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PubMed1997

[Typology of prolonged anxious-phobic disorders with agoraphobia].

There were studied 23 schizophrenic and cyclothymic patients with stable agoraphobia in the structure of anxiousphobic disorders (APD). No absolute correlation was found between stability of agoraphobia and severity of panic disorder (frequency and intensity of panic attacks). It was established that APD with manifestations of agoraphobia had been, perhaps, conditioned by the presence of comorbid disturbances in their structure which had determined peculiarities of the patients' behavior. Two types of prolonged APD with agoraphobic phenomena were recognized. Retention of agoraphobic disturbances in conditions of the first type was related to symptoms of generalized somatic disorder (generalized somatic anxiety) in clinical pattern of APD. Manifestations similar to panphobias prevailed, agoraphobic avoidance included all the situations in which the patient could find himself without help. In the states of the second type retention of agoraphobic disorders was conditioned by comorbidity of APD with asthenohypochondriac manifestations with somato-psychic fragility in their structure. Anxiety of expectation was formed in situations with emotional or physical tension. Agoraphobic avoidance in conditions of this type had displayed the character of preventive measures and one of manifestations of hypochondriac development of personality. The presence of pronounced anxiety (intensive panic attacks, generalized anxiety) in clinical pattern of prolonged agoraphobic conditions can serve a predictor of a favourable development of the disease.

Adult↗
PubMed1998

[Agoraphobia and "psychogenic"-attributed gait disorder as symptoms of "stiff-man" syndrome].

We report on two patients with truncal rigidity and agoraphobia. The fear of crossing open places had been judged as psychogenic in both cases. The detection of positive GAD-antibodies led to our final diagnosis. Treatment with liquorphoresis and clonazepam or diazepam alone resulted in a prompt amelioration of the rigidity and, to a lesser extent, of the agoraphobia as well. The stiff-man syndrome has neurological and psychological aspects and shows one more facet of the syndrome of agoraphobia first described by Westphal.

Adult↗
PubMed2004

Social anxiety and agoraphobia in the eating disorders: associations with eating attitudes and behaviours.

BACKGROUND: While eating disorders have a high comorbidity with anxiety disorders, little is presently known about how anxiety links to eating attitudes and behaviours and other related characteristics of eating-disordered individuals. The present study aimed to determine whether social anxiety and agoraphobia in eating-disordered individuals are linked to different eating attitudes and behaviours and levels of ego functioning. METHOD: The participants were 70 women who met DSM-IV criteria for an eating disorder. The Eating Disorder Inventory (EDI) was used as a measure of eating attitudes and ego-functioning characteristics, while the Social Phobia and Anxiety Inventory (SPAI) was used as a measure of levels of social anxiety and agoraphobia. RESULTS: High scores on the eating attitude scales of the EDI were associated with higher levels of social anxiety in eating-disordered individuals. High scores on the ego-dysfunction scales of the EDI were associated with higher levels of social anxiety and agoraphobia. CONCLUSIONS: The present findings suggest that eating-related attitudes and behaviours are associated with high levels of social anxiety, while psychological characteristics not specifically related to eating are associated with anxiety more broadly. The results highlight the importance of identifying and addressing comorbid anxiety in eating-disordered individuals, and suggestions are made for the treatment of such cases. Implications for future research are also discussed.

Adult↗
PubMed1988

Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety.

In a multicenter placebo-controlled study, the safety, side effects, and patient acceptance of alprazolam for the treatment of panic disorder and agoraphobia were examined. A total of 525 patients meeting DSM-III criteria for agoraphobia with panic attacks or panic disorder were randomly assigned to receive alprazolam or placebo, which they took for eight weeks. The mean daily dose at the end of the study was 5.7 mg of alprazolam or 7.5 capsules of placebo daily. Potentially serious reactions to alprazolam occurred in ten of 263 subjects who received the drug. These included acute intoxication (three), hepatitis (two), mania (two), amnesia (one), aggressive behavior (one), and depression (one). Treatment-related side effects that were worse in patients taking alprazolam than in those taking placebo included sedation, fatigue, ataxia, slurred speech, and amnesia. Sedation was the most frequent but tended to subside with dose reduction or continued administration of the drug. Patient acceptance of alprazolam, as measured by the rate of completion for study participants, was high. Eighty-four percent of patients receiving active drug completed the study compared with 50% receiving placebo.

