Panic Disorder: Clinical Diagnosis, Management and Mechanism

This book is an interesting state-of-the-art review of research findings in the field of panic disorder, including some recent biological discoveries. Dealing with the origin of the concept and its historical relationship with neurosis and agoraphobia, H. Katschining’s chapter introduces the distinction between acute and long-term anxiety that, thanks to Donald Klein’s pharmacological dissection of anxiety neurosis (1), was assumed by the Research Diagnostic Criteria and DSM in the late 1970s. Epidemiology and genetics are well reviewed in chapter 2, and chapter 8 deals with comorbidity with somatic disorders. The economic consequences of these prevalent, yet underdiagnosed, conditions are addressed in chapter 4.

Chapter 3, by C. Faravelli and A. Paionni, is devoted to the clinical course of panic disorder and includes some remarkable observations pertaining to the issues of the “prodromal experiences” of patients with the disorder. This chapter also gives attention to the quality of life and the risk of suicide in long-term sufferers.

Brain mechanisms and circuits as well as functional anatomy and challenges are covered extensively in chapter 5 by A. Malizia and David Nutt, who give special attention to the metabolic (lactate and bicarbonate) and respiratory (hyper- and hypocapnia) challenges. The respiratory theory of panic and the complexity of its relationship with different types of survival alarm mechanisms are also deeply reconsidered by E. Griez and K. Verburg in chapter 6.

The psychological model of panic, from psychoanalytic interpretations to behavioral theories such as the “interoceptive conditioning theory,” is summarized and explained by G. Thorn et al. in chapter 7. Cognitive theories and the distinction between panic attacks as a common event or as a peculiar cognitive pattern in patients with panic disorder are clearly reported in this chapter, which refers to the Clark and Barlow models.

The last part of the book is devoted to treatments with antidepressants. Treatment with tricyclics is addressed in chapter 9 with a focus on the necessity of optimizing loading of tricyclics within the “therapeutic window.” Monoamine oxidase inhibitors (MAOIs) are also dealt with in chapter 9; interest has been revitalized with the most recent and reversible MAOIs.

Treatment with benzodiazepines is covered in chapter 10, and the review supports their importance as antipanic agents during chronic therapy. In chapter 11, the importance of the role of SSRIs as the first treatment choice for panic disorder in many patients is well maintained through an extensive review of existing literature.

Chapter 12 focuses on more recent, although not yet validated, pharmacological therapies and augmentation strategies, and chapter 13 includes a brief but clear review of psychological interventions. Special note is made of the issue of cultural and ethnic differences in the response to this treatment.

The last chapter, written by all three editors of the volume, is dedicated to an overview and future prospects in the field. This book is designed for everyone interested in the field of panic disorder. This is certainly a good and well-thought-out book, but, like any other comprehensive review book, it portrays a constantly changing field at a single point in time. Unfortunately, the most recent findings, such as the importance of the clinical comorbidity between panic and bipolar disorder (2, 3), testimonies of the new clinical leadership in psychiatric research, are not included. The problem of writing a comprehensive book on a constantly changing topic can be compared to the famous Achilles-turtle paradox of Zeno of Elea. Like Achilles, even when running as fast as he is able, the editor of this type of book can hardly reach the progress of empirical research and the constant renewing of hypotheses in the field.