The hidden patient: unrecognized panic disorder.

The lifetime prevalence of panic disorder in the United States is 1.5%; nearly 3 times that many Americans experience recurrent panic attacks. Both conditions are associated with diminished well-being, increased alcohol and drug abuse, suicide attempts, and financial dependency, at rates often exceeding those for other psychiatric disorders, including major depression. In spite of these considerable social consequences, panic disorder and panic attacks often go unrecognized. Because their symptoms can present as other medical disorders, including myocardial infarction, temporal lobe epilepsy, Cushing's disease, anemia, hypoglycemia, and lupus, these patients are instead often seen in emergency departments and cardiac and other medical clinics. General practitioners, and especially physicians working in emergency departments, should be alert to the possibility of panic disorder, especially if the patient has a first-degree family member suffering from panic disorder.