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PubMed1999

Panic disorder and memory: does panic disorder result from memory dysfunction?

It is proposed that patients with panic disorder have a defect in fear-relevant episodic memory, and their panic attacks arise from automaticity in recollecting fear-relevant emotional-autonomic cluster. The cluster as a component of fear appears to have been dissociated from cognitive structure (episodic or informative memory trace) or from "information structure". A special method was created for testing this hypothesis where 30 panic disorder patients, 12 healthy controls, and 32 patients with other psychiatric diagnoses were asked to recall and describe a fearful experience. None of the patients in the panic disorder group could recall any fearful event or episode in their past. All but one subject among healthy controls and all the subjects in the non-panic group could recall one or more fearful event or episode. Possible theoretical implications of these results are discussed in the context of some classical concepts.

Adolescent↗
PubMed2004

Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics.

OBJECTIVE: This study assessed rates of detection and treatment of minor and major depressive disorder, panic disorder, and posttraumatic stress disorder among pregnant women receiving prenatal care at public-sector obstetric clinics. METHODS: Interviewers systematically screened 387 women attending prenatal visits. The screening process was initiated before each woman's examination. After the visit, patients were asked whether their clinician recognized a mood or anxiety disorder. Medical records were reviewed for documentation of psychiatric illness and treatment. RESULTS: Only 26 percent of patients who screened positive for a psychiatric illness were recognized as having a mood or anxiety disorder by their health care provider. Moreover, clinicians detected disorders among only 12 percent of patients who showed evidence of suicidal ideation. Women with panic disorder or a lifetime history of domestic violence were more likely to be identified as having a psychiatric illness by a health care provider at some point before or during pregnancy. All women who screened positive for panic disorder had received or were currently receiving mental health treatment outside the prenatal visit, whereas 26 percent of women who screened positive for major or minor depression had received or were currently receiving treatment outside the prenatal visit. CONCLUSIONS: Detection rates for depressive disorders in obstetric settings are lower than those for panic disorder and lower than those reported in other primary care settings. Consequently, a large proportion of pregnant women continue to suffer silently with depression throughout their pregnancy. Given that depressive disorders among perinatal women are highly prevalent and may have profound impact on infants and children, more work is needed to enhance detection and referral.

Adult↗
PubMed2003

Perceived criticism predicts severity of anxiety symptoms after behavioral treatment in patients with obsessive-compulsive disorder and panic disorder with agoraphobia.

In prospective research, psychiatric patients' perceived criticism (PC) from family members has been linked to higher rates of relapse and worse treatment outcome. Researchers have disagreed about whether PC contributes to poor treatment outcomes or whether it merely reflects the severity of a patient's disturbance. In this study, structural equation modeling was used to conduct a cross-lagged panel analysis of the relationship between PC and anxiety symptom severity assessed before and after treatment in anxiety-disordered patients. PC was found to be unrelated to concurrent symptom severity. Furthermore, pretreatment PC significantly predicted posttreatment symptom severity over and above the effect of pretreatment symptom severity, whereas pretreatment symptom severity failed to significantly predict posttreatment PC. Thus, these results are consistent with (although not proof of) the hypothesis that PC detracts from patients' ability to respond to treatment, and inconsistent with the hypothesis that PC is a reflection of a patient's symptom severity.

Adolescent↗
PubMed1994

Epidemiology of psychiatric disorders in Edmonton. Panic disorder.

A random sample of 3258 adult household residents of Edmonton, Alberta, Canada were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS), which gives DSM-III diagnostic data on each individual interviewed. This paper reports results for panic disorder. Panic disorder was found to affect women primarily (female:male morbidity risk 2.2:1). The mean age of onset (first symptom) was 19.3 years for men and 21.5 years for women. Rarely did symptoms first occur after the age of forty. The lifetime prevalence rate was 1.7% for women and 0.8% for men and the lifetime morbidity risk was 3.7% for females and 1.7% for males. All twelve panic symptoms were found to be highly specific for panic disorder. Women complained of more (means = 8.0) symptoms than men (means = 6.0). On average 7.3 symptoms were reported. Those with panic disorder showed increased lifetime prevalence rates for major depressive episode (73.4%), alcohol abuse/dependence (54.2%), drug abuse/dependence (43%) and phobia (44.2%). Altogether, 90.4% of those with panic disorder also met criteria for another DSM-III diagnosis, which was 2.7 times the rate in those who did not have panic disorder.

