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At least 19 recordsLinked to original sources
PubMedDate not supplied

Characteristics of panic attack subtypes: assessment of spontaneous panic, situational panic, sleep panic, and limited symptom attacks.

We report the analyses of daily journal descriptions of 790 self-defined panic attacks from 59 patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The DSM-III-R specified symptoms occurred with frequencies ranging from choking (17% of attacks) to palpitations (63% of attacks). The mean weekly panic attack severity correlated significantly with the number of symptoms per attack, but not their weekly frequency. Within a given person, situational and spontaneous panic attacks did not significantly differ over a number of characteristics, including severity, duration, frequency per week, diurnal distribution, and the number of symptoms per attack. Limited symptom attacks were less severe, but were otherwise similar to panic attacks. Also, panic attacks during sleep were less frequent than panic attacks in the awake state, but did not significantly differ on other descriptive characteristics. These data support the validity of the symptoms specified for panic attacks by DSM-III-R. They also suggest that within an individual, panic attacks of various subtypes may be descriptively similar, despite the differing contexts in which they arise. In addition, these data question the diagnostic significance of the limited symptom attack-panic attack distinction.

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↗
PubMedDate not supplied

DSM-IV panic attacks and panic disorder in a community sample of adolescents and young adults: how specific are panic attacks?

The study investigates the lifetime and 12-month prevalence, symptoms, age of onset and comorbidity patterns of DSM-IV panic attacks and panic disorder in a community sample of 3021 adolescents and young adults aged 14-24 years. Findings are based on DSM-IV symptoms and diagnoses assessed by interviews using a computerised, extended version of the Munich Composite International Diagnostic Interview (M-CIDI). Lifetime prevalence of DSM-IV panic disorder among 14-24 year-olds was 1.6% (0.8% with and 0.8% without agoraphobia). Panic symptoms were found to be quite frequent (13.1%) in the community, with lifetime prevalence of DSM-IV panic attack at 4.3% (12-month prevalence, 2.7%), with first onset rarely before puberty. Women were considerably more likely to have panic disorder and to have an earlier age of onset than males. Occurrence of DSM-IV panic attacks was strongly related to the subsequent development of various forms of mental disorders--not only panic disorder and agoraphobia. The conditional probability in those with panic attacks to develop other forms of mental disorders was 63% in males and 40% in females. Particularly 'late onset' panic attacks (after the age of 18 years) are associated strongly with the development of multimorbidity of mental disorders. This suggests that panic attacks are generally highly indicative for more severe psychopathology and not only for panic disorder and agoraphobia.

Adolescent↗
PubMed1998

Sodium lactate and hypertonic sodium chloride induce equivalent panic incidence, panic symptoms, and hypernatremia in panic disorder.

BACKGROUND: Although experimental induction of panic by infusion of 0.5 mol/L sodium lactate in persons with panic disorder was described three decades ago, the mechanism underlying this observation remains unclear. Here we asked if the rapid administration of the large sodium load contained in the 0.5-mol/L sodium lactate infusion might be involved in panic induction. METHODS: We compared in panic disorder and healthy subjects behavioral, electrolyte, endocrine, and acid-base responses to three double-blind randomly ordered equal volume 20-min infusions: 0.5 mol/L sodium lactate, hypertonic saline (3% sodium chloride), and normal saline placebo. RESULTS: Sodium lactate (0.5 mol/L) and hypertonic saline produced the same high incidence of panic and equivalent increases in panic symptoms, serum sodium, and plasma vasopressin in the panic disorder subjects. Neither hypertonic infusion increased cortisol or adrenocorticotropin. No normal subject experienced panic in any condition. The 0.5-mol/L sodium lactate infusion induced alkalosis, whereas hypertonic saline and normal saline induced a mild acidosis. CONCLUSIONS: Hypertonic sodium solution containing either chloride or lactate anion induces panic in panic disorder. The large sodium loads delivered by hypertonic saline and 0.5 mol/L sodium lactate may be involved in the mechanism of panic induction.

