Treatment of Comorbid Panic Disorder and Schizophrenia: Evidence for a Panic Psychosis

W hy is it important to consider com orbid panic disorder in schizophrenia? After all, schi,wphrenia wreaks such devastation on patients' lives that panic disorder would seem trivial in comparison. However, clinical experience and a growing literature suggest that comorbid panic disorder may be a major determinant of distress and dysfunction across many psychiatric disorders, including schizophrenia. I The recognition of panic disorder in patients with schizophrenia is crucial for designing effective treatment. In addition, panic disorder may play a significant pathogenetic role in some schizophrenic illness. During the past 30 years, the diagnosis of psychotic disorders has become increasingly precise. Symptoms that were once lumped together under one diagnosis are now accurately distinguished from one another, with disorders such as psychotic mania, delusional depression, and paranoid delusional disorder being properly differentiated. These more specific diagnoses came into common use as psychiatry better understood their symptom clusters, natural history, and treatment response. For example, the discovery of lithium made the distinction between psychotic mania and schizophrenia far more clinically pressing. As a result of recent interest in psychiatric