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DSM-II (American Psychiatric Association 1968) described an ill-defined condition of anxiety neurosis, a term first coined by Freud in 1895 (Breuer and Freud 1893–1895/1955), which included any patient with chronic tension, excessive worry, frequent headaches, or recurrent anxiety attacks. However, subsequent findings suggested that discrete, spontaneous panic attacks may be qualitatively dissimilar to other chronic anxiety states. Patients with panic attacks were found, for example, to be unique in their panic-induction responsiveness to sodium lactate infusion, familial aggregation, development of agoraphobia, and treatment response to tricyclic antidepressants (TCAs). Thus, DSM-III (American Psychiatric Association 1980) and the subsequent DSM-III-R (American Psychiatric Association 1987) divided the category of anxiety neurosis into panic disorder and GAD.

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FIGURE 12–2. Development of agoraphobia.After onset of unexpected panic attacks (solid bars), patient develops acute help-seeking behavior (X), then apprehension culminating in chronic anxiety (shaded areas), and finally agoraphobic behavior (black blocks).
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TABLE 12–3. DSM-IV-TR diagnostic criteria for panic disorder with or without agoraphobia
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TABLE 12–4. Biological models of panic disorder
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TABLE 12–5. Course and prognosis of panic disorder
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TABLE 12–6. Differential diagnosis of panic disorder
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TABLE 12–7. Comparison of symptoms of mitral valve prolapse and panic disorder
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TABLE 12–8. Pharmacological treatment of panic disorder
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TABLE 12–9. Cognitive and behavioral approaches to treating panic disorder

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