BETHESDA -- Most Americans who suffer from panic disorder aren't receiving promising treatments, in part because of doctors who are ignorant about the problem and fail to recognize its symptoms, a panel of mental health authorities said yesterday.
The disorder is marked by episodes of intense fear accompanied by physical symptoms such as a racing heart, dizziness, nausea, abdominal pain and shortness of breath. The bouts usually occur without any realistic threat, although the person may feel threatened by particular environments, such as a crowded elevator, a busy street or a shopping mall.
The panel, assembled by the National Institutes of Health to assess what is known about panic disorders, estimated that three-quarters of the people who suffer from episodes of paralyzing fear known as panic attacks never get appropriate treatment.
The condition will affect one in 75 Americans during their lifetime, the panel said in a "consensus statement" issued at the end of a three-day conference here. The statement was issued after the panel heard testimony from a variety of specialists.
Economic barriers such as poor insurance coverage prevent some patients from getting help, the panel said. But some patients see 10 or more doctors before they are accurately diagnosed.
Experts described patients who check into emergency room after emergency room thinking they are in the throes of a heart attack. Doctors seeking a physical cause run batteries of tests that show nothing; symptoms disappear, and the patients get sent home.
"Most primary-care physicians are not aware of this illness," Dr. Carl I. Margolis, an internist and psychiatrist from Rockville, said during a briefing that followed the conference. "I think primary-care physicians don't know how to treat this."
Knowledge about panic disorders is relatively new. Specialists began to recognize "panic" as a distinct type of anxiety disorder in the 1960s, but it wasn't until 1980 that the problem was recognized in the standard reference book of the American Psychiatric Association.
Despite this, the panel said, a growing body of research has shown that certain medications and a "talk" approach known as cognitive therapy have shown impressive records in treating panic. The medications include certain anti-depressants and benzodiazepines, a class of anti-anxiety drugs that includes Xanax and Valium.
