不同亚型惊恐障碍的临床症状比较

目的 :了解伴或不伴广场恐怖的惊恐障碍患者的临床症状有无差异。　方法 :对连续门诊的 46例伴广场恐怖的惊恐障碍患者 ,和 5 4例不伴广场恐怖的惊恐障碍患者的临床症状进行对照比较。　结果 :在恶心或腹部不适 ,麻木或刺痛 ,害怕发疯等症状评定上 ,存在显著差异 (P<0 .0 5 )。　结论 :惊恐障碍存在伴广场恐怖和不伴广场恐怖两个临床亚型 ,而伴广场恐怖的惊恐障碍是惊恐障碍一个更严重的亚型     

惊恐障碍者呼吸疾病患病率高

惊恐障碍的一些症状与某些侵袭呼吸系统的疾病相当类似。呼吸困难、窒息和窒息感为两者所共有的重要特征。症状的雷同或能指明其在病理生理学方面的某些重叠,至少表明惊恐障碍与某些呼吸障碍间有联系。本文探讨惊恐障碍病人呼吸疾病的患病率。作者假设惊恐障碍患者呼吸疾病的终生患病率和时点患病率高于强迫症或饮食障碍患者。方法:采取回顾性研究法。从一精神病医院焦虑门诊选择惊恐障碍30例、强迫症30例及进食障碍30例作为研究对象。各组均有男、女患者,平均年龄分别为35.5±10.1岁,     

惊恐障碍在综合性医院识别现状和艾司西酞普兰治疗效果

目的:探讨目前综合性医院临床各科室对惊恐障碍识别的临床分析和艾司西酞普兰在综合医院治疗惊恐障碍的有效性和安全性。方法:以胸闷、心慌、濒死感等不适主诉至我院就诊排除躯体疾病后转诊至医学心理科就诊268例患者,分析其中确诊为惊恐障碍的179例患者在临床各科室的首诊诊断构成,以及对其中168例惊恐障碍患者随机分为艾司西酞普兰组和帕罗西汀组,疗程8周,并用惊恐相关症状量表(PASS)、汉密尔顿焦虑量表(HAMA)、不良反应评定量表(SERS)对患者治疗前后进行评估。结果:确诊为惊恐障碍的179例患者在临床各科室的首诊诊断包括惊恐障碍、广泛性焦虑、抑郁症、心脏神经官能症、癔症、其他疾病等,首诊时诊断为惊恐障碍的患者仅占9.5%。患者在治疗1周、治疗2周艾司西酞普兰组的HAMA、PASS分值均低于对照组,而在治疗4、6、8周,两组患者的HA-MA、PASS分值差异无统计学意义(P>0.05)。在治疗8周时,艾司西酞普兰组治愈率为65.4%,有效率为91.4%,帕罗西汀组分别为63.7%,91.3%。两组差异无统计学意义。在不良反应方面,两组差异无统计学意义。结论:综合医院临床各科室对惊恐障碍患者首诊时的识别率较低。艾司西酞普兰治疗惊恐障碍疗效肯定,安全性较高。     

惊恐障碍的临床变量比较

目的；了解伴和不伴广场恐怖的惊恐障碍患者的临床变量有无差异。方法；对连续门诊的４６例伴广场恐怖的惊恐障碍患者，和５４例不伴广场恐怖的惊恐障碍患者的临床谱量进行对照比较。结果；在离婚、确诊前内科门诊，发作频率主诉等变量上存在显著差异，在有无早搏变量上存在非常显著差异。     

不同性别惊恐障碍患者的临床变量比较

目的 旨在了解惊恐障碍患者的临床变量与性别差异。方法 对连续来门诊的５４例男性和４６例女性惊恐障碍患者的临床变量进行了对照比较。结果 在大学文化程度、结婚与否、家庭压力等变量方面,存在显著的性别差异（Ｐ〈０．０５）。结论 提示已婚女性,在面临家庭压力时,易患惊恐障碍。     

