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PubMed2003

Pain thresholds as a putative functional test for cerebral laterality in major depressive disorder and panic disorder.

OBJECTIVE: Both major depressive disorder (MDD) and panic disorder (PD) exhibit an illness-related functional cerebral laterality with a frontal right/left asymmetry. Using experimental pain lateralization as a putative indicator of functional cerebral laterality, we assessed body side differences in pressure, cold and heat pain thresholds in patients with MDD and PD as well as in healthy control subjects (HC). To control for an attentional bias in perception, reaction times for selective attention were also measured for both visual fields. METHOD: 21 inpatients with MDD, 21 inpatients with PD (DSM-IV diagnosis) and 20 HC subjects, all right-handed, were investigated drug free. Pain thresholds for pressure, cold and heat were assessed at the right and left forearm or hand. A neuropsychological standard test was used to measure selective attention (signal detection, Wiener Testsystem), which allows for the discrimination between left and right visual field stimulus processing. RESULTS: In all participants, a left-sided increased pain sensitivity could be verified by using pressure pain, but not by thermal pain (cold, heat). The diagnosis of MDD or PD had no influence on pain threshold lateralization. There were no differences in reaction times of selective attention between the groups of patients and the HC. Neither did stimulus presentation in the left or right visual field affect reaction time differently. CONCLUSION: Body side asymmetry of pain perception was only found for pressure pain targeting mainly deep tissue (muscle) nociception. This asymmetry, however, cannot be regarded as an indicator of a pathological functional cerebral laterality in MDD and PD.

Adult↗
PubMed2006

Cognitive-behavioral therapy for comorbid generalized anxiety disorder and panic disorder with agoraphobia.

The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxiety disorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated with a structured interview, a battery of self-report questionnaires, and daily self-monitoring booklets. Results are promising: At posttreatment, 2 out of 3 participants achieved high endstate functioning and maintained this level at 3-, 6-, and 12-month follow-ups. The 3rd participant also improved but achieved moderate endstate functioning. The strengths and limitations of the treatment are discussed.

Adult↗
PubMed1997

Brain blood flow in anxiety disorders. OCD, panic disorder with agoraphobia, and post-traumatic stress disorder on 99mTcHMPAO single photon emission tomography (SPET).

BACKGROUND: We compared regional cerebral blood flow (rCBF) in three groups of patients with DSM-III-R anxiety disorders. METHOD: Fifteen patients with obsessive -compulsive disorder (OCD), 15 with panic disorder with agoraphobia (PA), and 16 with post-traumatic stress disorder (PTSD) and a similar group of healthy controls were assessed on brain-dedicated high-resolution SPET. RESULTS: MANOVA revealed significant rCBF differences between diagnostic groups (F = 4.4; d.f. = 3, 57; P = 0.007) and between cerebral regions (F = 6.4; d.f. = 1, 57; P = 0.01) in OCD and PTSD compared with PA and healthy controls, limited to bilateral superior frontal cortices and right caudate nuclei. Whole brain blood flow correlated positively with anxiety (r = 0.24, n = 46, P = 0.05). Beck depression scores correlated significantly negatively with left caudate rCBF (r = -0.24, n = 46, P = 0.05) and right caudate rCBF (r = -0.31, n = 46, P = 0.02). PTSD syndrome severity correlated significantly negatively with the left caudate (r = -0.49, n = 16, P = 0.03) and with right caudate rCBF (r = -0.7, n = 16, P = 0.001). CONCLUSIONS: Functional rCBF differences in anxiety disorders could relate to repetitive, intrusive, distressing mental activity, prominent in both OCD and PTSD.

Adult↗
PubMed1992

Generalized anxiety disorder vs. panic disorder. Distinguishing characteristics and patterns of comorbidity.

