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PubMed1984

[Agoraphobia and panic attacks. Biological and behavioral approaches].

Behavioral and biological issues in agoraphobia are reviewed. New classifications of agoraphobia based on longitudinal studies appear promising. Genetical studies bring some data suggesting that agoraphobia and panick attacks may be a familial and genetical disease. The effects of antidepressants on agoraphobia and panick attacks are still a disputed issue. Exposure in vivo appears as the effective component of behavioral treatment of anticipatory anxiety and allows a significant withdrawal of medication (eg antidepressant and/or benzodiazepine). A personal study on 27 agoraphobia cases is reported showing a significant rate of withdrawal after behavior therapy (p less than .05). Some examples of single case designs are reported to study the covariation of depression, phobia and panick attacks. Multicenter studies are needed to clarify the problem of effectiveness and specificity of antidepressant action on agoraphobia and panick attacks.

Agoraphobia↗
PubMed2001

Linkage genome scan for loci predisposing to panic disorder or agoraphobia.

We conducted a 10 cM linkage genome scan in a set of 20 American pedigrees (153 subjects), ascertained through probands with panic disorder (PD). Several anxiety disorders segregate in these families; they were diagnosed on the basis of Schedule for Affective Disorders and Schizophrenia interview. In this article, we describe results for panic disorder and agoraphobia, which are closely related, common, heritable anxiety disorders. This is the first complete linkage genome scan for agoraphobia and the third for PD. A total of 407 markers (389 autosomal, 18 X chromosome) were genotyped. Multipoint LOD score and NPL analysis were completed using GENEHUNTER2. For PD, two genomic regions meet criteria for suggestive linkage. One of these regions is on chromosome 1 (LOD score = 2.04). This region coincides with a region that generated a LOD score of 1.1 in a previous genome scan by Crowe et al. [2001: Am J Med Genet (Neuropsychiatr Genet) 105:105-109]. The other (LOD score = 2.01) is located on chromosome 11p and occurs at marker CCKBR, one of eight candidate genes examined. For agoraphobia, the most promising potential linkage was on chromosome 3 (NPL score = 2.75; P = 0.005). This was accounted for primarily by a single family that by itself generated an NPL score of 10.01 (P = 0.0039) and a LOD score of 2.10. These results provide initial evidence for a genetic locus on chromosome 3 that contributes to risk for agoraphobia. They also support suggestive linkage to two risk loci for panic disorder. Additional potential loci were identified with lesser statistical support; several of these were consistent with previously reported panic disorder linkage results. Overall, the results presented here suggest that PD and agoraphobia are complex traits that share some, but not all, of their susceptibility loci. Published 2001 Wiley-Liss, Inc.

Agoraphobia↗
PubMed2004

Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator.

BACKGROUND: Implantable cardioverter/defibrillator (ICD) treatment has reduced the mortality of patients with a high risk of sudden cardiac death. However, ICD discharges may cause anxiety with respect to new discharges and lead to preventive, for example, phobic, behavior. This study evaluated the frequency of panic disorders and agoraphobia in patients with ICD and assessed the risk factors in their development. HYPOTHESIS: Treatment with ICD represents a risk factor in the development of anxiety disorders. METHODS: Ninety patients with ICD were examined using a standardized lifetime Diagnostic Interview of Psychiatric Syndromes (DIPS). This interview makes it possible to estimate the incidence of panic disorders and agoraphobia. The impact of the severity of the underlying cardiac disease, the number of ICD discharges, and the subjective appraisal of the shock experience on the development of panic disorders and agoraphobia was assessed. RESULTS: Fifteen patients (16.7%) developed anxiety disorders after ICD implantation. The incidence was 21% in patients with and 6.9% in patients without ICD discharge. In patients with two or more ICD discharges annually, the incidence of panic disorders and agoraphobia was higher than that in patients with a single ICD discharge annually (62 vs. 10%, p<0.01). The intensity of self-observation of their body was significantly related to the development of anxiety disorders (p<0.001). CONCLUSION: Panic disorders and agoraphobia are frequent side effects of ICD treatment. Risk factors in the development of these disorders are two or more ICD discharges annually and a negative cognitive appraisal of ICD discharges. Therapeutic efforts should aim at reducing the number of ICD discharges and provide early psychological treatment.

Adaptation, Psychological↗
PubMed1993

The Zurich study. XX. Social phobia and agoraphobia.

