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At least 19 recordsLinked to original sources
PubMed1992

A prospective study of panic and anxiety in agoraphobia with panic disorder.

The features of panic and anxiety in the natural environment were studied by prospective self-monitoring in 39 patients with chronic agoraphobia and panic disorder. Panics overlapped greatly with anxiety episodes but were more intense. Panics occurred more often in public places than did anxiety episodes, but had otherwise similar symptom profile, time of occurrence, and antecedents. Most panics surged out of a pre-existing plateau of tonic anxiety which lasted most of the day. Spontaneous panics were less frequent than situational panics and occurred more often at home but were otherwise similar. These findings do not support the sharp distinction between panic and anxiety in DSM-III-R, not its emphasis on spontaneous panic in classifying anxiety disorders. Thoughts of dying and 'going crazy'/losing control accompanied only a minority of panic/anxiety episodes and seemed to be a product of intense panic rather than a cause.

Adult↗
PubMed1992

Noradrenergic neuronal dysregulation in panic disorder: the effects of intravenous yohimbine and clonidine in panic disorder patients.

In order to evaluate possible abnormal noradrenergic neuronal functional regulation in patients with panic disorder, the behavioral, biochemical and cardiovascular effects of intravenous yohimbine (0.4 mg/kg) and clonidine (2 micrograms/kg) were determined in 15 healthy subjects and 38 patients with panic disorder. A subgroup of 24 panic disorder patients were observed to experience yohimbine-induced panic attacks and had larger yohimbine-induced increases in plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) than healthy subjects and other panic disorder patients. A blunted growth hormone response to clonidine and a significant clonidine-induced decrease in plasma MHPG was also observed in this subgroup of panic disorder patients. These data replicate and extend previous investigations, which are consistent with a large body of preclinical and human data relating increased noradrenergic neuronal function to human anxiety and fear states.

Adult↗
PubMed1992

Self-monitoring of panic attacks and retrospective estimates of panic: discordant findings.

An event sampling method was used to study the frequency of panic attacks during treatment of agoraphobics. Results revealed a much lower incidence of panic attacks in agoraphobics according to self-monitoring than was expected on account of their retrospective estimation. When more stringent criteria for panic attacks are applied, retrospective overestimation becomes even more apparent. The implication of this finding for the classification of panic disorder patients is discussed.

Agoraphobia↗
PubMed1992

Brief treatment of emergency room patients with panic attacks.

OBJECTIVE: Most research on treatment for panic disorder has involved chronic forms of the illness. To determine the efficacy of early intervention, the authors examined the effects of treatment for patients with panic attacks who were seen in the emergency room, which is the first point of contact with the health delivery system for many persons with panic attacks. METHOD: The subjects were 33 patients with panic attacks seen in two emergency rooms. The presence of panic attacks was confirmed with a modified version of the Structured Clinical Interview for DSM-III-R; approximately 40% of the patients met the DSM-III-R criteria for panic disorder with agoraphobia. The patients were randomly assigned to groups receiving reassurance (N = 16) or exposure instruction (N = 17). Scores on the Fear Questionnaire agoraphobia subscale, Mobility Inventory, and Beck Depression Inventory and the frequency of panic attacks were determined at baseline, 3 months, and 6 months. RESULTS: The subjects who received exposure instruction significantly improved over the 6-month period on depression, avoidance, and panic frequency. The reassurance subjects did not improve on any measure and eventually reported more agoraphobic avoidance. CONCLUSIONS: These results suggest that early intervention with exposure instruction may reduce the long-term consequences of panic attacks. The exposure instruction was of value even though the subjects had relatively low levels of avoidance at the outset of the study.

Adult↗
PubMed1992

Neurobiological aspects of panic disorder.

The limbic system, temporal cortex and the locus coeruleus are important brain regions in the neuroanatomy of panic states. There is evidence for beta- and alpha 2-adrenoreceptor abnormalities and pre- and post-synaptic serotonergic alterations in panic disorder subjects. The anti-panic effects of chronic antidepressant drug treatment may relate to their down-regulation of various components of noradrenergic function and overall enhancement of serotonergic function. The efficacy of benzodiazepine agents in panic disorder and the altered sensitivity of panic patients to benzodiazepine agonists and inverse agonists suggest that alterations in benzodiazepine/GABA receptors may have a role in this disorder. A variety of other pharmacological agents also provoke panic, demonstrating that the biological origins of this disorder are quite diverse and complicated. Most importantly, a variety of new agents that selectively affect different components of these neurotransmitter/receptor systems are being developed. These novel agents offer future promise of greater efficacy with less adverse effects for individuals with panic disorder.

Antidepressive Agents↗
PubMed1992

Cognitive-behavioral therapy for benzodiazepine discontinuation in panic disorder patients.

