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PubMed1992

Protective effects of imipramine maintenance treatment in panic disorder with agoraphobia.

OBJECTIVE: This study was designed to assess and compare the differential relapse rates of patients with panic disorder and agoraphobia after discontinuation of acute treatment (6 months) or acute plus maintenance treatment (18 months) with imipramine. METHOD: Sixteen patients with panic disorder and agoraphobia who had shown marked and stable response to 6 months of acute imipramine treatment and a comparable group of 14 patients who had been in remission during an additional year of half-dose imipramine maintenance treatment entered a 3-month, double-blind discontinuation study followed by a 3-month drug-free period. Assessments of the patients were made according to operationalized response/relapse criteria, and plasma drug concentrations were monitored. RESULTS: Survival analysis revealed significantly different cumulative probabilities of continued response 6 months after discontinuation of imipramine treatment between the patients who had received only acute treatment and those who had received acute and maintenance treatment. CONCLUSIONS: The results support the hypothesis that successful imipramine maintenance treatment of patients with panic and agoraphobia can have protective effects against relapse, at least in the first 6 months after the maintenance treatment period.

Adult↗
PubMed1993

Chronic life stress and treatment outcome in agoraphobia with panic attacks.

OBJECTIVE: Factors associated with response to treatment for agoraphobia are as of yet poorly understood. The authors investigated the relationship between chronic forms of life stress and clinical improvement and recovery in subjects with agoraphobia. METHOD: Subjects meeting the DSM-III criteria for agoraphobia with panic attacks (N = 73) completed measures of life stress, agoraphobic symptoms, and depressive symptoms at the initiation and completion of the 12-week treatment protocol. Chronic stressors were assessed during intensive structured interviews 3-5 years after the completion of treatment and were rated by using a reliable, and previously validated, contextual rating system. The contextual life stress interview was completed by 54 subjects. The relationship of chronic forms of stress to treatment response was assessed by comparing symptomatic improvement in the subjects who had and had not experienced chronic stressors. RESULTS: Of the 54 subjects, 23 (43%) reported chronic stressors of marked or moderate severity. Subjects experiencing chronic stressors evidenced less improvement after treatment on both self-report and objective indexes of agoraphobic symptoms. Additionally, more subjects identified as nonrecovered experienced chronic stressors than did recovered subjects. CONCLUSIONS: Chronic stressors appear to predict a relatively unfavorable treatment outcome, as defined by higher levels of symptoms after treatment, less improvement, and less likelihood of recovery. These results have important implications for enhancing psychotherapeutic outcomes.

Adult↗
PubMed1987

The relationship between agoraphobia, social phobia and blood-injury phobia in phobic and anxious-depressed patients.

This paper reports the results of principal components and stepwise discriminant analyses of anxiety, depression and fear scores for 74 phobic and anxious-depressed psychiatric patients. Factor analysis indicated a coherent agoraphobia factor, with less coherent blood-injury and social phobia factors. Discriminant analysis showed a high degree of correct classification of diagnosed agoraphobic, blood-injury and social phobic patients particularly for agoraphobia. A frequency distribution of the phobia scores indicated an all or nothing quality to agoraphobic fears. The results indicate that agoraphobia is a fairly coherent syndrome, but that more work is needed on the concepts and measurement of blood-injury and social phobias.

Adult↗
PubMed1987

Hereditary agoraphobia and obsessive-compulsive behaviour in relatives of patients with Gilles de la Tourette's syndrome.

We present 11 pedigrees in which a propositus with Gilles de la Tourette's syndrome had first or second-degree relatives with obsessive-compulsive behaviour or agoraphobia with panic attacks, but only partially expressed the TS gene (i.e. had only motor tics or vocal tics, or neither). Of 90 females over the age of 18 presenting with TS, or with motor or vocal tics alone, nine had severe agoraphobia with panic attacks. There may be genetic subtypes of both obsessive-compulsive disorder and agoraphobia with panic attacks that are due to partial expression of the TS gene.

Adolescent↗
PubMed1999

Randomised placebo-controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia.

