The American Psychiatric Association Practice Guideline for the Treatment of Patients With Panic Disorder: Recommendations and Controversies

Fredric N. Busch, MD and Barbara L. Milrod, MD

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Abstract & Introduction

This paper examines the controversies generated by the American Psychiatric Association Practice Guideline for the Treatment of Patients with Panic Disorder and reviews the recommendations contained therein. Questions arise about the purpose of the guideline, the nature of evidence used in making recommendations, problems surrounding comorbidity, assessment of outcome, the current state of knowledge about long-term outcome, and the applicability of research studies to community practice. The guideline generally recommends cognitive behavioral therapy and psychopharmacologic treatment and offers some discussion as to when psychodynamic psychotherapy and other treatment approaches may be of additional value.

The Practice Guideline for the Treatment of Patients with Panic Disorder[1] by the American Psychiatric Association (APA) has generated some controversy in the field. We will shed some light on these issues and summarize the treatment recommendations. Important issues to review include: the purpose of the guideline, the nature of evidence used in making recommendations, problems surrounding comorbidity, assessment of outcome, the current state of knowledge about long-term outcome, and the applicability of research studies to community practice.

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