Acidosis↗
PubMed2002

Anxiety sensitivity as a predictor of the development of panic symptoms, panic attacks, and panic disorder: a prospective study.

The purpose of the study was to examine how anxiety sensitivity (AS) acts as a dispositional factor in the development of panic symptoms, panic attacks, and panic disorder. Between 1986 and 1988, data were collected from 505 undergraduates at an urban university. At Time 1, measures used were the ASI to assess AS, the trait scale of the State-Trait Anxiety Inventory (STAI-T) to measure trait anxiety, and self-report questionnaires to measure personal and family history of panic and anxiety symptoms. During the Spring of 1999, 178 of these subjects were re-contacted, and information was gathered on subjects' subsequent development of panic symptoms, panic attacks, panic disorder, and trait anxiety (STAI-T). The ASI was the strongest predictor of the development of panic symptoms and panic attacks. After controlling for trait anxiety, the ASI was not predictive of the development of panic disorder.

Adult↗
PubMed1991

Chronology of panic and avoidance, age of onset in panic disorder, and prediction of treatment response. A report from the Cross-National Collaborative Panic Study.

The relevance of the chronology between panic disorder and avoidance behavior and of an early, medium or late onset of panic disorder was tested. Groups from the sample of the cross-national collaborative panic study (CNCPS) were compared for differences in basic characteristics and for the ability to predict treatment response. Patients who developed avoidance behavior before the full syndrome of panic disorder had less often a full agoraphobia but were not different in their response to treatment. Patients with an early onset of panic disorder suffered more often from agoraphobia. The treatment response was similar in the groups with early, medium or late onset of panic disorder. Neither the chronology between panic disorder and avoidance behavior nor the age of onset of panic disorder predicted outcome in short-term treatment with alprazolam or imipramine.

Adult↗
PubMed2005

Selective GABAergic treatment for panic? Investigations in experimental panic induction and panic disorder.

gamma-Aminobutyric acid (GABA) is the most important inhibitory neurotransmitter in the central nervous system (CNS). It exerts its rapid inhibitory action mostly through GABA(A) receptors, which are targets for benzodiazepines, barbiturates, neuroactive steroids and distinct anticonvulsive agents. There is considerable evidence that dysfunction of GABA(A) receptors or dysregulation of GABA concentrations in the CNS (or both) plays an important role in the pathophysiology of panic disorder. Currently, benzodiazepines are the only drugs directly targeting the GABA(A) receptors that are approved for the treatment of anxiety disorders. Because of their well-known anxiolytic effects, they are widely used in this setting, but side effects limit their use in long-term treatment. The question of whether drugs that selectively increase GABA concentrations in the CNS could improve symptoms of anxiety has been discussed. Recent investigations by our group have demonstrated that enhancement of endogenous GABA (through blockade of GABA transaminase by vigabatrin or through inhibition of GABA transporters by tiagabine) exerts anxiolytic effects on experimentally induced panic. Our studies in healthy volunteers have shown that both compounds lead to a significant reduction in panic symptoms elicited by cholecystokinin-tetrapeptide. Moreover, benzodiazepine-like effects on the activity of the hypothalamic-pituitary-adrenal axis have been observed in association with vigabatrin treatment. Small open studies in patients with panic disorder also showed an improvement in panic and anxiety with both compounds. This review summarizes our recent research on the effects of selective GABAergic treatment in experimentally induced panic and outlines the possible role of compounds targeting the GABA binding site of the GABA(A)-benzodiazepine receptor for the treatment of panic and anxiety.

Animals↗
PubMedDate not supplied

Panic is panic: homogeneity of the panic attack experience.