BACKGROUND: In the treatment of panic disorder with agoraphobia, the efficacy of pharmacological, psychological and combined treatments has been established. Unanswered questions concern the relative efficacy of such treatments. AIMS: To demonstrate that moclobemide and cognitive-behavioural therapy (CBT) are effective singly and more effective in combination. METHOD: Fifty-five patients were randomly assigned to an eight-week treatment of: moclobemide plus CBT; moclobemide plus clinical management ('psychological placebo'); placebo plus CBT; or placebo plus clinical management. RESULTS: Comparisons between treatments revealed strong effects for CBT. Moclobemide with clinical management was not superior to placebo. The combination of moclobemide with CBT did not yield significantly better short-term results than CBI with placebo. The CBT results remained stable during a six-month follow-up, although a substantial proportion of patients treated with placebo plus CBT needed additional treatment. CONCLUSIONS: CBT was highly effective in the treatment of panic disorder with agoraphobia and reduced agoraphobia to levels that were comparable to those of non-clinical controls.

Adolescent↗
PubMed2003

Styles of adaptation in panic disorder with and without agoraphobia.

Two groups of women with a main DSM-IV diagnosis of panic disorder, one with and one without agoraphobia (respectively, n = 26 and n = 14) were compared on several clinical variables. Forward logistic regressions were run for the presence of agoraphobia. Age of onset, duration of illness, presence of major depressions, and cluster classification on Axis II did not predict the criterion variable. Diagnosis and scores on avoidant personality disorder led, respectively, to 65% and 72.5% rates of correct classifications. Among panic symptoms, fear of going crazy and palpitations significantly predicted agoraphobia (75% of correct allocations). Three adaptive variables assessed by the Serial Color-Word Test (a serial version of the Stroop task) led to a 90% rate of correct classification. Agoraphobic patients were mainly characterized by an anxious or over-controlling style, which permitted a pseudo-objective mastery of the conflict situation. The findings seem to support the clinical relevance of the Serial Color-Word Test.

Adaptation, Psychological↗
PubMed1983

Agoraphobia, compulsive behaviours and behaviour completion mechanisms.

Anxiety is identified with a state of high arousal. Agoraphobia is differentiated from specific phobias which are inherent responses to situations which threatened primitive man. In agoraphobia, attacks of high arousal are produced by situations which delay ongoing activity. It is hypothesised that such delays produce arousal by activating behaviour completion mechanisms. Evidence is reviewed which indicates desensitization has a lasting effect in agoraphobia but not in specific phobias. It is suggested that desensitization reduces the arousal produced by behaviour completion mechanisms. Aversive therapy in homosexuality reduces the subjects' drive to carry out compulsive sexual behaviours but does not alter sexual orientation. It is suggested that compulsive sexual behaviours are not activated by primary sexual drives but by behaviour completion mechanisms which are also responsible for other compulsive behaviours. Aversive therapy acts by reducing the arousal produced by the behaviour completion mechanisms. As both aversive therapy and desensitization reduce such arousal, desensitization should be able to replace aversive therapy in the treatment of compulsive behaviours.

Agoraphobia↗
PubMed1987

Agoraphobia and parental bereavement.

The prevalence of parental bereavement was determined in 50 married female outpatients with a DSM-III diagnosis of agoraphobia and in a control group of married female outpatients diagnosed as having non-psychotic psychiatric disorders other than agoraphobia. The two groups were matched for age and overall severity of psychiatric symptoms. Compared with the general population, the patient control group reported a statistically significant excess of parental, but not maternal, bereavement. The agoraphobic group was significantly younger than the control group at the time of parental loss. These data, together with other reports, suggest a contribution of paternal bereavement before the age of 30 years to agoraphobia in married women and a contribution of recent parental bereavement ot psychiatric disorder in general.

Adult↗
PubMed1989

Behaviour completion mechanisms, anxiety and agoraphobia.