Adult↗
PubMed1992

Clinical experiments in maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia.

Several issues remain to be ascertained beyond the acute response to imipramine hydrochloride in patients with panic disorder. Study 1 consisted of a prospective, systematic characterization of half-dose 12-month maintenance in patients with panic disorder with agoraphobia who had shown marked and stable response to 6 months of acute-phase treatment with imipramine. Study 2 assessed the 6-month cumulative relapse rate following discontinuation of acute-phase imipramine treatment in a comparable sample of patients. The same assessment battery was used in both studies, and the integrity of experimental drug conditions was verified by plasma drug level determinations. In contrast to the high relapse rate following discontinuation of acute-phase treatment, none of the patients showed relapse or had sustained worsening in panic or phobia measures during the half-dose maintenance period. The results underscore the importance of pharmacological prophylaxis and provide empirical guidelines for a successful low-dose maintenance regimen for patients with panic disorder and agoraphobia who respond markedly to imipramine.

Adult↗
PubMed1999

Long-term maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia.

BACKGROUND: There has been little systematic work done regarding the long-term treatment of panic disorders. The aim of the present study was to assess the 12-month cumulative risk of relapse specifically due to discontinuation of imipramine and to test the hypothesis that maintenance treatment with imipramine protects patients with panic disorder and agoraphobia from such reversals. METHOD: Following an acute-phase open trial with imipramine (2.25 mg/kg per day) involving 110 patients for 6 months, the 56 patients who were in stable remission, did not require additional treatment, and consented to be randomly assigned to double-blind maintenance (n = 29) or discontinuation (n = 27) conditions were followed up with planned assessments every 2 months during a 1-year period. There were no behaviorally oriented interventions or instructions at any time during the 18 months of the study. RESULTS: Maintenance treatment (1 relapse) and discontinuation (10 relapses) conditions had significantly different survival curves (Mantel-Cox statistic chi(2)1 = 10.47, P = .001). None of the additional 10 variables from demographic, clinical, and open-treatment domains considered in the proportional hazard model disrupted the significant relationship between experimental drug condition and relapse; other things being equal, a patient receiving imipramine maintenance was 92.5% lower in the hazard rate of relapse than a patient receiving placebo. CONCLUSION: The results confirm the very high degree of prophylactic effectiveness of maintenance imipramine treatment and demonstrate that relapse, although substantial, occurs in a minority of patients with panic disorder and agoraphobia who are in stable remission prior to treatment discontinuation.

Adult↗
PubMed2006

The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication.

CONTEXT: Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). OBJECTIVE: To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. DESIGN AND SETTING: Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. PARTICIPANTS: English-speaking respondents (N=9282) 18 years or older. MAIN OUTCOME MEASURES: Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. RESULTS: Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only). CONCLUSION: Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.

Adolescent↗
PubMed1995

The impact of stress, fear of fatness, and panic disorder with agoraphobia on eating disorder symptomatology: a case study.

This case describes the interaction between an anxiety disorder and an eating disorder. It shows how the interplay between stress, fear of fatness, and panic disorder with agoraphobia changed a patient's eating disorder from bulimia nervosa to to an eating disorder focused on food restriction. Implications for the assessment and treatment of panic disorder with agoraphobia and an eating disorder focused on food restriction are discussed.

Adult↗
PubMed1983

The relative efficacy of imaginal and in vivo desensitization in the treatment of agoraphobia.

Claims have often been made that in vivo procedures are generally superior to imaginal approaches in the clinical management of anxiety and avoidance behavior. Such claims seem unwarranted in that the relevant clinical research appears only to have involved either flooding or rapid exposure techniques. The aim of the present study was specifically to examine the relative efficacy of imaginal and in vivo desensitization in the clinical management of debilitating phobia. Six agoraphobic women participated in the study which employed a multiple-baseline single-subject methodology. Severity of phobia was repeatedly assessed on measures of avoidance behavior and subjective distress, and subjects self-monitored pulse rate. Significant reductions in phobic behavior were observed during both imaginal and in vivo desensitization, but neither treatment was found to be more effective than the other. Moreover, the same pattern of results was observed for both treatment and generalization settings. As such, the results do not support previous suggestions that in vivo exposure is necessarily superior to imaginal desensitization in the treatment of agoraphobia. Encouraging follow-up results provided some confirmation of previous findings indicating the effectiveness of self-management procedures in the long-term control of agoraphobia.