The problems in association with agoraphobia and social phobia were examined in an 11-year prospective longitudinal study of a Swiss cohort of young adults. The weighted prevalence rates according to DSM-III were 2.9% for agoraphobia and 3.8% for social phobia. Although the problem of agoraphobia was greater in females, an equal sex ratio was observed for social phobia. There was a significant degree of comorbidity between the two subtypes of phobia, with females exhibiting a significantly greater frequency of co-occurrence of both disorders than males. The course of the two disorders was quite similar. In general, subjects with both disorders reported a more severe course. Assessment of comorbidity of phobias and other disorders revealed that agoraphobia was most significantly associated with extended neurasthenia, sexual problems, and the consumption of cannabis. On the other hand, social phobia was associated with other disorders than agoraphobia, with the strongest associations emerging for simple phobia, extended insomnia, and alcohol abuse. These findings support the validity of the distinction between different subtypes of phobia. The longitudinal analysis revealed that also phobia in general was not stable at the diagnostic level phobic symptoms were quite persistent across time.

Adolescent↗
PubMed1993

Decreased lymphocyte beta-adrenoreceptor function correlates with less agoraphobia and better outcome in panic disorder.

Previous studies have demonstrated reduced function of peripheral beta-adrenoreceptors in panic disorder with agoraphobia (PDA). We recently reported that decreased lymphocyte beta-receptor function was associated with milder agoraphobia and better treatment response in PDA. We now report on lymphocyte beta-receptor function in 12 additional patients with PDA. Lower cyclic AMP responses to isoproterenol were significantly correlated with milder agoraphobia and better response to naturalistic treatment. Lower beta-receptor density tended to correlate similarly with agoraphobia and treatment response. These findings further support the hypothesis that decreased peripheral beta-receptor function in PDA reflects an adaptive process associated with greater resistance to agoraphobia and greater capacity for recovery with treatment.

Adult↗
PubMed1997

Embarrassment about the first panic attack predicts agoraphobia in panic disorder patients.

In order to find out whether contextual variables of the first panic attack and the person's reaction to it predict the development of agoraphobia in panic disorder patients, 60 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia and 30 patients suffering from panic disorder without agoraphobia were interviewed about their first panic attack. Single comparisons between groups of agoraphobic and non-agoraphobic patients were carried out and a logistic regression model was applied. Occurrence of the first panic attack in public and the feeling of embarrassment were found to be significantly associated with the development of agoraphobia. It is concluded that eliciting this specific form of social concern at an early stage might help to identify patients at risk for later agoraphobia, which could, in turn, help to further specify early therapeutic interventions and concentrate therapeutic efforts on a high-risk group of panic disorder patients.

Adaptation, Psychological↗
PubMed1989

Relationship and chronology of depression, agoraphobia, and panic disorder in the general population.

The comorbidity of disorders and chronology of first symptoms of depression, agoraphobia, and panic disorder were investigated. The Diagnostic Interview Schedule was administered to 3258 household residents. Strong associations were shown among all three disorders. However, the comorbidity of agoraphobia and panic disorder seemed to be accounted for by the relationship of both disorders with depression. The mean age at appearance of first symptoms was earlier for agoraphobia (low teens) than for depression or panic disorder (both about age 20). The results do not support the view that panic disorder is an integral component of agoraphobia, but rather that it is more closely associated with depression. The fact that agoraphobia precedes depression casts doubt on the thesis that depression is primary to anxiety disorders. Interpretation should, however, be viewed with caution because of the retrospective nature of the diagnostic instrument.

Adolescent↗
PubMed2004

Comorbidity of irritable bowel syndrome, panic disorder, and agoraphobia in a Japanese representative sample.

OBJECTIVES: Irritable bowel syndrome (IBS) is considered to be a transcultural functional bowel disorder with high comorbidity and psychiatric disorders; but well-designed epidemiologic studies have never been performed in Japan. The purpose of this study was to establish the prevalence of IBS, together with the comorbidity rates of panic disorder (PD) and agoraphobia, employing a large-scale survey based on stratified random sampling. METHODS: A total of 4,000 subjects aged 20-69 years completed a questionnaire and the results were weighted to ensure representativeness of the Japanese general population. The questionnaire covered key symptoms of IBS, PD, and agoraphobia. The prevalence of IBS and its subtypes was calculated by gender. The comorbidity of PD and agoraphobia with IBS was compared with morbidity in non-IBS subjects; and comorbidity in IBS subjects who had consulted medical practitioners regarding their symptoms and in those who had not was also compared. RESULTS: The prevalence of IBS was 6.1% in total. It was significantly higher in females than in males. Diarrhea-predominant IBS was more prevalent in males and constipation-predominant IBS in females. The morbidity rates of PD and agoraphobia were significantly higher in IBS than in non-IBS subjects. Comorbidity did not differ between female and male IBS subjects, while morbidity was significantly higher in female than in male non-IBS subjects; and comorbidity did not differ between consulter and nonconsulter subjects. CONCLUSIONS: The prevalence of IBS and its comorbidity with PD and agoraphobia in Japan were demonstrated to be similar to those reported in Western industrialized countries.

