Primary Care Physician Responses to a Panic Disorder Vignette: Diagnostic Suspicion and Clinical Management

Abstract

Objective: To study current patterns of panic disorder (PD) recognition and management by primary care physicians (PCPs). Method: We administered a vignette describing a female PD patient to 189 PCPs. Results: Three-quarters of respondents believed that PD was at least 50 percent probable, and the mean PD likelihood rating was 63 percent. Diagnostic suspicion was significantly higher for PD than for other anxiety disorders, major depressive disorder, and cardiac disorders. Medication was rated as significantly more necessary than medical testing and mental health referral. A benzodiazepine was suggested by 78 percent of respondents, while 35 percent suggested a serotonin reuptake inhibitor (SRI). Under half rated the patient as requiring medical testing, mostly for hyperthyroidism (70%) and/or cardiovascular disorder (62%), and half felt that the patient required mental health referral. Conclusions: The data suggest that most PCPs are able to recognize PD. However, they may be excessively inclined to prescribe benzodiazepines rather than more appropriate medications.