Little attention has been paid to the situations which provoke the initial attack of anxiety in agoraphobia. According to the behaviour completion hypothesis many normal subjects experience increased tension in such situations when there is a delay in the completion of a behaviour. One hundred and eight medical students completed a questionnaire designed to investigate this hypothesis. They reported experiencing increased tension or anxiety significantly more frequently in situations provoking agoraphobia when the situations contained a component of delay, as compared to such situations without this component, or to situations not commonly provoking agoraphobia. It is proposed that tension, anxiety and panic form a continuum of increasing levels of arousal, but are associated with different cognitions. It is further proposed that the arousal level of agoraphobics is sensitized, so that delay which provokes mild increases of arousal in the healthy, provokes high arousal in agoraphobics. This finding supports the hypothesis that delay in behaviour completion is a mechanism in the generation of tension and anxiety.

Adult↗
PubMed2006

The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To present nationally representative data on the prevalence, correlates, and comorbidity of DSM-IV panic disorder (PAN), including the differentiation between panic with agoraphobia (PDA) and without agoraphobia (PDWA) and agoraphobia without a history of panic disorder (AG). METHOD: The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Prevalence, correlates, and comorbidity of PAN, PDA, and PDWA with Axis I and II disorders were determined. RESULTS: Prevalences of 12-month and lifetime PAN were 2.1% and 5.1%. Rates of 12-month and lifetime PDWA were 1.6% and 4.0%, exceeding those of 12-month (0.6%) and lifetime (1.1%) PDA. Rates of 12-month and lifetime AG were extremely low, 0.05% and 0.17%. Being female, Native American, middle-aged, widowed/ separated/divorced, and of low income increased risk, while being Asian, Hispanic, or black decreased risk for PAN, PDA, and PDWA. Individuals with PDA were more likely to seek treatment and had earlier ages at onset and first treatment, longer episodes, and more severe disability, impairment, panic symptomatology, and Axis I and II comorbidity than those with PDWA. CONCLUSION: PDA may be a more severe variant of PAN. Overrepresentation of PDA in treatment settings reflects increased treatment seeking and the severity of PDA relative to PDWA. The very low prevalence of AG leaves open questions about the meaning of the disorder as a distinct clinical entity as defined in the DSM-IV.

Adolescent↗
PubMed1988

Prescribing patterns in agoraphobia with panic attacks.

Although medication is used commonly in the treatment of agoraphobia with panic attacks, the actual drug-prescribing patterns of the medical profession have not been well studied in this condition. The present study compares the prescribing patterns of general practitioners and psychiatrists in their treatment of agoraphobia with panic attacks. The medical records of 111 agoraphobic patients with panic attacks were analysed and divided into those who were referred by general practitioners and those who were referred by psychiatrists. Over all, in the treatment of agoraphobia with panic attacks, general practitioners prescribed drugs less often than did psychiatrists. They used fewer combinations of drugs and tended to prescribe tricyclic antidepressant agents in doses which generally are considered to be below the therapeutic range. This finding would suggest that general practitioners are less effective than are psychiatrists in prescribing for this condition as judged by current practice, although they are less likely to prescribe combinations of drugs--a practice which might well be to their credit.

Adult↗
PubMed2001

A VR-based multicomponent treatment for panic disorders with agoraphobia.

Agoraphobia consists of a group of fears of public places such as going outside, using public transportation and being in public places, which cause serious interference in daily life. Many studies demonstrated the effectiveness of a multicomponent cognitive-behavioral treatment strategy for panic disorder with agoraphobia. The traditional protocol involves a mixture of cognitive and behavioral techniques which are intended to help patients identify and modify their dysfunctional anxiety-related thoughts, beliefs and behavior. Emphasis is placed on reversing the maintaining factors identified in the cognitive and behavioral patterns. We use Virtual Reality (VR) to support Panic Disorder treatment. The preliminary treatment protocol for Panic Disorder and Agoraphobia, named Experiential-Cognitive Therapy (ECT), was developed at the Applied Technology for Neuro-Psychology Lab of Istituto Auxologico Italiano, Verbania, Italy, in cooperation with the Psychology Department of the Catholic University of Milan, Italy. The actual version included the efforts of researchers from the Center for Advanced Multimedia Psychotherapy, California School of Professional Psychology, San Diego (CA), USA, and from the Seoul Paik Hospital, Inje University, Seoul, Korea. The goal of ECT is to decondition fear reactions, to modify misinterpretational cognition related to panic symptoms and to reduce anxiety symptoms. The characteristics of the approach will be presented through the description of the clinical protocol.

