What can be learnt from the natural history of anxiety disorders?

BACKGROUND: There is insufficient knowledge of the long-term course of panic disorder (PD). AIM: To determine the long-term course and prognostic variables in patients diagnosed with PD. METHODS: Patients who were diagnosed of anxiety states between 1950 and 1961, were examined using a structured clinical interview (SCID-DSM-III-R) between 1984 and 1988 (n=144). A re-examination was performed in the period 1997-2001 (N=125). Mean length of follow-up from onset was 47 years. RESULTS: PD tends to be chronic. Among those who recovered, 93% had done so already by the 1980s. Lack of regular treatment compliance, progression to agoraphobia and number of episodes of panic disorder were associated with worse outcome. Agoraphobia without panic attacks and somatization symptoms were the most prevalent clinical status at follow-up. CONCLUSION: After several decades, participants improve with regard to number of panic attacks, though most continue to have residual symptoms.