Wood W G
Quillen-Dishner College of Medicine, Johnson City, Tennessee.
Psychiatr Med. 1990;8(3):197-209.
The diagnosis of panic disorder without agoraphobia can very often be quite difficult because of the similarity with physical disorders particularly in the cardiac, gastrointestinal or neurological systems. The distinction must be made between panic attacks appearing as medical problems and medical problems appearing as panic attacks. Sometimes the diagnosis of panic attacks is made only after the medical diagnoses have been excluded. Panic disorder with agoraphobia however is much easier to detect if one carefully traces the historical development of agoraphobia and carefully distinguishes between the anxiety produced by agoraphobia and the panic attacks related to panic disorder. Panic disorder must also be distinguished from other anxiety disorders since the treatment for panic disorder still is quite specific. Once diagnosed however, the treatment of panic disorder without agoraphobia is rather simple. It involves the use of a benzodiazepine, either alprazolam or clonazopam, and perhaps the concomitant use of either imipramine or phenelzine sulfate for the rapid control of anxiety symptoms and continued treatment of the disorder. It is also very helpful to have the patient in psychotherapy either using a supportive or cognitive approach. If the patient has a panic disorder with agoraphobia, the pharmacological approach is the same, with the initiation of treatment using either alprazolam or clonazopam, but the psychotherapeutic approach is somewhat different in that behavioral therapy is emphasized rather than purely supportive or cognitive approaches. Given the fact that 1%-2% of the population is at risk for panic disorder, it is important that the condition be rapidly recognized and treated effectively since the currently available modalities of treatment result in almost total resolution of symptoms. Some individuals will remain on medication for several years while others will find it possible to decrease and/or discontinue their medications after only a few months or a few years. There is little excuse at this point for this disorder to be ineffectively diagnosed or treated.
由于与身体疾病，特别是心脏、胃肠或神经系统疾病相似，无广场恐惧症的惊恐障碍的诊断常常非常困难。必须区分表现为医学问题的惊恐发作和表现为惊恐发作的医学问题。有时只有在排除医学诊断后才会做出惊恐发作的诊断。然而，如果仔细追溯广场恐惧症的历史发展，并仔细区分广场恐惧症产生的焦虑和与惊恐障碍相关的惊恐发作，有广场恐惧症的惊恐障碍就更容易被发现。惊恐障碍还必须与其他焦虑症区分开来，因为惊恐障碍的治疗仍然相当具有特异性。然而，一旦确诊，无广场恐惧症的惊恐障碍的治疗相当简单。它包括使用苯二氮䓬类药物，如阿普唑仑或氯硝西泮，可能还需要同时使用丙咪嗪或硫酸苯乙肼来快速控制焦虑症状并持续治疗该疾病。让患者接受支持性或认知性心理治疗也非常有帮助。如果患者患有伴有广场恐惧症的惊恐障碍，药物治疗方法相同，开始治疗时使用阿普唑仑或氯硝西泮，但心理治疗方法有所不同，因为强调行为疗法而非纯粹的支持性或认知性方法。鉴于1% - 2%的人口有患惊恐障碍的风险，重要的是该疾病能被迅速识别并得到有效治疗，因为目前可用的治疗方式几乎能使症状完全缓解。一些人会持续服药数年，而另一些人可能在几个月或几年后就有可能减少和/或停止用药。此时，这种疾病被误诊或治疗无效几乎没有借口。