Agoraphobia↗
PubMed1992

Serotonin, panic disorder and agoraphobia: short-term and long-term efficacy of citalopram in panic disorders.

A serotonin-anxiety connection has been widely recognized. In panic disorder (PD), however, most researchers have emphasized noradrenergic mechanisms. Serotonin related findings in PD, e.g. the documented antipanic potential of selective serotonin reuptake inhibitors (SSRIs), are reviewed, lending support for a serotonergic deficit contributing to the pathophysiology of PD. Since citalopram is the most selective SSRI described, it was chosen as a tool for testing whether the serotonin reuptake inhibition per se is responsible for this antipanic effect. Twenty patients with PD with or without agoraphobia (DSM-III-R criteria) were treated openly with citalopram and assessed with CAS, MADRS, SCL-90 the Agoraphobia Scale, other self-ratings, and a panic diary. Thirteen of the 17 patients completing 8 weeks of treatment were judged as responders. The response seemed similar to or better than that seen with other antidepressants. The response covered broad aspects of morbidity, e.g. anticipatory anxiety, agoraphobia and somatization. In the first week, a transient increase of panic-related symptoms was observed. Sixteen of the patients were enrolled in a 15 months' study of long-term maintenance treatment; 11 patients completed this phase. The gains were maintained during this follow-up, and further improvement was observed. Side-effects were similar to those of other SSRIs and mostly mild. For instance, weight-gain was not associated with citalopram treatment. The results support the hypothesis that serotonin reuptake inhibition is essential for the antipanic effect of antidepressants as well as for the initial paradoxical increase of anxiety often seen with these drugs. Thus, an initial deterioration, possibly due to transient decrease of serotonin transmission, turns to improvement when serotonergic potentiation has occurred.

Adult↗
PubMed1988

Thyroid hormones in panic disorder, panic disorder with agoraphobia, and generalized anxiety disorder.

Fifty-two patients with generalized anxiety disorder who had symptoms persisting for at least 6 months, 41 patients suffering from either panic disorder (32 patients) or panic disorder with agoraphobia (9 patients), and 14 control subjects were screened for thyroid disease. Total serum thyroxine (TT4), serum-free thyroxine index (FT4I), and triiodothyronine resin uptake (T3RU), were examined for the entire sample, using a one-way analysis of variance (ANOVA). No significant differences were found in TT4 (p = .24), FT4I (p = .24), and T3RU (p = .19). Thyroid-stimulating hormone (TSH) was examined in a subsample of 10 patients with generalized anxiety disorder, 11 with panic disorder or panic disorder with agoraphobia, and 10 controls. One-way ANOVA again showed no significant differences, although there was a trend (p = .07). This is the first report that compares generalized anxiety disorder patients, panic disorder patients, and patients with panic disorder and agoraphobia with controls on measures of thyroid function. It is also the first to report normal values in the thyroid indices of generalized anxiety disorder patients.

Adult↗
PubMed1987

Three cases of overlap between panic disorder, social phobia, and agoraphobia.

Panic disorder, agoraphobia, and social phobia are subtypes of the anxiety disorders as defined by DSM-III. Panic disorder and agoraphobia are thought to be closely related, whereas social phobia is considered to be distinct on the basis of demographic characteristics, course, symptoms, biological responsiveness, and treatment specificity. Three cases are presented in which these classificatory distinctions are blurred and the course of the illness seems to involve temporally overlapping manifestations of panic attacks, social phobia, and agoraphobia. Diagnostic and treatment issues and implications for research are discussed.

Adult↗
PubMed1984

Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances.