Adolescent↗
PubMed1990

The Zurich Study. IX. Panic disorder and sporadic panic: symptoms, diagnosis, prevalence, and overlap with depression.

The purpose of the present epidemiological study is to investigate and describe panic disorder and sporadic panic attacks among a cohort of young adults, aged 28 years, from the Canton of Zurich in Switzerland. Both DSM-III panic disorder and sporadic panic are characterized by frequent symptoms of somatic anxiety and tension, as well as by frequent symptoms of depressed mood and low vitality. Sporadic panic is more prevalent than panic disorder and shows a greater excess of females over males. The association with depressions (major depression and recurrent brief depression) is similarly high for both types of panic syndromes, while the association with other anxiety disorders is negligible. Several indicators suggest a marked similarity between sporadic panic and DSM-III panic disorder. More impressive differences were observed between subjects with panic disorder alone and subjects with comorbidity of panic and depression. For the latter group, the SCL-90R scores indicated higher severity. Comparison of the scores of life events, conflicts, self-esteem, and the number of chronic problems in childhood suggests a more specific nosological pattern for subjects with panic and depression as compared with those with panic alone.

Adult↗
PubMedDate not supplied

Classic conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter/defibrillator.

OBJECTIVE: A model for the development of anxiety disorders (panic disorder with or without agoraphobia) is needed. Patients with an implantable cardioverter/defibrillator (ICD) are exposed to repeated electric shocks. If the theory of anxiety development by aversive classic conditioning processes is valid, these repeated shocks should lead to an increased risk of anxiety disorders. To study this hypothesis, we retrospectively studied 72 patients after implantation of an automatic ICD. METHODS: Patients were assessed with the semistructured Diagnostic Interview of Psychiatric Disease 1 to 6 years after implantation of an automatic ICD. Panic disorder and/or agoraphobia was diagnosed in patients who fulfilled all DSM-III-R criteria for those conditions. RESULTS: Anxiety disorder developed in 15.9% of patients after ICD implantation. This was significantly related to the frequency of repeated defibrillation (shocks) to stop malignant ventricular arrhythmias. Dysfunctional cognitions are an additional vulnerability factor. CONCLUSIONS: The data support both the conditioning hypothesis and the cognitive model of anxiety development. These findings suggest that ICD patients are an appropriate risk population for a prospective study of the development of anxiety disorders.

Aged↗
PubMed2002

Quality of life in social anxiety disorder compared with panic disorder and the general population.

OBJECTIVE: Quality of life in a treatment-seeking cohort of patients with social anxiety disorder was compared with that of patients with panic disorder who were matched for age, comorbid illnesses, and gender and with population-based norms. METHODS: The study participants were 33 patients with social anxiety disorder and 33 patients with panic disorder who had participated in clinical trials and who had completed the Medical Outcomes Study Short-Form-36 (SF-36) as part of a baseline evaluation. The patients did not have significant comorbid psychiatric disorders. Paired t tests were used to compare baseline scores on subscales of the SF-36 between the two cohorts. One-sample t tests were used to compare scores on subscales of the SF-36 with expectation scores based on 2,474 persons from the general population. RESULTS: Compared with the general population, the patients with social anxiety disorder had significantly greater impairment as measured by the SF-36 social functioning and mental health subscales. Subscale scores also indicated poorer emotional role functioning, but the difference was not significant. However, they were significantly less impaired than the patients with panic disorder in terms of physical functioning, physical role, and mental health. CONCLUSIONS: Patients with social anxiety disorder who do not have significant comorbid depression or anxiety are substantially impaired in quality of life, but to a lesser extent than patients with panic disorder, who suffer from both mental and physical impairments in quality of life.

Adult↗
PubMed2002

Personality disorder comorbidity in panic disorder patients with or without current major depression.

