bacterial infections such as untreated strep, Dr. Hyman said. When the
body generates antibodies to fight strep, it may mistakenly attack the striatum,
he explained.

This theory has prompted researchers to begin studying the use of penicillin as
prophylaxis of OCD recurrences, he said.

"Preliminary findings suggest that [the penicillin] model is correct," said
Susan E. Swedo, M.D., acting scientific director at the National Institute of
Mental Health.

Combined cognitive behavior therapy and antidepressant drugs are the treatment
of choice for panic disorder, said David A. Spiegel, M.D., medical director of
the center for anxiety and related disorders at Boston University.

Although researchers are not sure exactly what triggers panic disorder, some
evidence suggests that it results when the part of the brain that controls
anxiety and emotions malfunctions, he said.

Once a panic-disorder diagnosis is established, "primary-care physicians can
provide medication and a majority of patients will respond," Dr. Spiegel said.

Having ancillary staff in the office with appropriate training in cognitive
behavioral therapy also is useful in helping patients who suffer from panic
disorders, he said.

"Managed-care companies do not currently pay for cognitive therapy but I believe
that is changing [because] in the long run it saves considerable amounts of
money," the Boston researcher noted.

There is about a 17-year lag between onset of anxiety disorder symptoms and the
time that a patient receives appropriate treatment, noted Eric Hollander, M.D.,
director of clinical psychopharmacology and the director of the compulsive,
impulsive and anxiety disorders program at Mount Sinai School of Medicine in New
York.

"It is really critical that [physicians] ask the right screening questions, make
the right diagnosis and get these patients into specific types of treatment,"
said Dr. Hollander, also the clinical director of the Seaver Autism Center at
Mount Sinai.

When physicians make the correct diagnosis and the patient receives appropriate
treatment, "we are actually spending less money on provider costs" in the long
run, Dr. Hollander noted