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일차진료에서의 공황장애

Panic Disorder in Primary Care

김정범
대한가정의학회 (The Korean Academy Of Family Medicine)|2004.03|Korean Journal of Family Medicine|제25권 제3호|pp. 193-204

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참고문헌

키워드

공황장애panic disorderprimary care일차진료시기적절한 진단적절한 치료timely diagnosisproper treatment
주제분류가정의학

초록

공황장애는 일차진료에서 매우 흔한 질환이나 임상 실제에서 인지율이 낮으며 진단이 되더라도 적절한 치료를 제공하지 못하는 점이 많다. 이런 과소인지 및 과소치료로 인해 공황장애 환자들은 의료기관을 많이 이용하고 의료비 지출이 많으며 심각한 기능장애를 가진다. 공황장애는 정확히 진단을 내리면 치료가 잘 되는 질환이므로, 효과적인 치료로 공황발작, 예기불안, 공포적 회피뿐만 아니라 심혈관 증상, 과민성장증후군 증상, 비특이적인 소화기 증상, 건강염려증 등의 공황장애와 연관된 신체 증상들도 일반적으로 해결된다. 그러므로 일차진료에서 시기적절한 진단과 적절한 치료를 제공하는 것이 매우 중요하다. 이를 위해 일차진료의들은 공황장애의 선별과 진단방법에 대한 풍부한 지식이 필요하고, 이 장애에 대한 치료 지침이 널리 보급되어야 하고, 치료율을 높이기 위해서는 환자들을 교육하고 자주 방문하게 하고 자기-관찰(self-monitoring)을 하도록 권장하는 것이 또한 필요할 것이다.

Abstract

Even though panic disorder is commonly encountered in primary care setting, accurate diagnosis is rare and appropriate treatment is even rarer. This failure to recognize and adequately treat panic disorder leads likely contributes to inordinately high rates of medical utilization, medical cost, and excessive disability in these patients. Panic disorder is a highly treatable condition. With effective treatment, cardiovascular symptoms, irritable bowel syndrome and more specific gastrointestinal symptoms and even hypochondriasis all tend to improve as well as panic attacks, anticipatory anxiety, and phobic avoidance. Therefore timely diagnosis and proper treatment of panic disorder are very important in primary care. Primary care physicians need to be familiar with early detection and accurate diagnosis. Treatment guidelines for panic disorder also need to be disseminated widely. Patient education with more frequent visits and monitoring must be provided to increase rates of treatment.

참고문헌 (57)