Much of the panic literature uses samples that are diagnostically heterogeneous. The panic experience must be homogeneous if we are to combine such heterogeneous groups for research and if we are to use panic characteristics to predict consequences. This study, using the symptom sequences of 21 patients with panic attacks, sought to assess interpatient agreement and compare symptom rankings in patient subgroups. Median polish performed on the symptom sequences suggested interpatient agreement (F = 3.39, p less than or equal to .05). This was further supported by Kendall's coefficient of concordance using symptom runs for various etiologic models (W = 0.338, p less than .0001). The accuracy of the DSM-III to diagnose panic attacks was implied by the lack of association of measures of accuracy--patient effects and diagnostic confidence--with symptom rankings, demographic data, or clinical parameters. In conclusion, this study supports the uniformity of the panic experience.

Adult↗
PubMed1993

[Stress, anxiety, panic. Panic attack and panic disorder. A new psychiatric concept].

Pathological anxiety--painful and incapacitating--can be defined as perception of stress with cognitive distortion. The traditional unitary model of anxiety neurosis is replaced by the american model (DSM III) with "panic disorder" and "panic attacks" representing the cornerstone of the new construct, based on the evidence (by Donald Klein) of the efficacy of so-called antidepressant drugs. Behavioral and cognitive treatments are useful, mainly in anxiety with agoraphobia. "General anxiety disorder" is now considered as a "residual category". Clinical aspects, differential diagnosis, circumstances of onset, pharmacological induction of panic attacks (specially by lactate and caffeine), and treatments, are reviewed.

Anxiety Disorders↗
PubMed1983

Panic disorder and major depression. Increased risk of depression, alcoholism, panic, and phobic disorders in families of depressed probands with panic disorder.

In a large, case-control family study of depression, 77 (58%) of 133 depressed probands displayed anxiety symptoms that met DSM-III criteria for agoraphobia, panic disorder, or generalized anxiety disorder. In two thirds of these 77 cases, these symptoms were associated with depressive episodes. In a previous study, the lifetime rate of major depression and anxiety disorders among first-degree family members of probands with major depression plus an anxiety disorder was found to be significantly increased regardless of when the anxiety symptoms occurred. In this study we analyzed our data according to the specific anxiety disorders observed. Major depression plus panic disorder in probands was associated with a marked increase in risk in relatives for a number of psychiatric disorders; relatives were more than twice as likely to have major depression, panic disorder, phobia, and/or alcoholism than the relatives of probands with major depression without any anxiety disorder. These results indicate that the relationship between major depression and anxiety disorders requires further study.

Adolescent↗
PubMed1996

[Panic disorder and panic attack].

Panic disorder first appeared as a specific diagnostic entity in 1980, in the third Edition of "Diagnostic and Statistical Manual of Mental Disorders" (DSM III). The classical anxiety neurosis was divided into two separate entities: panic disorder and generalized anxiety disorder, whose major criteria for distinction was based, in a simplified manner, on the presence or absence of panic attacks in the patient's history. Validity of the concept of panic disorder as a clinical and autonomous entity is now widely accepted. It is based on numerous epidemiological, phenomenological, biological, genetic and therapeutic studies that have established, that panic disorder may be clearly distinguished from other anxiety and mood disorders. However, this disorder still has unknown aetiology and criteria for definition remain purely clinical. Controversies as regards the validity of diagnostic criteria for panic disorders may account for its successive definitions in the DSM III-R, then in the DSM IV. In fact, in contrast to the definition of panic attacks that has remained practically constant, panic disorder was initially defined by the recurrence of panic attacks. It is now considered by the authors of the DSM IV as a disorder characterized by a chronic anxiety, focused on the risk for panic attacks showing symptoms evocative of autonomic dysregulation. In the DSM IV, panic attack is now considered as a syndrome which is not specific for panic disorder. Panic disorder may be diagnosed in a patient who has suffered from recurrent panic attacks, provided that one at least of the latter have been associated with one of the following symptoms: persisting fear from other panic attacks; concerns about possible implications of panic attacks or their consequences; major behavioural changes related to the attacks. Evolving positions of the successive authors of the DSM contrast with more conservative attitudes of the authors of the CIM 10, who still consider agoraphobia as a key symptom. Whatever the issues of these definitions, it must be kept in mind that panic disorder is a severe syndrome, and leads to major suffering and significant impairment of the patients' quality of life as well as their social life and interpersonal relationships. Comorbidity with depressive and addictive disorders is frequent, and panic disorder is considered by numerous authors as a risk factor for suicide. Due to the severity of panic disorder, its frequency and the fact that it is too often undiagnosed (although there are effective therapeutic strategies), efforts are fully warranted, so that patients may benefit from early diagnosis and adequate treatment.

