الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Panic disorder is a common, chronic illness associated with
considerable morbidity and social cost. Its central features are recurrent
unexpected panic attacks (sudden rushes of fear accompanied by several
somatic symptoms such as dyspnea, palpitations and dizziness) and
associated avoidance and worry related to the possible recurrence,
consequences, or health implications of the attacks (Basoglue, /991)
Panic disorder was previously subsumed under various anxiety
syndromes, such as anxiety neurosis, neurocirculatory asthenia, and Da
Costa syndrome. Now it is subsumed under anxiety disorders with
specific phenomenology, treatment response, genetics, family history,
and epidemiology (Asnis and Prag, /995).
I::pidemiological studies have reported lifetime prevalence rates of
1.5 to 5% for panic disorder and 3 to 5.6% for panic attacks. For example,
a recent study of more than I ,600 randomly selected adults in Texas
found a life time prevalence rate of 3.8% for panic disorder, 5.6% for
panic attacks, and 2.2% for panic attacks with limited symptoms .
Women are 2 - 3 times more likely to be affected than men. The
differences among races are small and the only social factor identified as
contributing to the development of panic disorder is a recent separation or
divorce. Panic disorder most commonly develops in young adulthoodthe
mean age of presentation is about 25 years- but both panic disorder
and agoraphobia can develop at any age (Fyer et at, /995).
All hough earlier thought to be a mild disorder, panic disorder is
now recognized to be associated with significant degree of dysfunction in
social occupational , and family activities comparable to depressive
disorders . Of particular concern recent reports suggesting that pauic
disorder is associated with a high prevalence of suicidal behaviors (As11is
and Pmg, 1995).
There is marked overlap between panic, depression, and anxiety
disorders at the levels of biology, presentation, and treatment. For
exa111ple dexamethazone suppression test (DST) in panic patients is non
suppression for 24% of patients while in depression and generalized
anxiet; disorders was 50-70% and 15% respectively (Baker, /989). Panic
attack;; may be present in patients having depression or generalized
anxiety disorders. Also panic patients respond to some antidepressants
and antianxiety drugs. Epidemiological surveys and retrospective studies in the primary
care selling have demonstrated that panic disorder is a primary cause of
morbidity and increased utilization of medical services. Half of all visits
to a primary care provider are precipitated by the somatic symptoms that
are often associated with this anxiety disorder. Since many of these
symptoms resemble those of clinical diseases, patients frequently undergo
extensive and costly diagnostic procedures to rule out conditions such as
coronary artery disease, inflammatory bowel disease, and asthma.
Persistent, unexplained medical somatic symptoms not only place an
undue financial burden on outpatient services and hospitals, but also have
a negative impact on social and vocational function (Kato11 a11d Way11e,
1996; Salvador et al/996; a11d Zaubler and kato11, 1998).
Panic disorder is associated with substantial impairment in
personal happiness and role functioning, that impaired quality oflife is
prop(•ttional to symptom severity, and that there is a marked increase in
use of health services. Much of this use is inappropriate, unnecessary, and
costly and is associated with frustration among providers and recipients.
Evidence suggests marked price offset once panic disorder is correctly
diagnnsed and treated. Effective treatment leads to increased work
productivity and improvement in mental and physical measures of quality
of life (Davidso11 a11d Jollatllall, 1996).
Brain imaging has made surprisingly remarkable progress since the
early historic days of invasive radiology. Now invasive radiology has
been replaced with a number of spectacularly precise techniques as:
structural (CT scan and MRI) and functional (PET, SPECT and MRS)
imaging, direct imaging during neurosurgery, EEG and its computer
assisted derivatives, and transcerebral ultrasonography (Jabourian et al,
1996).
Brain abnormalities have been reported in panic disorder. These
include changes in electroencephalographic mapping (Edlu11d et aL,
1987), Increased incidence of atrophy and focal abnormalities in the
mesotemporal regions on magnetic resonance imaging (MRI) (Fo11tai11e
et al., 1990), and regional changes in brain perfusion and metabolism on
positron emission tomography (PET) Stewart et aL, 1988) and (Nordahl
et aL, 1990). Also brain stem auditory evoked potential studies on panic
patieilt showed prolonged III-V interpeak interval, possibly reflecting
hyperactivity of brain stem nor adrenergic nuclei (K11ott et al., 1986).