Panic disorder. Spectrum of severity and somatization.

One hundred++ ninety-five primary care patients were screened for panic disorder utilizing the National Institute of Mental Health Diagnostic Interview Schedule (DIS) as well as four additional questions that screened for core autonomic symptoms of panic disorder. A spectrum of severity of panic disorder was found. A subgroup of patients, labeled in the study as having simple panic, was found to have anxiety attacks associated with four or more autonomic symptoms, but they did not meet DSM-III recurrence criteria (three anxiety attacks within a 3-week period). Compared to primary care patients without panic attacks, patients with both simple panic and panic disorder exhibited multiple phobias, avoidance behavior, a high lifetime risk of major depression, and elevated scores on self-rating scales of anxiety and depression. The four autonomic screening questions that the authors added to the DIS interview increased the sensitivity of the DIS in identifying patients with panic disorder. Patients with panic disorder who selectively focus on their frightening autonomic symptoms may not be identified by screen questions that only focus on the cognitive awareness of anxiety.