The discontinuation of benzodiazepine treatment in patients with panic disorder may be associated with emergent withdrawal and anxiety symptoms, relapse of panic, and the inability to complete benzodiazepine taper. Although some patients may respond to slow taper strategies or the use of pharmacologic adjuncts, many continue to experience significant difficulties during benzodiazepine discontinuation. This paper presents a cognitive-behavioral conceptualization of benzodiazepine discontinuation difficulties, emphasizing "fear of fear" cycles. From this perspective the discontinuation process is seen as exposing panic disorder patients to somatic sensations associated with panic at a time when there is both increased anxiety and concern about re-emergence or worsening of panic episodes. As a consequence, patients may re-enter a cycle of catastrophic interpretations of symptoms, increased vigilance and fear, and panic. Cognitive-behavioral interventions may ameliorate discontinuation-associated difficulties and prevent the return of the panic disorder. Preliminary data supporting the efficacy of these interventions are described.

Anti-Anxiety Agents↗
PubMed1979

Psychosexual aspects of the panic-fear personality types in asthma.

Numerous earlier studies have demonstrated the close relationship between MMPI Panic-Fear categories and various medical outcome measures in asthma. The present study relates MMPI Panic-Fear categories to psychosexual development. Specifically, High Panic-Fear patients demonstrate oral preoccupations, Low Panic-Fear patients demonstrate anal preoccupations, while Moderate Panic-Fear patients do not demonstrate pre-Oedipal preoccupations. Thus, MMPI Panic-Fear categories, useful in predicting medical outcome measures, have now been related to developmental levels, with the explanatory power of developmental concepts as well as their implications for psychological treatment.

Adolescent↗
PubMed2025

Mendelian randomization underscores the importance of clinical nursing in mitigating anxiety and panic attack risks among low-educated populations.

Considering the complex and underexplored interplay between educational attainment (EA) and the prevalence of anxiety and panic attacks, which carries significant societal implications, we have designed a two-sample Mendelian randomization (MR) study. The primary objective of this research is to elucidate the causal relationship between education level and the risk of anxiety and panic attacks, thereby providing novel insights for clinical and nursing strategies. Our study adheres to the STROBE-MR guidelines and employs a classical two-sample MR analysis to investigate the causal relationship between EA (exposure) and the occurrence of anxiety/panic attacks (outcome). The data for 8 education-related phenotypes, along with anxiety and panic attack outcomes, were sourced from European population-based Genome-wide association studies databases. To ensure robustness, we applied 5 distinct MR analytical methods, supplemented by comprehensive sensitivity analyses, heterogeneity assessments, and evaluations of reverse causality bias to uphold rigorous quality control standards. Our findings, robust across various MR methods and consistent after inverse variance-weighted and false discovery rate (FDR) corrections, indicate a significant association between lower EA and an increased risk of anxiety or panic attacks. Specifically, individuals with no formal qualifications exhibited a higher risk (P-value&#x2005;=&#x2005;.005, OR&#x2005;=&#x2005;1.017, 95% CI&#x2005;=&#x2005;1.005-1.029, FDR&#x2005;=&#x2005;0.011). In contrast, higher levels of education were associated with a reduced risk: College or University degree (P-value&#x2005;<&#x2005;.01, OR&#x2005;=&#x2005;0.989, 95% CI&#x2005;=&#x2005;0.984-0.995, FDR&#x2005;=&#x2005;0.0007), EA (P-value&#x2005;<&#x2005;.01, OR&#x2005;=&#x2005;0.999, 95% CI&#x2005;=&#x2005;0.998-0.9995, FDR&#x2005;=&#x2005;0.0009), and A levels/AS levels or equivalent (P-value&#x2005;=&#x2005;.011, OR&#x2005;=&#x2005;0.988, 95% CI&#x2005;=&#x2005;0.978-0.997, FDR&#x2005;=&#x2005;0.019). These conclusions were consistently supported by at least 4 MR methods and successfully passed all quality control checks. Our study demonstrates a negative correlation between years of education and the risk of anxiety and panic attacks, suggesting that clinical nursing and patient education efforts should prioritize tailored psychological support and patient communication for individuals with lower EA. This population warrants enhanced attention and more compassionate care to mitigate their elevated risk of anxiety-related disorders.

Humans↗
PubMed1978

Panic-fear in asthma: a divergence between subjective report and behavioral patterns.

The reported frequency of occurrence of Panic-Fear symptoms during asthmatic attacks varies widely and is related to treatment response independently of the objective severity of asthma. In a previous study, symptom minimizers (Low Panic-Fear) requested few as-needed (PRN) medications and treatments while hospitalized, even on days when significant airway obstruction was present. In contrast symptom emphasizers (High Panic-Fear) requested PRNs frequently, even on days when no airway obstruction was present. In the present study, these behavioral differences toward PRNs occurred despite the similar ability of patients in various Panic-Fear groups to perceive and report changes in airway obstruction. Together these results suggest that specific behavioral strategies, which do not derive from differences in symptom perception, influence the treatment response of asthmatic patients differing in Panic-Fear symptomatology.

