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

Disclosures
In This Article

Purpose of the Guideline

The guideline begins with a Statement of Intent: "This guideline is not intended to be construed or to serve as a standard of medical care." This statement emphasizes the individuality of particular cases, the variety of available treatment approaches, and the importance of the clinician's judgment in making treatment decisions. With regard to its purpose, on page 1, the guideline "summarizes data to inform the psychiatrist of the care of patients with panic disorder" and offers as its function "to assist the psychiatrist in caring for the patient with panic disorder." The guideline was developed from a comprehensive literature review that was drafted by a work group of experts in panic disorder, as well as from comments submitted by multiple groups and individuals. It was approved the APA Assembly and Board of Trustees.

Despite the statement of intent, we believe that the existence of the guideline presents potential medico-legal and economic problems. For example, psychodynamic psychotherapy is a commonly used treatment approach for panic disorder but is recommended much less strongly by the guideline than cognitive behavioral therapy and medication. The reason cited for this assessment is a lack of systematic studies regarding psychodynamic psychotherapy. Questions arise as to whether the existence of these recommendations places clinicians who practice psychodynamic psychotherapy at some legal risk. The guideline notes that patients should be fully informed about the availability and advantages and disadvantages of the various treatments. The views presented by the guideline about the various advantages and disadvantages of treatment, however, are not generally accepted by all practitioners who treat patients with this syndrome.[15,16]

Based on the recommendations made, insurance companies can point to the guideline in support of a decision not to fund psychodynamic psychotherapy.

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