In order to examine the validity of the distinction between generalized anxiety disorder (GAD) and panic disorder (PD) we compared 41 subjects with GAD and 71 subjects with PD. The GAD subjects had never had panic attacks. In contrast to the symptom profile in PD subjects suggestive of autonomic hyperactivity, GAD subjects had a symptom pattern indicative of central nervous system hyperarousal. Also, subjects with GAD had an earlier, more gradual onset of illness. In terms of coexisting syndromes, GAD subjects more often had simple phobias, whereas PD subjects more commonly reported depersonalization and agoraphobia. GAD subjects more frequently had first-degree relatives with GAD, whereas PD subjects more frequently had relatives with PD. A variety of measures indicated that our GAD subjects had a milder illness than those with PD. Also, fewer GAD subjects gave histories of major depression than did PD subjects. Among GAD subjects, coexisting major depression was associated with simple phobia and thyroid disorders and among PD subjects, comorbid depression was associated with social phobia and hypertension. Our findings indicate that the separation of GAD from PD is a valid one. They also indicate that, within disorders, unique patterns of comorbidity may exist that are important both clinically and theoretically.

Adult↗
PubMed1992

Medical aspects of panic disorder.

Panic attacks may be due to one or more of a large number of underlying physical or psychiatric disorders. Only when these possible etiologies have been excluded may the diagnosis of panic disorder be established.

Acute Disease↗
PubMed2005

[Intensive Naikan therapy for generalized anxiety disorder and panic disorder: clinical outcomes and background].

OBJECT: Intensive Naikan therapy (INT) is used to treat irrational recognition, and to develop awareness of others and self-reflection. Several reports have also shown that INT is effective for treating anxiety disorders. The purpose of the present systematic study was to investigate the factors contributing to the efficacy and clinical outcomes of INT by assessing the background, psychological evolution, and treatment required after such therapy. METHOD: Twenty-eight anxiety disorder inpatients at Tottori University Hospital, 15 with general anxiety disorders (GAD) and 13 with panic disorders (PD), were treated with INT. Age, sex, duration of the present anxiety episode, and diagnosis were investigated. The Tokyo University Egogram (TEG), Yatabe-Guilford personality inventory (YG test) and Rosenzweig picture frustration (PF) study were conducted before and after INT to investigate psychological changes. The long-term efficacy of INT for PD and GAD was assessed with Global Assessment of Functioning (GAF). Whether the patients achieved awareness of others, awareness of egocentricity, feelings of love, and self reflection after INT were investigated. RESULTS: 1) All patients showed improved GAF; the average GAF score increased from 51 +/- 8 (before Naikan therapy) to 83.2 +/- 15 (after therapy). The clinical outcomes of INT were as follows: 17 patients showed extremely effective results (60.7%), 6 were effective (21.4%), 3 were slightly effective (10.7%), and 2 were unchanged (7.1%). Overall, 23 patients (82.1%) showed remarkable improvements as a result of INT (improved group) and 5 showed no remarkable improvements (not improved group). 2) The improved group included significantly more patients with obsessive tendencies or nervous personalities such as a premorbid personality. In addition, significantly more of the patients in this group underwent daily INT and improved more rapidly in the short-term. 3) According to the STAI (state trait anxiety inventory), both state-(S-anxiety), and trait-anxiety (T-anxiety) significantly decreased after INT. The PD group showed significantly reduced S and T-anxiety, but the GAD group only showed significantly reduced T-anxiety. The adult (A) and free child (FC) TEG scales significantly increased, and according to YG, nervousness (N) and depression (D) significantly decreased while general activity (G) and social extraversion (S) significantly increased. Furthermore, according to the PF study, extraggression (E -A) after INT significantly decreased and imaggression (I-A) significantly increased. In the improved group, significantly more patients became more aware of their partners (Naikan) and achieved an objective outlook, awareness of egocentricity, feelings of love and self-reflection after INT. CONCLUSIONS: Our results suggest that INT for PD and GAD is extremely effective, and a very important form of psychotherapy. Attainment of self-reflection caused psychological changes that motivated the patients to continue Naikan therapy daily. We consider this a key factor in maintaining the efficacy of INT.

Adolescent↗
PubMed1994

The prevalence of respiratory disorders in panic disorder, major depressive disorder and V-code patients.

Point prevalence and lifetime prevalence of respiratory disorders were assessed in 100 panic disorder (PD), 100 major depressive disorder (DD) and 100 V-code (VC) patients. Both current and past frequency of respiratory diseases were significantly higher in PD patients in comparison to VC patients, while no significant differences in point and lifetime prevalence between PD and DD or DD and VC patients were observed. It is hypothesized that a disturbed respiratory physiology may have differential effects depending upon the nature of the disorder and the appraisal by the patient.

Adult↗
PubMed1999

Cognitions in generalized anxiety disorder and panic disorder patients. A prospective approach.