Adult↗
PubMed1990

Situational exposure treatment versus panic control treatment for agoraphobia. A case study.

Situational in vivo exposure has been widely used in the treatment of agoraphobia. However, only a low to moderate proportion of individuals treated with this approach have shown a high level of therapeutic gain. The recent recognition of panic as central to the development and maintenance of a great many cases of agoraphobic avoidance suggests that treatments focused directly on panic may contribute to a more comprehensive approach to agoraphobia. The present single case demonstrates that whereas two modes of situational exposure produced only limited improvement an approach focused directly on panic had greater effectiveness. The specific effects of the treatment components within the panic control package are analyzed in detail.

Adaptation, Psychological↗
PubMed1996

Polycythaemia and agoraphobia.

Using single photon emission computerized tomography (SPECT), we demonstrated that in patient A, a 20-year-old male with polycythaemia, the cerebral blood flow was decreased (presumably as a result of increased viscosity and or microemboli), probably leading to frightening visual distortions (dysmorphopsia) associated with scintillating specks of bright colors (Teichopsia). This had presumably precipitated agoraphobia. After hospitalization, when the patient had not responded to efforts at systematic desensitization, he improved through a combination of multiple venesections and antiplatelet aggregation therapy (aspirin 75 mg o.d.) over 3 months combined with systematic desensitization. A subsequent SPECT demonstrated an increase in cerebral blood flow to normal levels, which coincided with improvement of agoraphobic symptoms and disappearance of visual distortions on further follow-up. This paper depicts another yet undocumented example of an alarming physical symptom probably leading to a cognitively-based panic sufficient to cause agoraphobia by classical conditioning. It also suggests that prior treatment of such physical symptoms is likely to facilitate the process of systematic desensitization.

Adult↗
PubMed1989

The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder.

The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS determined by the so-called hyperventilation provocation test (a brief period of voluntary hyperventilation with recognition of symptoms). The overlap rates with HVS were: 48% for panic disorder, 83% for panic disorder with agoraphobia and 82% for generalized anxiety disorder. However, a pilot study on transcutaneous monitoring of carbon dioxide tension leads us to question the validity of the voluntary hyperventilation method that we used to determine HVS-status. It is unclear whether hyperventilation plays an important role in panic and general anxiety, as our overlap findings suggest. For patients who recognize the symptoms induced by voluntary hyperventilation, the hyperventilation provocation procedure provides a therapeutic means of exposure to feared bodily sensations.

Adult↗
PubMed1989

Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia.

The present study investigates the differential effectiveness of three treatment packages for agoraphobia. Patients suffering from panic disorder with agoraphobia (DSM-III-R) received one of three treatments: Breathing Retraining with Cognitive Restructuring (BRCR), graded self-exposure in vivo (EXP), or a combination of BRCR and EXP. Treatments consisted of 8 sessions. Assessment consisted of self-report measures for panic, phobic anxiety and avoidance, depression, general anxiety, somatic complaints and fear of body sensations, and of two respiratory measures (respiratory rate and alveolar pCO2). The treatments resulted in a reduction in symptomatology on all self-report measures, except panic frequency, and in a decrease in respiratory rate. There was no evidence for a differential efficacy for any of the treatments on any of the variables. Contrary to expectation, and at odds with findings from earlier studies, BRCR had no significant effect on panic frequency. A detailed comparison of sample characteristics of patients in our study and previous studies, did not yield insight into possible causes for the failure to replicate earlier results. The limited effectiveness of breathing retraining in reducing panic, as observed in the present study, leads us to conclude that the role of hyperventilation in panic is less important than previously thought.

Adult↗
PubMed1993

Gender effects and alcohol use in panic disorder with agoraphobia.