The nature of the relationship between 'panic disorder', agoraphobia and general anxiety disorder remains open. The aetiological theories which have tried to link them with the aid of biological and psychological concepts fail to take account of conflicting observations. 'Panic' attacks are not confined to agoraphobic and related disorders, being indistinguishable from the attacks of acute anxiety and phobic aversion manifest in a wide range of anxiety and affective disorders. There is continuity and discontinuity in the evolution of agoraphobia; those affected differ in respect of a range of premorbid features from patients with other disorders and control subjects. These variables include family history, life development, trait anxiety and other personality characteristics including introversion, neuroticism and probably emotional dependence on others. Not all the claims made on behalf of the efficacy of pharmacological treatment on the one hand and behavioural therapies on the other are substantiated. The success achieved by behavioural treatment appear to endure over some years. But the residual disabilities and defects that follow all forms of treatment and the problems posed by patient selection and high drop-out rates have received insufficient attention. Aetiological theories of agoraphobia and related conditions have been advanced along biomedical, psychological and psychodynamic lines. Some evidence supports each kind of theory. But none is wholly consistent with the findings regarding its phenomenology and evolution. Recent biological investigations have led to the formulation of hypotheses in relation to anticipatory and chronic anxiety in terms of changes in synaptic connections, enhancement of transmitter release as well as alterations in molecular configuration and regulation of gene expression. It would be premature to conclude that these findings can provide a unitary conceptual framework for the explanation of human anxiety disorders. The psychological, behavioural and psychodynamic aspects of this group of disorders should all continue to receive due attention both in clinical management and scientific investigation.

Adolescent↗
PubMed1995

[Treatment of panic disorders and agoraphobia. Psychotherapy, psychopharmacotherapy and their combination].

During the last two decades substantial progress has been achieved in the development and evaluation of effective treatment approaches to panic disorder and agoraphobia. Many clinical research studies in this area were begun after the definition of operationalized diagnostic criteria for panic disorder and agoraphobia in the DSM-III in 1980. Different concepts concerning the etiology, pathogenesis and maintaining factors of these disorders are still controversial. At the beginning of this controversy, psychopharmacological treatment was believed to suppress spontaneous panic attacks while behavioral treatment mainly focused on anticipatory fears and avoidance behavior. Meanwhile both treatment approaches have proved their effectiveness in reducing panic attacks and agoraphobia. Therefore, it was hypothesized that a combination of both individual treatments could enhance therapeutic efficacy. The few studies examining this question did not allow clear conclusions because of methodological shortcomings. In the short run, there seems to be a trend for better results with combined treatment. In the long run, however, combined therapy has not been observed to be superior to cognitive-behavioral therapy without any psychopharmacological support. In practice, adverse side effects restrict the application of psychopharmacological approaches. On the other hand, qualified cognitive-behavioral therapists are not always available, or patients are referred to them by general practitioners and psychiatrists after a delay. Criteria for the application of behavioral therapy, psychopharmacological therapy and their combination are proposed and discussed.

Agoraphobia↗
PubMed1997

The relationship of attributional style to agoraphobia severity, depression, and treatment outcome.

The present study examined the relationship of attributional style, as measured with a revised version of the Attributional Style Questionnaire (ASQ) and measures of agoraphobia severity, depression, and treatment outcome in 73 Ss who met DSM-III criteria for agoraphobia with panic attacks and participated in one of three 13-week treatment conditions: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. Subjects completed assessments at four periods: pretreatment, midtreatment, posttreatment, and at 3 month follow-up. In addition to the three dimensions typically examined on the ASQ, this revised version also measured Ss' estimates of the perceived importance, and future likelihood for both positive and negative events. Congruent with previous research, moderate but somewhat inconsistent associations were observed between attributional style and depression both within and across assessment periods. Predictions about associations between attributional style and agoraphobic severity were not supported; however, an interaction was observed between depression and attributional style with respect to severity of agoraphobia. There was no evidence of group differences across treatment types, although there were several significant changes in attributional style across time. Attributions for health related events were also examined. Conceptual, clinical, and research issues related to the findings are discussed.

Adolescent↗