Anxiety Disorders↗
PubMed2006

Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder.

BACKGROUND: There is increasing evidence that subthreshold forms of psychopathology are both common and clinically relevant. To enable classification of these subthreshold forms of psychopathology, it may be useful to distinguish not only a threshold for illness but also for health. Our aim was to investigate this with regard to panic. METHOD: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), which is based on a large representative sample of the adult general population (18-65 years) of The Netherlands (n=7076). The Composite International Diagnostic Interview was used as a diagnostic instrument. By defining two thresholds, three groups were formed: panic disorder, subthreshold panic disorder and no-panic. These groups were compared using multinomial regression analysis, chi2 and analysis of variance. RESULTS: The 12-month prevalence of panic disorder was 2.2% while that of subthreshold panic disorder was 1.9%. Symptom profiles and risk indicators associated with panic disorder and subthreshold panic disorder were similar, and half of the risk indicators were more strongly associated with panic disorder than with subthreshold panic disorder. Subthreshold panic disorder occupied an intermediate position between panic disorder and no-panic with regard to the number of symptoms, the percentage of subjects with co-morbidity, and functioning. CONCLUSIONS: Subthreshold panic disorder is common, and seems clinically relevant, but is milder than panic disorder. These results thus support the use of a double threshold in panic. Further research should focus on the positioning of the thresholds, the course of subthreshold panic disorder and its treatment options.

Adult↗
PubMed1998

Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group.

OBJECTIVE: Although panic attacks account for only a portion of the morbidity of panic disorder and panic attack frequency assessments are unreliable, studies of drug efficacy in panic disorder have generally used reduction in panic attack frequency as the primary measure of improvement. The authors studied the efficacy of fluoxetine treatment in panic disorder and measured the relative contributions of changes in symptoms to overall improvement. METHOD: Patients with a diagnosis of panic disorder (N = 243) were randomly assigned to treatment with 10 or 20 mg/day of fluoxetine or placebo. Primary outcome measures were change in panic attack frequency and clinician-rated Clinical Global Impression improvement scores. Other assessments included a panic attack inventory, clinician-rated and patient-rated versions of the Panic and Phobic Disorder Change Scale, a phobia rating scale, the Hamilton Anxiety Rating Scale, the 21-item Hamilton Depression Rating Scale, and the Sheehan Disability Scale. Correlations were determined between outcomes in individual symptom domains and overall clinical outcome. RESULTS: Fluoxetine, particularly the 20-mg/day dose, was associated with more improvement than was placebo in patients with panic disorder across multiple symptom measures, including global improvement, total panic attack frequency, phobic symptoms, and functional impairment. Global improvement was most highly correlated with reductions in overall anxiety and phobic symptoms and least correlated with reduction in panic attacks. Fluoxetine treatment for panic disorder was well tolerated, with a safety profile consistent with that observed for fluoxetine in other disorders. CONCLUSIONS: These data provide support for the efficacy and safety of fluoxetine treatment in reducing panic attacks, phobic symptoms, anxiety, and depressive symptoms in patients with panic disorder. Reductions in panic attack frequency in subjects given either fluoxetine or placebo were less closely related to overall clinical improvement than reductions in phobic avoidance, anxiety, depressive symptoms, and functional impairment, suggesting that outcome measures in this disorder should be more broadly based.

Adult↗
PubMed2002

The match-mismatch model and panic patients' accuracy in predicting naturally occurring panic attacks.