Adult↗
PubMed1982

The dexamethasone suppression test in panic disorder and agoraphobia.

Reports that imipramine and phenelzine prevent panic attacks in agoraphobia suggest the possibility that agoraphobia and/or panic disorder might be a clinical manifestation of underlying depression. To test this hypothesis, dexamethasone suppression tests (DSTs) were performed in 10 patients meeting DSM-III criteria for agoraphobia with panic attacks, 6 for panic disorder, and 4 whose diagnosis could have been either panic disorder or agoraphobia except that another axis I disorder precluded such a diagnosis. Abnormal DSTs were observed in only 3 patients and appeared to be attributable to causes other than panic attacks or agoraphobia. The results suggest that panic attacks and endogenous depression are separate disorders and that the antipanic properties of imipramine and phenelzine are separate from their antidepressant actions.

Adult↗
PubMed1982

Agoraphobia.

The authors focus on the nature of agoraphobia and on treatments for it. A variety of myths about agoraphobia are examined such as those concerning the patient's childhood, sexual development, and marital history, and the conclusion is that none of these helps in understanding the nature of the condition. The recent notion that agoraphobia is merely a form of endogenous depression is refuted. Of the four traditional languages of psychiatry, the medical and behavioural models are currently more in vogue than the genetic or psychoanalytic, but there are limitations in all models. It is shown why the behavioural therapies for agoraphobia may not be as universally helpful as implied by the recent research literature. The apparent success of both pharmacotherapy and behaviour therapy leaves models of agoraphobia which are at variance with each other, and the authors suggest possible lines of research which might resolve the contradiction.

Agoraphobia↗
PubMed1985

The familial occurrence of agoraphobia.

Agoraphobia is believed to run in families, but this belief is not well supported by the literature. Data were gathered on the risk of agoraphobia in parents and siblings of 60 agoraphobic probands; 12 1/2% of the relatives were reported to have or have had agoraphobia. This risk is significantly greater than estimates of the population incidence, and requires explanation. The details of the pedigrees do not directly support simple genetic models while investigations into environmental factors in agoraphobia by other workers have been inconclusive. As a putative case has been established for the familial occurrence of agoraphobia, further work is required to shed light on whether genetic or cultural factors are paramount.

Adolescent↗
PubMed1995

A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia.

BACKGROUND: This multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT). METHOD: Double-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68. RESULTS: At week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT+buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT+buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect. CONCLUSION: Buspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.

Adolescent↗
PubMed2006

[Gender differences in psychopathologic features of agoraphobia with panic disorder].

BACKGROUND/AIM: To examine gender differences in the major psychopathologic features in agoraphobia with panic disorder. METHOD: The study was conducted as a clinical study. The sample consisted of 119 patients, 32 men (26.9%) and 87 women (73.1%) with the basic diagnosis of agoraphobia with panic disorder. All the patients were evaluated with the clinical instruments suitable for the assessment of various clinical features associated with agoraphobia with panic disorder--questionnaires (the Hopkins Symptom Checklist 90, the Panic Appraisal Inventory, the Fear Questionnaire, the Beck Anxiety Inventory, and the Beck Depression Inventory), and the clinical rating scale (the Panic and Agoraphobia Scale). After the data collection, the sample was divided into two groups by the gender. Then the groups were compared. RESULTS: There were no differences between the genders in the global psychopathologic features (the age at the onset of a disorder, duration of a disorder, severity and frequency of panic attacks, intensity of general psychiatric symptoms, intensity of general anxiety and depression). The women, howerer, reported a subjective perception of a more severe agoraphobic avoidance and males were significantly more likely than the females to anticipate the serious somatic consequences of panic attacks and worry about somatic health. CONCLUSION: There were a few gender specific psychopathologic features in patients with agoraphobia with panic disorder, so further studies would be necessary to come to a more precise conclusion.

Adult↗
PubMed2000

[Differentiated types of chronic agoraphobia].