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had significantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had significantly more cognitions in the physical catastrophe category. Furthermore, GAD-patients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive specificity of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.

Adolescent↗
PubMed2005

The effect of pharmacotherapy on personality disorders in panic disorder: a one year naturalistic study.

BACKGROUND: In this prospective study, Personality Disorders (PersD) were evaluated in patients with Panic Disorder (PD), before and after one year of pharmacotherapy to verify whether personality characteristics changed after treatment. METHOD: Sixty PD patients and 60 sex and age-matched normal controls participated in the study. All subjects were evaluated with the SCID-IV, the Structured Interview for DSM-IV Personality Disorders (SIDP), the SCL-90, the Ham-A and the Ham-D. Patients were treated with paroxetine or citalopram and were evaluated monthly for one year to assess the remission of symptoms. The SIDP was re-administered to the patients at the end of the study. RESULTS: Before treatment, PD patients showed a higher prevalence (60%) of PersD than normal subjects (8%). After treatment, PersD rate decreased (43%) due to the reduction of the rate of paranoid, avoidant and dependent PersD. When the effect of the treatment on personality traits was evaluated, we found that avoidant traits decreased only in remitted patients, paranoid traits decreased both in remitted and in non-remitted patients, and dependent traits decreased only in patients with major depression comorbidity. LIMITATIONS: The small sample size and the short length of the follow-up period of our study suggest caution in the generalization of our results. CONCLUSIONS: In our PD patients, an improvement of symptoms was associated with a reduction of paranoid, avoidant and dependent traits, with a normalization of paranoid traits and a persistence of avoidant and dependent characteristics. Therefore, our data suggest that in PD patients not only paranoid traits but also avoidant and dependent traits show, at least in part, a state phenomenon.

Adult↗
PubMed1988

Major depressive disorder and panic disorder. Effects of comorbidity on treatment outcome with antidepressant medications.

Recent studies suggest that major depressive disorder (MDD) and panic disorder (PD) may coexist in a significant number of patients. The relevance of this association may be such that patients with the simultaneous diagnosis are at risk for more severe psychopathology and poorer treatment outcome. To explore this possibility further, we compared treatment outcome of two groups of patients: one with comorbidity of MDD and PD (N = 19) and another with MDD only (N = 22). Patients with comorbidity of MDD and PD scored significantly worse on a number of outcome assessments.

Antidepressive Agents↗
PubMedDate not supplied

Generalized anxiety disorder versus panic disorder: participation in controlled efficacy trials.

Seventy-one patients with panic disorder (PD) and 46 patients with generalized anxiety disorder (GAD) were studied in relation to their behavior before, during, and after participation in two contemporaneous and procedurally similar double-blind drug efficacy trials. The two groups were administered a battery of assessments aimed at comparing them on the nature and intensity of various symptom domains, social and work-related disability, personality, life events, and previous treatments. The results yielded few significant differences that were not due to definitional factors, most notably a more prevalent history of depression and treatment for depression in the GAD group and a higher rate of pharmacological treatment in the PD group. On the other hand, the two groups behaved in a comparable way in the screening, experimental, and postexperimental phases of the trials. The findings are in support of more similarities than differences between the groups. In addition, the comparable behavior of the two groups throughout the three phases of the trial suggests that differential pretreatment attrition and compliance with placebo-controlled trials may not present major confounding problems in comparative treatment effectiveness studies between GAD and PD diagnostic groups.

Adult↗
PubMed2002

Relationship between separation anxiety disorder, parental panic disorder, and atopic disorders in children: a controlled high-risk study.

OBJECTIVE: To test the hypotheses that rates of atopic disorders are elevated in offspring of parents with panic disorder (PD) and in children with separation anxiety disorder (SAD). METHOD: Rates of atopic disorders were assessed in 343 offspring (aged 6-17 years) of parents with PD, nonpanic psychiatric disorders, and no psychiatric disorder. Lifetime history of atopic disorders was determined by parental responses to a clinician-administered questionnaire assessing medical treatment for asthma and allergies. Logistic regression analyses assessed the association between atopic disorders and parental PD, and between atopic disorders and probable or definite childhood SAD. Analyses controlled for age, sex, socioeconomic status, and treatment for other medical illnesses. RESULTS: Increased rates of atopic disorders were found in offspring of parents with PD (odds ratio [OR] = 2.56, 95% confidence interval [CI] = 1.27-5.16, p = .009) and in children with SAD (OR = 2.71, 95% Cl = 1.22-6.03, p = .015). Associations remained significant when both parental PD and SAD were included in the model, suggesting that each contributed independently to increased rates of atopy. The interaction of parental PD and child SAD was not significant. CONCLUSIONS: Atopic disorders in children are associated with parental PD and with childhood SAD. Results do not appear to support that having both childhood SAD and a parent with PD confers increased risk for atopic disorders above and beyond either condition alone.