阿普唑仑治疗惊恐障碍时出现抑郁症状

阿普唑仑(alprazolam)系三唑苯并二氮(艹卓)类药物,治疗广泛性焦虑障碍有效。初步研究证实对惊恐障碍亦有疗效。作者应用中、高剂量的阿普唑仑治疗46例焦虑障碍患者时,有15例(33%)出现重性抑郁症。本文所有参加8周双盲对照研究的患者,均符合DSM-Ⅲ空旷恐怖症伴惊恐发作或惊恐障碍的诊断标准。8周后,原接受阿普唑仑治疗者继续应用,用安慰剂者改用阿普唑仑治疗1年。惊恐发作前患者没有抑郁症状,并且惊恐发作后出现重性抑郁症(DSM-Ⅲ标准)的患者,在入组时无抑郁症状。本文从中选2例病例报告如下: 例1,女性,32岁,已婚,患空旷恐怖     

夜间惊恐发作多导睡眠图监测及共病分析

研究背景惊恐发作系指反复发生、有时为不可预料的焦虑或惊恐症状。尽管大多数惊恐发作都在白天发作,但夜间惊恐发作也相当常见,而更关注夜间发作。夜间惊恐发作患者较白天发作患者存在更严重的失眠,大多数患者可因一次夜间惊恐发作而继发预期焦虑和回避行为。本研究通过对夜间惊恐发作患者视频多导睡眠图监测参数和临床伴随症状的分析,探讨其睡眠特征,为更好诊断、鉴别诊断和治疗夜间惊恐发作提供依据。方法采用夜间视频多导睡眠图监测20例夜间惊恐发作患者和23例健康志愿者睡眠过程,汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD,20项)评价患者焦虑、抑郁症状及睡眠障碍。结果与正常对照组相比,夜间惊恐发作组患者总睡眠时间减少、睡眠效率和睡眠维持率降低、觉醒时间延长、觉醒次数和>5min的觉醒次数增加,以及非快速眼动睡眠期Ⅰ期所占比例增加、慢波睡眠和快速眼动睡眠期所占比例减少(均P<0.05);而两组患者睡眠潜伏期、快速眼动睡眠潜伏期、醒起时间、快速眼动睡眠次数、非快速眼动睡眠期Ⅱ期所占比例、呼吸暂停指数和睡眠呼吸暂停低通气指数比较,差异无统计学意义(均P>0.05)。13例(13/20)夜间惊恐发作患者伴焦虑症状、17例(17/20)伴抑郁症状;13例次(13/20)伴入睡困难、17例次(17/20)伴睡眠维持障碍(频繁觉醒和再度入睡困难)、7例次(7/20)伴早醒。结论夜间惊恐发作患者深睡眠减少、浅睡眠增加、睡眠质量差,且多伴有轻或中度焦虑和(或)抑郁症状及睡眠障碍。夜间多导睡眠图监测可用于排除易与夜间惊恐发作相混淆的疾病(如睡眠呼吸暂停综合征、梦魇)等,避免误诊。     

101例惊恐发作患者诊断归属及发作场所调查

目的:分析101例惊恐发作患者诊断归属及发作场所变化。方法:对101例惊恐发作患者以美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍用定式临床检查-临床版(SCID-CV)进行诊断;采用自制问卷调查发作情况。结果:符合DSM-Ⅳ惊恐障碍90例(89.1%),广泛性焦虑障碍6例(5.9%),抑郁障碍3例(2.9%),强迫障碍及精神分裂症各1例。90例惊恐障碍患者中,首次发作场所为家中50例,公共场所31例,途中9例;76.6%患者常在初次发生发作的场所发作,23.4%发作场所没有倾向性,仅1例发作场所固定。11例非惊恐障碍患者首发场所为家中3例,公共场所8例;此后发作场所均不固定。结论:约90%惊恐发作患者诊断为惊恐障碍,首次多发作于家中,并且倾向于在初次发作的场所发作;非惊恐障碍患者发作场所不固定。     

惊恐障碍症状严重度与昼夜节律

多数学者认为惊恐障碍的症状在日间加重,而早醒、抑郁症状早晨最重则是内源性抑郁的典型特征。本文调查惊恐障碍患者的广泛性焦虑、恐怖性焦虑和恐怖性回避症状昼夜变化和24小时内惊恐发作的分布情况。方法:共有40名惊恐障碍患者,均有长期惊恐发作史,符合DSM-Ⅲ-R惊恐障碍(伴或不伴广场恐怖症)诊断标准,其中六名在研究期间还符合重性抑郁诊断标准,予以删除,余下34名。其中20名曾有重症抑郁发作,另14名无。40名正常对照组都是国立精神卫     

