Medical illness and response to treatment in primary care panic disorder.
OBJECTIVE
Although studies have suggested that comorbid medical illness can affect the outcome of patients with depression, little is known about whether medical illness comorbidity affects treatment outcome in patients with anxiety.


METHODS
Primary care patients with panic disorder (n=232), participating in a randomized collaborative care intervention of CBT and pharmacology, were divided into those above (n=125) and below (n=107) the median for burden of chronic medical illness and assessed at 3, 6, 9 and 12 months.


RESULTS
Subjects with a greater burden of medical illness were more psychiatrically ill at baseline, with greater anxiety symptom severity, greater disability and more psychiatric comorbidity. The intervention produced significant and similar increases in amount of evidence-based care, and reductions in clinical symptoms and disability that were comparable in the more and less medically ill groups.


CONCLUSIONS
The comparable response of individuals with more severe medical illness suggests that CBT and pharmacotherapy for panic disorder work equally well regardless of medical illness comorbidity. However, the more severe psychiatric illness both at baseline and follow-up in these same individuals suggest that treatment programs may need to be extended in time to optimize treatment outcome.
Department of Psychiatry and Behavioral Science, University of Washington School of Medicine at Harborview Medical Center, WA 98104, USA. roybyrne@u.washington.edu
Peter
P
Roy-Byrne
Murray B
MB
Stein
Joan
J
Russo
Michelle
M
Craske
Wayne
W
Katon
Greer
G
Sullivan
Cathy
C
Sherbourne
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications; D002140:California; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000188:drug therapy*; D011320:Primary Health Care; D016896:Treatment Outcome; D014861:Washington