Adolescent↗
PubMedDate not supplied

Cognitions in generalized anxiety disorder and panic disorder patients.

Forty-three patients with generalized anxiety disorder (GAD) and 44 patients with panic disorder (PD) were given a standardized interview about thoughts and images during times of anxiety. The two groups differed significantly regarding the ideational content of anxiety. GAD patients experienced more thoughts focusing on themes of mental catastrophes and other catastrophes when suffering from anxiety or anxiety attacks, while PD patients mostly described the theme of physical catastrophes. Only 34% (n = 30) of the total sample reported experiencing images when feeling anxious/having panic. For PD patients (70%) onset of anxiety or panic attacks was precipitated by somatic symptoms (a physical feeling). GAD patients reported that onset of anxiety was precipitated by all three alternatives given: a physical feeling (42%), anxious thoughts (37%), or "it all came at once" (21%). The implications of these results are discussed.

Adult↗
PubMed1991

Mitral valve prolapse, panic disorder, and chest pain.

Mitral valve prolapse is a common cardiac disorder that can readily be diagnosed by characteristic auscultatory and echocardiographic criteria. Although many diseases have been associated with mitral valve prolapse, most affected individuals have the primary form of the disorder. Mitral valve prolapse is an inherited condition commonly associated with myxomatous degeneration of the mitral valve and its support structures. Complications of mitral valve prolapse, including cardiac arrhythmias, sudden death, infective endocarditis, severe mitral regurgitation (with or without chordae tendineae rupture), and cerebral ischemic events, occur infrequently considering the wide prevalence of the disorder. Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period or one panic attack followed by fear of subsequent panic attacks for at least 1 month. It too is a common condition with a prevalence and age and gender distribution similar to that of mitral valve prolapse. Panic disorder and mitral valve prolapse share many nonspecific symptoms, including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and pre-syncope. Chest pain is the symptom in both conditions that most commonly brings the patient to medical attention. The clinical description of chest pain in patients with mitral valve prolapse is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with mitral valve prolapse. Multiple investigative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that mitral valve prolapse and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurrence is, in fact, entirely predictable. There is, however, no convincing evidence of a cause-effect relationship between the two disorders, nor has a single pathophysiologic or biochemical mechanism been identified that unites these two common conditions. Until specific biologic markers for these disorders are identified, it may be impossible to do so. The lack of a proven cause-and-effect relationship between mitral valve prolapse and panic disorder and the absence of a unifying mechanism do not diminish the clinical significance of the high rate of co-occurrence between the two conditions. Primary care physicians and cardiologists frequently encounter patients with mitral valve prolapse and nonspecific symptoms with no discernible objective cause who fail to respond to beta-blockade. Panic disorder should be considered as a possible explanation for symptoms in such patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Anxiety Disorders↗
PubMed1987

The study of panic disorder using positron emission tomography.

Positron emission tomography (PET) is a brain imaging technique which safely provides quantitative, regional measurements of biochemical and physiological processes. Because of its capabilities, PET is well suited to the study of psychiatric disorders. Among psychiatric disorders, panic disorder is especially well suited for study. Since anxiety attacks can be precipitated by biological agents, blocked by anti-panic medications, and studied in a laboratory setting, PET can be used to investigate the elements necessary for the generation and treatment of anxiety attacks. Recently, we employed PET to identify several abnormalities in a sub-group of patients with panic disorder. Patients with panic disorder who were vulnerable to lactate-induced anxiety attacks had abnormal hemispheric asymmetries of parahippocampal blood flow, blood volume, and oxygen metabolism; abnormally high whole brain metabolism; and abnormal susceptibility to episodic hyperventilation. This article reviews the current concepts of panic disorder; it provides an introduction to the components, capabilities and limitations of PET; and it describes the strategy now being employed at Washington University to investigate the neurobiology of panic disorder.

