Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs.

Epidemiologic surveys and retrospective studies in the primary care setting 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, including chest pain, dyspnea, tachycardia, dizziness, and abdominal discomfort. 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 disorder, and asthma. Persistent, unexplained medical symptoms not only place an undue financial burden on outpatient services and hospitals, but also have a negative impact on social and vocational function. The primary care physician is in a unique position to recognize patients who may be at risk for panic disorder and to initiate appropriate treatment, preventing prolonged functional impairment and unnecessary cost to the patient and the health care system.