To investigate the relationship between current or past major depressive disorder (MDD) on comorbid personality disorders in patients with panic disorder, we compared the comorbidity of personality disorders using the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) in 34 panic disorder patients with current MDD (current-MD group), 21 with a history of MDD but not current MDD (past-MD group), and 32 without lifetime MDD comorbidity (non-MD group). With regard to personality disorders, patients in the current-MD group met criteria for at least one personality disorder significantly more often than patients in the past-MD group or the non-MD group (82.4% vs. 52.4% and 56.3%, respectively). The current-MD group showed statistically significantly more borderline, dependent, and obsessive-compulsive personality disorders than the past-MD group or non-MD group. With stepwise regression analyses, number of MDD episodes emerged as an indicator of the comorbidity of cluster C personality disorder and any personality disorders. Future studies should determine whether aggressive treatment of comorbid personality disorders improves the outcome (e.g., lowers the likelihood of comorbid MDD) of patients with panic disorder.

Adult↗
PubMed1989

Panic disorder and the menstrual cycle: panic disorder patients, healthy control subjects, and patients with premenstrual syndrome.

The authors prospectively evaluated 20 normally menstruating women with panic disorder across a minimum of two drug-free menstrual cycles. There were no significant effects of menstrual cycle phase on anxiety ratings in the panic disorder patients or in 20 healthy control subjects; this contrasted with a robust increase in premenstrual anxiety in 20 subjects with premenstrual syndrome. These findings suggest that the symptoms of panic disorder are not commonly exacerbated by the premenstrual phase of the menstrual cycle and highlight the need for prospective evaluation in the attempt to document an association between psychiatric symptoms and the menstrual cycle.

Adult↗
PubMed1997

Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder.

BACKGROUND: Panic disorder is associated with poor quality-of-life (QOL). However, little is known regarding the impact of panic disorder or infrequent panic on work-related disability. The purpose of this study was (1) to document QOL and panic-related work disability in subjects with panic disorder or infrequent panic, (2) to identify independent predictors of QOL and disability, and (3) to compare outcomes in subjects with panic disorder versus infrequent panic. METHOD: This cross-sectional community survey included 97 subjects with panic and matched controls. Subjects were screened for panic disorder or infrequent panic using the Structured Clinical Interview for DSM-III-R. The QOL questionnaire addressed life satisfaction as well as panic-related work disability. A structured interview assessed possible predictors of impaired QOL including comorbidity, illness attitudes and behaviors, coping style, family measures, and symptom perceptions. RESULTS: QOL was significantly (p < or = .001) poorer in subjects with panic than in controls. Comorbid depression, social support, worry, and severity of chest pain predicted QOL. Although subjects with infrequent panic reported a lower QOL than controls, subjects with panic disorder had more panic-related disability and poorer QOL than those with infrequent panic. Predictors of work disability included panic frequency, illness attitudes, family dissatisfaction, and gender. CONCLUSION: Although both infrequent panic and panic disorder impact QOL and disability, panic disorder has a greater effect. Using predictors, patient education, provision of support, and focused therapy could potentially improve QOL and disability.

Absenteeism↗
PubMed1998

Heart rate and blood pressure in panic disorder, major depression, and comorbid panic disorder with major depression.

Secondary major depression is common in patients with panic disorder (PD) and has been reported to worsen prognosis. Little is known about the effect of comorbid depression on the autonomic symptoms associated with PD. In this study, the heart rate and blood pressure of 44 patients with PD, 20 patients with major depression (MD), and 12 patients with both panic disorder and depression (PDD) were measured during postural challenge. Patients with PDD were found to have higher diastolic and systolic pressures throughout (P < 0.05), and to have a higher resting cardiac load (P < 0.05). This heightened autonomic arousal remained when the effects of age, race, and the frequency of panic attacks were removed. The results suggest that PDD patients may have increased autonomic dysfunction.

Adult↗
PubMed2002

Agoraphobia without a history of panic disorder may be part of the panic disorder syndrome.