Anxiety Disorders↗
PubMed1990

Differential responses to anxiogenic challenge studies in patients with major depressive disorder and panic disorder.

Anxiogenic challenge studies (intravenous lactate infusion and oral fenfluramine challenge) were conducted in 17 patients with panic disorder (PD), 12 patients with major depressive disorder and a history of panic attacks (MDD-PD), 27 patients with major depression and no history of panic (MDD), and 12 normal controls. PD and MDD-PD patients revealed significantly greater anxiogenic responses to lactate infusion and fenfluramine administration than either MDD patients or controls. PD patients revealed the most robust anxiogenic responses to both challenges as well as associated significant prolactin and cortisol responses to fenfluramine. The findings suggest that the predisposition to panic attacks as seen in PD and MDD-PD patients may represent a distinct neurobiological diathesis which may coexist with a major depressive diathesis in some patients. The delineation of subgroups within the more heterogenous groups of patients with MDD and/or PD will lead to greater precision in the development of clinical treatment strategies. Thus, MDD-PD patients (better called panic-depressives) may have a more severe illness than patients with MDD alone which must be accounted for in the course of pharmacotherapy and psychotherapy.

Administration, Oral↗
PubMedDate not supplied

Abnormal visual event-related potentials in obsessive-compulsive disorder without panic disorder or depression comorbidity.

Visual event-related potentials and spline map topography during a discriminative response task (DRT) were studied in 8 obsessive-compulsive disorder (OCD) patients without comorbidity for panic disorder or depression and in 12 age-matched controls. In the DRT task (like in a go/no-go task) the subject had to press a button when the target stimuli appeared and had to retain the response when the non-target stimulus appeared (vertical bars were intermixed with an equal probability of horizontals). OC patients had greater N1 latency than controls and their N1 and P3 amplitude was larger for the target stimuli, but not for non-target stimuli. In the normals, non-target stimuli (no-go task) produced a larger activation than target stimuli (go task). In the OCD patients the target stimuli produced the same large activation as the non-target. These findings are consistent with theories that consider OCD to be an attentional disorder deriving from a misallocating of cognitive resources. Moreover, spline map topography confirmed that P3 hyperactivation is localised principally on the frontal lobes.

Adult↗
PubMed2004

Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: an ambulatory monitor study.

BACKGROUND: Physiologic responses of patients with anxiety disorders to everyday events are poorly understood. OBJECTIVE: To compare self-reports and physiologic recordings in patients with panic disorder (PD), patients with generalized anxiety disorder (GAD), and nonanxious controls during daily activities. DESIGN: Participants underwent four 6-hour recording sessions during daily activities while wearing an ambulatory monitor. Physiologic and subjective data were recorded every 30 minutes and during subject-signaled periods of increased anxiety or tension or panic attack. SETTING: Participants' everyday environment. PARTICIPANTS: Twenty-six patients with PD and 40 with GAD, both without substantial comorbidity, and 24 controls. INTERVENTIONS: Recordings obtained during everyday activities. MAIN OUTCOME MEASURES: Recordings of heart interbeat intervals, skin conductance levels, respirations, motion, and ratings of subjective somatic symptoms and tension or anxiety. RESULTS: Patients with anxiety disorders rated higher on psychic and somatic anxiety symptoms than did controls. Common to both anxiety disorders was diminished autonomic flexibility that manifested itself throughout the day, accompanied by less precise perception of bodily states. The main differences between patients with PD and GAD were a heightened sensitivity to body sensations and more frequent button presses. There also was a trend toward heightened basal arousal in patients with PD, manifesting itself in a faster heart rate throughout the day. CONCLUSIONS: Patients with PD or GAD are more sensitive to bodily changes than nonanxious individuals, and patients with PD are more sensitive than those with GAD. Patients with PD experience more frequent distress than those with GAD and controls, but their physiologic responses are comparable in intensity. The findings suggest that the perception of panic attacks reflects central rather than peripheral responses. The diminished autonomic flexibility observed in both anxiety conditions may result from dysfunctional information processing during heightened anxiety that fails to discriminate between anxiety-related and neutral inputs.

Adult↗