The match-mismatch model of panic states that panic disorder patients tend to overestimate the probability of panic prior to engaging in a fear-provoking situation. Furthermore, patients are expected to become more accurate in predicting panic over subsequent occasions of exposure. We tested the model with naturally occurring panic attacks. Patients rated the probability of a panic attack in the morning, and these ratings were compared to the actual occurrence of panic that day. Ratings were collected daily in a baseline period before treatment, during treatment, and again for 2 weeks after treatment. The results confirmed that panic disorder patients tend to overpredict the likelihood of panic. However, patients did not become more accurate in their predictions over time. In fact, overprediction bias increased because expectancy of panic remained stable, in spite of the decline of the frequency of panic from pre- to post-test. Thus, over a short course of therapy panic patients tend to persist in overestimating the chance that panic may occur. At baseline, expectancy of panic and the tendency to overpredict were not associated with other aspects of the symptomatology. Neither expectancy nor overprediction bias was predictive of treatment outcome. Finally, improvement in treatment was not associated with a decreased expectancy of panic.

Adult↗
PubMed2001

Acute panic inventory symptoms during CO(2) inhalation and room-air hyperventilation among panic disorder patients and normal controls.

There is scant literature on anxiety symptoms induced during respiratory challenges developed to induce panic symptoms and attacks. Here we report on the prevalence of Acute Panic Inventory (API) symptoms during three consecutive respiratory challenges to patients with panic disorder (PD) and normal controls (NC). The challenges performed using a closed canopy system included voluntary room air hyperventilation (RAH), inhalation of 5% CO(2), and 7% CO(2)-enriched air. The PD patients were 41 men and 53 women whose mean age was 33.4 (SD = 8.55). The normal comparison group consisted of 35 men and 27 women with a mean age of 31.3 (SD = 9.21). The diagnosis of panic disorder was made using the Structured Clinical Interview for DSM-III-R. All potential normal controls underwent structured clinical interview using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version Modified for the Study of Anxiety Disorders (SADS-LA), and must have been free of a lifetime history of anxiety disorders, affective disorders, substance use disorders, and schizophrenia. All participants also had a complete medical evaluation and were in good health. The experiment consisted of seven experimental epochs: three baseline/recovery periods each followed by a respiratory challenge, and then a final recovery epoch. The API was administered at the end of each epoch. Clinical staff trained and experienced in rating panic attacks rated participants' response during each challenge as panic or no panic. Three groups were defined for analysis: PD patients who panicked, PD patients who did not panic, and NC who did not panic. Staff ratings indicated that the 7% CO(2) challenge was the most panicogenic, followed by the 5% CO(2), and the RAH challenges. Conventional statistics (analysis of variance and partial correlations) indicated that many baseline symptoms as well as symptom increments differed across groups, and were associated with the outcome of panic/no panic during each challenge. However, logistic regression analysis indicated that only a few symptoms independently predicted the panic/no panic outcome because many symptoms were redundant. The symptom cluster of fear in general, dizziness, difficulties with concentrating, and doing one's job predicted panic to RAH. The cluster of fear in general, confusion, dyspnea, and twitching/trembling predicted the response to 5% CO(2). Finally, fear in general, confusion, twitching/ trembling and dizziness predicted the response to 7% CO(2). While univariate analyses indicated that many symptoms distinguished between panic and no panic outcome, logistic regression revealed that group differences were subsumed under a few prominent symptoms, namely, fear in general, confusion, dizziness, twitching/trembling, and dyspnea. The results are discussed in the context of patient (having a diagnosis of PD) and panic effects (rated as panicking to a challenge).

Acute Disease↗
PubMed2006

Psychopathology of panic attacks in panic disorder.