惊恐障碍患者血清脂质水平的初步研究

探讨惊恐障碍患者的血脂水平及明确高胆固醇 (Tch)水平是否仅伴发于惊恐障碍或与其他精神障碍有关。　　方法　采用酶法测定在性别、年龄上相匹配的 3 0例惊恐障碍患者、3 0例抑郁症患者及 3 0例正常对照者的血清脂质水平。　　结果　惊恐障碍男患者的血清Tch水平明显高于抑郁症患者和正常对照者 ,稳定内科疾病与高血清Tch水平无关 ;在抑郁症组中 ,焦虑障碍史者的血清Tch水平显著增高。　　结论　提示惊恐障碍男患者的血清高Tch水平 ,可能涉及去甲肾上腺素或 5-羟色胺活性增高假说机制     

Gender differences in panic disorder: findings from the National Comorbidity Survey.

OBJECTIVE: Several epidemiological studies have demonstrated a higher prevalence of panic disorder in women than in men. This study explored whether the prevalence of specific panic symptoms differs by gender. METHOD: National Comorbidity Survey data from 609 respondents who met DSM-III-R criteria for panic disorder or panic attacks were analyzed to test for gender differences across 18 panic symptoms. RESULTS: Among National Comorbidity Survey respondents with panic disorder or panic attacks, female respondents were more likely than male respondents to experience respiration-related difficulties during panic attacks. CONCLUSIONS: Specific symptoms occurring during panic attacks differ by gender. The pathophysiology of these symptom differences may involve gender differences in sensitivity to CO(2) and in the threshold for panic attacks during hypoxic and hypercapnic states.     

Gender differences in patients with posttraumatic stress disorder in a general psychiatric practice.

OBJECTIVE: This report examined gender differences in the clinical manifestations of current posttraumatic stress disorder (PTSD) in treatment-seeking patients. METHOD: Outpatients with PTSD (N=138) were interviewed with the Structured Clinical Interview for DSM-IV. RESULTS: Compared with male patients, female patients experienced more reexperiencing symptoms and were more likely to meet criteria for current PTSD and to report sexual trauma as their index trauma. Men with PTSD were more likely than women with PTSD to meet criteria for a substance use disorder and for antisocial personality disorder. No gender differences were found in the frequency of other types of comorbid disorders, the number of comorbid disorders, or the presence of PTSD as a primary disorder. CONCLUSIONS: Overall, male and female patients with current PTSD present with fairly comparable clinical profiles.     

Sensitivity to seasonal changes in panic disorder patients

It has been suggested that symptoms of panic disorder may be significantly affected by seasonal factors including weather changes, although few studies have explored the issue. The purpose of the present paper was to investigate clinical data to examine sensitivity of panic disorder patients to seasonal changes and seasonal fluctuation of panic disorder symptoms. A self-rating questionnaire consisting of the Seasonal Pattern Assessment Questionnaire (SPAQ) and additional self-rating questions were analyzed in 146 Japanese patients (50 male, 96 female) with panic disorder (DSM-IV) at an outpatient clinic for anxiety disorder. The average of the Global Seasonality Scores (GSS) was 12.5+/-4.7 and 25.3% of the patients were suggested to suffer from seasonal affective disorder, according to the GSS. Frequency of the panic attack was found to fluctuate seasonally, with peaks in August and December (P=0.005 and 0.01, chi2 test). The present results indicate that panic disorder patients may be more sensitive to seasonal and meteorological factors than the general population and become more fragile in a specific season or months. This might assist in the development of preventive measures for the frequent recurrence of symptoms in panic disorder.     

Comorbid personality disorders in subjects with panic disorder: do personality disorders increase clinical severity?

Personality disorders are common in subjects with panic disorder. Personality disorders have been shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders affect clinical severity in subjects with panic disorder. This study included 122 adults (71 women, 41 men) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) criteria for panic disorder (with or without agoraphobia). Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and the Panic and Agoraphobia Scale, Global Assessment Functioning Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Patients who had a history of sexual abuse were assessed with Sexual Abuse Severity Scale. Logistic regressions were used to identify predictors of suicide attempts, suicidal ideation, sexual abuse, and early onset of disorder. The rates of comorbid Axes I and II psychiatric disorders were 80.3% and 33.9%, respectively, in patients with panic disorder. Patients with panic disorder with comorbid personality disorders had more severe anxiety, depression, and agoraphobia symptoms, had earlier ages at onset, and had lower levels of functioning. The rates of suicidal ideation and suicide attempts were 34.8% and 9.8%, respectively, in subjects with panic disorder. The rate of patients with panic disorder and a history of childhood sexual abuse was 12.5%. The predictor of sexual abuse was borderline personality disorder. The predictors of suicide attempt were comorbid paranoid and borderline personality disorders, and the predictors of suicidal ideation were comorbid major depression and avoidant personality disorder in subjects with panic disorder. In conclusion, this study documents that comorbid personality disorders increase the clinical severity of panic disorder. Borderline personality disorder may be the predictor of a history of sexual abuse and early onset in patients with panic disorder. Paranoid and borderline personality disorders may be associated with a high frequency of suicide attempts in patients with panic disorder.     