Adult↗
PubMed1992

Seasonal panic disorder: a possible variant of seasonal affective disorder.

The present communication concerns a 30 year-old female patient with panic disorder in whom panic attacks appeared to be seasonally-related. Characteristically, attacks were more frequent and severe during the months of October to May with spontaneous remissions during the months of June to September. Since 70% of patients with seasonal affective disorder (SAD), a variant of affective illness characterized by recurrent winter depressions with remissions in summer, suffer from anxiety disorders, we propose that seasonal panic disorder may be a variant of SAD. Since SAD is associated with phase delay of circadian rhythms, some forms of panic disorder may be related to phase instability of circadian rhythms. Moreover, since administration of artificial bright light therapy is currently the most effective treatment for SAD, it is suggested that patients with panic disorder should be questioned as to whether their symptoms are seasonally related. If a positive association is established, these patients should be offered treatment with light therapy prior to or coincident with the institution of pharmacotherapy.

Adult↗
PubMed1992

Recognizing panic in cardiac patients.

Patients presenting with apparent myocardial infarctions may in fact be suffering from panic attacks; many symptoms of the latter mimic those of the former. Cardiovascular nurses who know what to listen for in patients' descriptions can recognize indications that panic may be occurring. This article describes panic attacks, panic disorder, and the long-term consequences that often accrue when this highly treatable problem is not recognized. Particularly when no evidence of myocardial damage is found, a cardiovascular nurse's recognition of panic can lead to a referral for appropriate psychological treatment, preventing years of needless suffering and unnecessary health care costs.

Female↗
PubMed1977

Panic-fear in asthma: requests for as-needed medications in relation to pulmonary function measurements.

Requests for as-needed medications and treatments (PRNs) by asthmatic patients scoring high, moderate, or low on the Asthma Symptom Checklist panic-fear category were studied for days when patients were matched at normal, intermediate, and subnormal levels of pulmonary function. Low panic-fear patients were the least likely to request PRNs regardless of the pulmonary function level. In contrast, high panic-fear patients often requested PRNs each level of pulmonary function. Only moderate panic-fear patients made progressively more PRN requests on days when pulmonary functions were lower. These observations and others concerning the adverse influence of extreme panic-feat coping styles upon the treatment of asthma were discussed.

Adult↗
PubMed1992

CSF diazepam-binding inhibitor concentrations in panic disorder.

Diazepam-binding inhibitor (DBI) is a neuropeptide that has been detected in the brain and cerebrospinal fluid (CSF). Previous studies have suggested the possible role of DBI as a potential endogenous anxiogenic ligand modulating GABAergic transmission at the benzodiazepine-GABA receptor complex. The measurement of DBI immunoreactivity (DBI-IR) in CSF of panic-disorder patients and normal controls was undertaken to assess whether there were differences in the CSF concentration of this peptide to assess possible relationships with other monoamines and peptides. Lumbar CSF was obtained from 18 panic patients (4 men, 14 women) and 9 controls (5 men, 4 women). As a group, no significant differences were found between panic patients' CSF concentration of DBI-IR (1.12 +/- 0.27 pmol/mL) and normal volunteers (1.23 +/- 0.27 pmol/mL). No gender differences were demonstrated. However, we did find a positive correlation between CSF levels of DBI and CSF corticotropin releasing hormone (CRH) in our panic patients.

Adult↗
PubMed1992

Alcohol abuse, substance abuse, and panic disorder.

The purpose of this article is to review the literature concerning the interaction of alcohol and/or substance abuse with panic disorder, the comorbidity of these disorders, possible causal relationships, biologic relationships, and the recognition and treatment of dually disordered patients. A number of studies suggest significant comorbidity between panic disorder and alcoholism or abuse of drugs, especially cocaine and sedatives. Panic may lead to drinking or sedative use and also result from prolonged use or withdrawal of alcohol or other drugs. Possible biologic relationships involve the gamma-aminobutyric acid (GABA)-benzodiazepine receptor complex and the central noradrenergic system. Although treatment of panic in substance abusers has not been studied specifically, guidelines for recognition and management of these patients, including use of antipanic medication, are discussed.

Alcoholism↗
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↗
PubMed1976

The treatment of pathological panic states with propranolol.

The authors report on the effects of propranolol, a beta-adrenergic blocking agent, on 10 patients with pathological panic states. Propranolol was effective in treating acute pathological panic, but modest doses of the drug administered for brief periods of time did not alleviate chronic panic attacks associated with agoraphobia. The drug suppressed panic associated with depressive syndromes but did not affect the depression and had no clear effect on anticipatory anxiety. The authors suggest that further study of these findings may clarify other clinical problems.

Acute Disease↗