  1. "et al. Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the US results of the National Comorbidity Study. Arch Gen Psychiatry 1994", pp.8~19
  2. "Utilization of health care services by patients with anxiety and anxiety disorders."
  3. "Leon AC. Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder. Arch Gen Psychiatry 1994", pp.395~401
  4. "Where do panic attack sufferers seek care", 40, pp.237~243 (1995)
  5. "Panic disorder in the medical setting.", 58, pp.13~17 (1997)
  6. "and course of anxiety and depression in general practice. Arch Gen Psychiatry 1991", pp.700~6
  7. "U.S. Department of Health and Human Services. public Health Service National Center for Health Statistics" (1985)
  8. "Klerman GL. Quality of life in panic disorder. Arch Gen Psychiatry 1989", pp.984~92
  9. "Personal and psychosocial risk factors for physical and mental health outcomes and course of depression among depressed patients.", 63, pp.345~355 (1995)
  10. "Buesching DP. Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry 1994", pp.740~50
  11. "Treatment typically provided for comorbid anxiety disorder.", 6, pp.231~237 (1997)
  12. "Fink R. Reducing long term diazepam prescribing in office practice. A controlled trial of educational visits. JAMA 1986", pp.2536~9
  13. "dependence and withdrawal. In Roy-Byrne PP editors. Benzodiazepines in clinical practice", pp.131~54, APA Press 1991
  14. "Pierce C. Failure to spot mental illness in primary care is a global problem. Clin Psychiatry News 1993", pp.5~
  15. "Panic and depression: a worldwide primary care perspective", 13, pp.7~11 (1998)
  16. "et al. An international study of psychological problems in primary care preliminary report from the World Health Organization Collaborative Project on ？psychological problems in general health care.？ Arch Gen psychiatry 1993", pp.819~24
  17. "Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition.", 101, pp.371~380 (1996)
  18. "Jacobsen G. Treatment of endogenous anxiety with phobic", pp.51~9
  19. "Goldberg BP. Somatic presentation of DSM-III psychiatric disorders in primary care. J Psychsom Res 1985", pp.563~9
  20. "Sharp DM. Controlled comparison of patients with panic disorder. Br J Gen Pract 1994", pp.352~6
  21. "Von Korff M. Somatization and psychiatric disorder in the Epidemiologic Catchment Area study. Am J Psychiatry 1991", pp.1494~500
  22. "Undertreatment of panic disorder in primary care role of patient and physician characteristics.", 15(6), pp.443~450 (2002)
  23. "treatment of mental illness by non-psychiatrist physicians. Arch Gen psychiatry 1985", pp.89~94
  24. "Katon W. panic disorder in the medical setting National Institute of Mental Health" (1989)
  25. "The epidemiology of panic disorder and generalized anxiety disorder among emergency room patients evidence for a group at risk (in press)."
  26. "et al. Distressed high utilizers of medical care", pp.355~62
  27. "Katon W. Panic disorder and somatization. Review of 55 cases. Am J Med 1984", pp.101~8
  28. "Mease PJ. Psychiatric illness in patients with chronic fatigue and rheumatoid arthritis. J Gen Intern Med 1991", pp.277~85
  29. "et al. Psychiatric morbidity in irritable bowel syndrome. Paper presented at the annual meeting of the American Psychiatric Association" (1989)
  30. "a new look at an old disease. Psychosomatics1 990"
  31. "results of the Zurich Cohort Study of Young Adults", pp.849~53
  32. "et al. Mitral valve prolapse in the general population", pp.577~81
  33. "Vandenbroucke JP. psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic. Psycholog Med 1993", pp.167~73
  34. "et al. Utility of a new procedure for diagnosing mental disorders in primary care", pp.1749~56
  35. "Brief diagnostic interviews (SDDS-PC) for multiple mental disorders in primary care: a pilot study.", 4, pp.220~227 (1995)
  36. "Treatment of Panic Disorder ed by Wolfe BE", pp.41~56 (1994), American Psychiatric Press
  37. "American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders", pp.393~444 (1994)
  38. "epidemiology in primary care. J Fam Pract 1986", vitalia(pp), pp.233~9
  39. "Sheehan KH. The classification of anxiety and hysterical states. I. Historical review and empirical delineation. J Clin psychopharmacol 1982", pp.235~44
  40. "O'Gorman TW. Reduction in hypochondriasis with treatment of panic disorder. Br J Psychiatry 1986", pp.631~5
  41. "Dupont RL Jr. Secondary depression in panic disorder and agoraphobia. I. Frequency severity and response to treatment. Arch Gen Psychiatry 1988", peck(ld jc), pp.437~43
  42. "Panic disorder and agoraphobia.", pp.810~ (2000), Oxford University Press
  43. "Post RM. Increased sensitivity to caffeine in patients with panic disorders. Arch Gen psychiatry 1984", pp.1067~71
  44. "DJ. Panic effects in alcohol withdrawal", pp.240~3
  45. "Viewig WVR. Marked sinus tachycardia resulting from the synergistic effects of marijuana and nortriptyline. Am J Psychiatry 1983", pp.626~7
  46. "Klein DF. Thyroid dysfunction in phobic patients. psychosom 1984", pp.603~6
  47. "Grafing M. Panic disorder in cardiology patients a review of the Missouri Panic", Cardiology Project. J Psychiatr Res 1993, 1 35~46
  48. "Eisenberg L. Treating depression and anxiety in primary care closing the gap between knowledge and practice. N Engl J Med 1992", pp.1080~4
  49. "Consensus statement on panic disorder from the international consensus group on depression and anxiety.", 59, pp.47~54 (1998)
  50. "The pharmacotherapy of panic disorder", pp.167~ (1998), Marcel Dekker Inc
  51. "Pharmacotherapy for panic disorder", pp.266~ (2002), American Psychiatric Publishing Inc.
  52. "Pharmacotherapy of Panic Disorder: proposed guidelines for the family physician.", 11(4), pp.280~290 (1998)
  53. "Early nonresponse to fluoxetine as a predictior of poor 8-week outcome.", 152, pp.1500~1503 (1995)
  54. "Cowley DS. Course and outcome in panic disorder a review of recent follow-up studies. Anxiety 1994", pp.151~60
  55. "Practice guideline for the treatment of patients with panic disorder.", 155, pp.1~34 (1998)
  56. "Craske MG. Mastery of Your Anxiety & Panic II", pp.1~173 (1994)
  57. "Combined pharmacotherapy and cognitive behavior therapy in the treatment of panic disorder.", 18, pp.2~5 (1998)

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