Staging of Panic Disorder: Implications for Neurobiology and Treatment

Objectives: the aim of this review was to survey the available literature on psychological development of panic disorder with or without agoraphobia [PD(A)] and their relationship with the neurobiology and the treatment of panic. Methods: both a computerized (PubMed) and a manual search of the literature were performed. Only English papers published in peer-reviewed journals and referring to PD(A) as defined by the diagnostic classifications of the American Psychiatric Association or of the World Health Organization were included. Conclusions: a staging model of panic exists and is applicable in clinical practice. In a substantial proportion of patients with PD(A) a prodromal phase and, despite successful treatment, residual symptoms can be identified. Both prodromes and residual symptoms allow to monitor the evolution of the disorder during recovery via the rollback phenomenon. The different stages of the disorder, as well as the steps of the rollback, have a correspondence in the neurobiology and in the treatment of panic. However, the treatment implications of the longitudinal model of PD(A) are not endorsed and adequate interventions of enduring effects are missing.