The study included 60 patients aged 18-65 years with anxious-phobic disorder (APD)--agoraphobia with and without panic disorders. Diagnosis of the disease was performed according to ICD-10. It was established that dynamics and outcome of APD with stable agoraphobia depend on some comorbid psychic disorders (neurotic, nonpsychotic affective, personality disorders, slow-progredient schizophrenia). Influence of such disorders on APD depends on level of realization of the comorbid correlations: symptomatic (nondelirious hypochondria) and intersyndromal ones (affective and personal disorders as well as slow-progredient schizophrenia). Typology of APD with stable agoraphobia is proposed, that is determined by comorbid correlations with the phenomena of nondelirious (overvaluable or neurotic) hypochondria. Agoraphobia, comorbid with the phenomena of overvaluable hypochondria, is characterized by isolated phobic avoidance (1-2 situations), lack of the signs of progredience of psychopathologic disorders and relatively favourable outcome (lack of the cases of invalidism, decrease of a professional status in 8% of the patients). Agoraphobia, comorbid with the phenomena of neurotic hypochondria, is characterized by total phobic avoidance, syndromal comorbidity with polymorphic and generalized somatophormic disorders, depressive disorders syndromally completed, slow-progredient schizophrenia and less favourable outcome (avoidance behaviour of severe degrees was found in 57% of the patients, including 18% of patients disabled due to mental disease).

Adolescent↗
PubMed1983

Family study of agoraphobia. Report of a pilot study.

A family study of agoraphobia (n = 20), panic disorder (n = 20), and nonanxious controls (n = 20) showed the morbidity risk for all anxiety disorders to be 32% among first-degree relatives of agoraphobics, 33% among relatives of patients with panic disorder and 15% among relatives of controls. Relatives of agoraphobics were also shown to be at higher risk for alcohol disorders. Female relatives were found to be at greater risk for anxiety disorders, reflecting their increased susceptibility to these illnesses, and male relatives were at greater risk for alcohol disorders. The increased risk for anxiety disorders in the relatives of agoraphobics was not specific for agoraphobia but included panic disorder and other phobias as well. The findings indicate that agoraphobia is a familial disorder and that family data may help to determine whether agoraphobia is separate from other anxiety and phobic disorders.

Adult↗
PubMed1986

Relationship between panic disorder and agoraphobia. A family study.

A family study of patients with agoraphobia (n = 40), panic disorder (n = 40), and nonanxious controls (n = 20) showed that the morbidity risk for panic disorder was increased among the relatives of agoraphobics (8.3%) and the relatives of patients with panic disorder (17.3%). The morbidity risk for agoraphobia was also increased among the relatives of agoraphobics (11.6%) but not the relatives of panic disorder patients (1.9%). Male relatives of agoraphobics were shown to be at higher risk for alcohol disorders (30.8%). No greater risk for primary affective disorders was found among the relatives of agoraphobic or panic disorder patients or among the relatives of probands with secondary depression compared with relatives of probands without secondary depression. Probands and relatives with agoraphobia reported an earlier onset of illness, more persistent and disabling symptoms, more frequent complications, and a less favorable outcome than probands and relatives with panic disorder. The findings suggest that agoraphobia is a more severe variant of panic disorder. They also lend support to the separation between anxiety disorders and affective disorders.

Adult↗
PubMed1990

Risk factors for the onset of Diagnostic Interview Schedule/DSM-III agoraphobia in a prospective, population-based study.

We analyzed the onset of agoraphobia in a large prospective study of the general population. The annual incidence of Diagnostic Interview Schedule/DSM-III agoraphobia is estimated at 22 per 1000 population per year. Latent class analysis of new cases in the at-risk population reveals the existence of two subtypes of agoraphobia. The relationship of the incidence of the two subtypes to sociodemographic and psychopathologic risk factors suggests different origins. The data also show that in two thirds of the 260 new cases of Diagnostic Interview Schedule/DSM-III agoraphobia, onset occurs without a history of panic attack. We analyzed the relationship of these epidemiologic results to earlier clinical findings in terms of possible measurement and sampling differences.

Adolescent↗
PubMed1991

Agoraphobia in phenylketonuria.

We describe agoraphobia as a complication of phenylketonuria (PKU) in young adults. The five patients have classic PKU and received phenylalanine-restricted diet only in childhood. Only one has normal intelligence. All but one were also depressed. All were anxious. Three of the five had initiated the phenylalanine-restricted diet after 3 months of age. Two returned to the phenylalanine-restricted diet with dramatic reduction of symptoms. The frequency of manifestations of agoraphobia was also examined in 50 young women with PKU enrolled in a longitudinal study of psychosocial factors in maternal PKU, 47 of their acquaintances and 49 women with diabetes. All were administered a test of agoraphobic-avoidant behaviour. The women with PKU appeared to be more prone to social withdrawal and fear of leaving home. Twenty per cent were within the agoraphobia range of the Mobility Inventory. Those still on diet and those with non-PKU hyperphenylalaninaemia reported less avoidant behaviour than those who had terminated the diet in childhood. These results suggest that young adults with PKU are at risk for agoraphobia but that return to the phenylalanine-restricted diet may be an effective treatment.

Adult↗