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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). |