Summary of Guideline for the Treatment of Panic Disorder and Agoraphobia

Abstract

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the treatment of panic disorder and agoraphobia Conclusions: Evidence-based treatments for panic disorder and agoraphobia are now clear. These conditions are chronic and disabling in nature, are complicated by delayed treatment and the presence of other psychiatric conditions, and the presence of severe agoraphobia is a negative prognostic indicator. Choice of therapy will depend on the skill of the therapist in applying psychological treatments as well as the preferences of the patient, but there is a role for both psychological and evidence-based pharmacological approaches. The present article is a summary version of the comprehensive Clinical Practice Guideline (Australian and New Zealand Journal of Psychiatry, 2003) which was developed in accordance with National Health and Medical Research Council (NHMRC) criteria. It provides a two-page desk-top summary for use in clinical practice. Economic evaluation of the available evidence-based treatments showed that at 1 year the cost of cognitive behaviour therapy (CBT) is less than the cost of the average drug therapy (CBT becomes cheaper than paroxetine at 8 months, than clomipramine at 11 months and cheaper than imipramine at 13 months). During the second and subsequent years the superiority of CBT increases whether or not the drugs are continued. Evidence levels for specific treatments are provided in the comprehensive guideline and placed in the context of overall principles of thorough assessment and quality clinical management.