Agoraphobia without a history of panic attacks is a disorder lacking strong support. Data from the Australian National Survey were explored in respect to panic disorder with or without agoraphobia (PDA, PD), and agoraphobia without a history of panic disorder (AG). Panic disorder, agoraphobia, and panic disorder with agoraphobia occurred in 3.5% of the adult population. People with this group of disorders were more likely to be female and more likely to seek help than people with other anxiety disorders. Significant anxiety symptoms and unease about safety when out and about occur in all three disorders. People with the double disorder PDA report more comorbid disorders, are more disabled, and have higher neuroticism scores than people with PD or AG. People with AG are older and consult less than people with PD or PDA. Agoraphobia has been devalued as a cause of human suffering. This idea is wrong. Agoraphobia is as common, comorbid, and disabling as PD, but less disabling than the double disorder of PDA.

Adolescent↗
PubMed1997

Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Collaborative Paroxetine Panic Study Investigators.

Paroxetine has been shown to be effective in panic disorder in three 10- to 12-week studies. This trial studied the longer term effects of paroxetine in patients with DSM-III-R defined panic disorder. Patients who satisfactorily completed a 12-week, double-blind, placebo-controlled study of paroxetine and clomipramine could choose to continue receiving their randomized treatment for a further 36 weeks. Efficacy assessments included the daily panic attack diary, the Clinical Global Impression Scale, the Hamilton Anxiety Rating Scale, the Marks Sheehan Phobia Scale and the Sheehan Disability Scale. In total, 176 patients were included in the intention-to-treat population. The number of full panic attacks decreased in all three groups during the 12-week study, and improvements continued with long-term therapy. Paroxetine was statistically significantly more effective than placebo throughout the long-term study with respect to reduction from baseline of full panic attacks, and at the end of treatment with respect to the proportion of patients who eventually experienced no panic attacks. There were no significant differences between paroxetine and clomipramine. The proportion of patients who withdrew from the study due to adverse effects was greater in the clomipramine group (19%) than in either the paroxetine group (7%) or the placebo group (9%). Paroxetine was significantly more effective than placebo and as effective as (but better tolerated than) clomipramine in the long-term treatment of panic disorder. Not only was efficacy maintained, but continued improvement was also seen, indicating the importance of long-term treatment in patients with panic disorder.

Adolescent↗
PubMed1998

Cardiovascular death from panic disorder and panic-like anxiety: a critical review of the literature.

Several symptoms of panic disorder mimic those of cardiovascular diseases and patients with this disorder frequently consult physicians with the fear of dying from a heart attack. The salient question is: Can the patient with panic disorder die from the cardiovascular consequences of his/her panic attacks? We critically review the six studies that have examined the association between panic disorder (or panic-like anxiety) and cardiovascular mortality or complications associated with the cardiovascular system. We then briefly review the evidence by which mechanisms panic may be linked to cardiovascular mortality and conclude with proposed guidelines for patient management.

Cardiovascular Diseases↗
PubMed1992

Psychodynamics of panic disorder and social phobia.

d psychological treatments of psychiatric disorders are often wrongly polarized. The related anxiety disorders, panic disorder and social phobia, illustrate the interdependence of biology and psychology. The author describes current psychodynamic understanding of the factors that contribute to the etiology and pathogenesis of these disorders. He concludes by stressing the value of integrated, psychodynamic treatment.

Behavior Therapy↗
PubMed1992

Cognitive-behavioral approaches to panic disorder and social phobia.

In the past several years, substantial progress has been made in developing relatively efficient and seemingly effective brief psychosocial treatments for anxiety disorders. Knowledge has advanced along both biological and psychological fronts, although the greater effort has been put into understanding the neurobiological basis of anxiety disorders and developing appropriate, effective pharmacological treatment. Nevertheless, psychological knowledge has also advanced, and a more recent trend is to integrate psychological and biological advances at the level of psychopathology and treatment. The author highlights recent developments in understanding the psychological basis of two anxiety disorders: panic disorder and social phobia. He then describes psychosocial treatment protocols for these disorders that have been developed at the Center for Stress and Anxiety Disorders at the State University of New York at Albany, and reviews data on their effectiveness.

Cognitive Behavioral Therapy↗