PURPOSE: This study examined the relationships among certain subtypes of panic attacks (full vs. limited symptom; spontaneous vs. situational) and between these subtypes, panic disorder subtypes, and other characteristics of panic disorder, especially agoraphobia. METHOD: Data were drawn from a large (n = 1,168) treatment study of panic disorder in which panic attacks were carefully subtyped and counted using a diary. Relationships between variables at baseline were examined primarily using non-parametric methods, and the course of improvement for panic subtypes among completers was plotted. RESULTS: The median number of spontaneous panic attacks per week at baseline was similar among patients with panic disorder without agoraphobia (PD), limited phobic avoidance (PDL), and agoraphobia (PDA). The median number of situational attacks and the median agoraphobia ratings rose progressively across diagnostic subtypes. Anticipatory anxiety, HAM-A, HAM-D, and disability scores were higher in PDA than in PD. Full and limited symptom panic attacks were positively correlated. The proportion of total attacks that were limited rose during the first two weeks of treatment, suggesting conversion of full to limited symptom attacks before complete disappearance. Spontaneous and situational attacks were correlated minimally or not at all. Agoraphobia ratings were more positively correlated with situational than with spontaneous panic attacks. Few of the correlations among measures at baseline were high. CONCLUSIONS: Full and limited symptom panic attacks differ primarily in severity. Spontaneous and situational attacks are relatively independent, and situational attacks are more closely related to agoraphobia. These findings are consistent with previous work suggesting that spontaneous attacks reflect a biological component, whereas situational attacks reflect a cognitive component in the psychopathology-- and possibly the pathogenesis-- of panic disorder. This provides a rationale for the use of combined pharmacotherapy and psychotherapy in the treatment of panic disorder. Future investigations of panic disorder should carefully separate panic attack subtypes.

Agoraphobia↗
PubMed1999

Frequency of panic attacks and panic disorder in adolescents.

By using data from the Bremer Adolescent Study, this report presents findings on the frequency, comorbidity, and psychosocial impairment of panic disorder and panic attacks among 1,035 adolescents. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Panic disorder and other psychiatric disorders were coded based on DSM-IV criteria using the computerized-assisted personal interview of the Munich version of the Composite International Diagnostic Interview. Panic disorder occurred rather rare, with only 0.5% of all the adolescents met the DSM-IV criteria for this disorder sometimes in their live. Panic attack occurred more frequently, with 18% of the adolescents reported having had at least one panic attack. Slightly more girls than boys had panic attack and panic disorder. The occurrence of panic attack and panic disorder were the greatest among the 14-15 year olds. The experience of having a panic attack was associated with a number of problems, the most frequent being avoiding the situation for fear of having another attack. Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. Panic disorder comorbid highly with other psychiatric disorder covered in our study, especially with that of major depression. Among those with a panic disorder, about 40% of them were severely impaired during the worst episode of their illness. Only one out of five adolescents with panic disorder sought professional help for emotional and psychiatric problems. The implication of our findings for research and clinical practice are discussed.

Adolescent↗
PubMed1992

Panic disorder in the families of patients with normal coronary arteries and non-fear panic disorder.

Patients with non-fear panic disorder (NFPD) meet DSM-III-R criteria for panic disorder, but do not report subjective fear or anxiety. Although apparently common in medical settings, this controversial group is in need of further diagnostic validation. This study assessed family history of panic disorder in patients with chest pain and normal coronary arteries (CP/NCA) and either NFPD, panic disorder with fear, or no panic. It was hypothesized that the two panic disorder groups would have similar, elevated rates of panic disorder in their first-degree relatives, compared to patients without panic. The results support the hypothesis; about 17% of the first-degree relatives of both NFPD and panic disorder patients were diagnosable with panic disorder according to proband interviews, whereas only 4.6% of the first-degree relatives of patients without panic were so diagnosable. These results support the diagnostic validity of NFPD in CP/NCA patients, because such patients had a family history of panic disorder similar to patients with a more classical panic disorder presentation. The lack of fear symptoms and behavior in NFPD may cause panic disorder to be overlooked as a potential cause of somatic symptoms in patients with no medical explanation for their condition.

Chest Pain↗