Previous studies have found some significant, but weak, gender differences in panic and agoraphobia with females generally being more symptomatic. The present study sought to expand this line of research by examining alcohol use and self-medication in relation to gender differences and measures of psychopathology. Seventy-four male and 162 female patients with panic disorder with agoraphobia were compared. There were some significant, but relatively small, gender differences with females reporting higher levels of phobic avoidance. Males reported significantly more weekly alcohol intake and also perceived alcohol to be a more effective strategy in coping with anxiety. Alcohol-related factors were significantly correlated with several measures of psychopathology for males but this was less evident in females. The correlations were not large but the results do suggest that a subset of males consume moderate to large amounts of alcohol, believe self-medication to be an effective anti-anxiety strategy, and yet report higher levels of psychopathology such as social fears.

Adult↗
PubMed1987

Platelet [3H]imipramine binding in generalized anxiety disorder, panic disorder, and agoraphobia with panic attacks.

The density of platelet [3H]imipramine binding sites is reported to be decreased in unipolar depression and, hence, is a putative biological marker. There is considerable evidence for a phenomenological and biological relationship of panic disorder with affective disorder. We studied platelet [3H]imipramine binding site density in unmedicated subjects with generalized anxiety disorder (GAD; n = 55), panic disorder (PD) with and without agoraphobia (n = 52), and normal controls (n = 26) in order to determine whether or not patients with panic disorder differed from controls in this biological assay. We found no differences in binding site density (Bmax) or affinity (Kd) among the PD, PD with agoraphobia, GAD, and control groups. Nor did we find a relationship between Bmax or Kd and the severity of depressive symptoms or the presence of a family history of affective disorder. In view of two conflicting prior studies, the use of [3H]imipramine binding in panic disorder remains problematic.

Adult↗
PubMedDate not supplied

DSM-II personality characteristics of panic disorder with agoraphobia patients in stable remission.

The Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess DSM-III axis II personality disorders (PD), was administered to 12 panic disorder with agoraphobia patients during a 6-month stable and virtually symptom-free remission period with the aim of assessing the personality characteristics of these patients in the best possible approximation of the not-ill condition in clinical reality. The personality profile of the sample remained unchanged during remission and was predominated by avoidant PD traits. In a finer grain analysis, the stable and commonly endorsed individual PDQ items were compared with previously reported panic disorder and normal control subjects, which showed that the present sample was more like the panic patients in their tendency to see themselves as rather unassertive, indecisive, self-critical, and emotional individuals who are easily frustrated and feel rejected when criticized by others. These results suggest that avoidant behavioral and attitudinal patterns may be enduring personality characteristics of panic disorder with agoraphobia patients.

Adult↗
PubMedDate not supplied

Personality and treatment response in agoraphobia with panic attacks.

The present study investigated the association of specific personality characteristics with agoraphobia, and whether they predicted long-term outcome following a group cognitive behavior therapy program. Thirty-three patients with agoraphobia with panic attacks, 18 with social phobia, and 26 "normals" were used in the study. Personality factors were measured with the Maudsley Personality Inventory (MPI), the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B). The results showed that (1) agoraphobics are more extroverted and more likely to include others in their activities than are social phobics; however, they are less extroverted, more neurotic, more hostile and intropunitive, and less likely to include others in their activities than are normals; (2) social phobics are similarly less extroverted, more neurotic, and more hostile and intropunitive than normals, but, in addition, are less likely to exert control over others, more likely to want to be controlled, and less expressive of affection than normals; and (3) personality characteristics did not predict treatment outcome.

Adult↗
PubMed1986

Development of agoraphobia after surviving cancer.

We present a case conference on a 32-year-old accountant who developed embryonal carcinoma of the testis, two months after the birth of a son with a missing leg. His cancer was successfully treated with surgery and chemotherapy. After 5 years, when he was told that he need not be closely followed by his physicians anymore because he had been cured of cancer, he developed agoraphobia with panic attacks. This interfered with his occupational and social adjustment. His phobia was treated successfully with pharmacotherapy, behavior therapy, and psychotherapy. We explore the psychologic impact of cancer, the activation of separation anxiety and aggressive impulses after its successful treatment, the crippling nature of his agoraphobia, and the ingredients of his successful response to treatment.

Adult↗