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February 1992

Anxiety Disorders and Hyperventilation

Arch Intern Med. 1992;152(2):413. doi:10.1001/archinte.1992.00400140149032

To the Editor. —  The article by Brown et al1 and the accompanying editorial by Ballenger2 on anxiety disorders in the May 1991 issue of the ARCHIVES portray the very best and the very worst in American health care practice. On the one hand, these authors document the amazing array of diagnostic and therapeutic approaches now available, ie, a patient presenting with a panic attack can (and likely will) have a computed tomographic scan of the head, an echocardiogram, perhaps a lactate infusion test, and will likely be treated with a combination of a benzodiazepine and a tricyclic antidepressant. This approach is the "best" that modern health care will provide, costing thousands of dollars and ensuring probable drug dependency for life.On the other hand, nowhere in the 16 pages by Brown et al1 and Ballenger2 is the diagnosis of simple acute recurrent hyperventilation described by having