Obsessive-compulsive and panic symptoms in patients with first-admission psychosis

OBJECTIVE: The occurrence, persistence and specificity of the association between comorbid obsessive-compulsive and panic symptoms and three psychotic disorders--schizophrenia/schizoaffective disorder, bipolar disorder with psychosis, and major depression with psychosis--were examined in a first-admission, epidemiologically defined group of patients with psychotic symptoms. METHOD: The Structured Clinical Interview for DSM-III-R obsessive-compulsive and panic modules were administered at baseline and 24-month follow-up to patients with schizophrenia/schizoaffective disorder (N=225), bipolar disorder with psychosis (N=138), and major depression with psychosis (N=87) participating in the Suffolk County (N.Y.) Mental Health Project. The rates of subsyndromal symptoms and disorder criteria met were compared across the three psychosis groups. Recognition and treatment of anxiety symptoms at initial discharge and impact of the baseline presence of anxiety symptoms on 24-month clinical status were also examined. RESULTS: Obsessive-compulsive and panic symptoms were present at baseline in 10%-20% of all three groups. There was no specific association between obsessive-compulsive symptoms and any specific psychosis diagnosis; however, women with major depression with psychosis had a significantly higher rate of panic symptoms than the other two groups, and schizophrenia/schizoaffective disorder patients with baseline panic symptoms were significantly more likely to exhibit positive symptoms of psychosis after 24 months. CONCLUSIONS: The authors found no specific association between obsessive-compulsive symptoms and diagnosis early in the illness course, but the finding of an association between panic symptoms and psychotic depression among female patients and between baseline panic and positive psychotic symptoms in schizophrenia/schizoaffective disorder patients at 24 months suggests the need for further study.     

Increased response to a putative panicogenic nocebo administration in female patients with panic disorder

Experimental challenge studies may generate and test hypotheses regarding the pathophysiology of panic disorder and may serve to identify pathophysiologically relevant subtypes. It has been suggested that gender-related differences may be relevant in the development and maintenance of panic disorder. In a randomized double blind design the effects of placebo and sodium lactate administration in 14 female and 16 male patients with panic disorder and 23 healthy control subjects were compared using the Acute Panic Inventory (API) score and derived formal criteria for a panic attack. Panic attack frequency following sodium lactate was 76.6% in the patient group. Although control subjects had a lacate-induced increase in the API score as well, this effect was much weaker. No panic attacks occurred in patients with panic disorder or healthy control subjects receiving a placebo. However, a gender effect was observed in the putative panicogenic placebo condition: female patients with panic disorder had more subthreshold panic anxiety as measured with the API score. The data give evidence for an increased nocebo response in female patients with panic disorder.     

The relationship of panic disorder to agoraphobia

Twenty patients with agoraphobia or panic disorder were compared to each other using multiple variables of clinical illness. No differences were found. Only one of thirteen agoraphobic patients did not experience panic attacks. The agoraphobia symptoms never preceded the panic attacks in those twelve patients experiencing both agoraphobia and panic attacks. This study data and that of others is most consistent with the hypothesis that agoraphobia is a secondary manifestation of panic disorder.     

Association between a functional polymorphism in the progesterone receptor gene and panic disorder in women

Although genetic factors are known to be important risk factors for panic disorder there is as yet no conclusive data regarding specific gene variants. Prompted by evidence supporting progesterone to influence the pathophysiology of panic disorder, polymorphisms in the progesterone receptor gene, a single nucleotide polymorphism (G331A) and an insertion/deletion polymorphism (PROGINS) were investigated in 72 patients with panic disorder and 452 controls. The frequency of the A-allele of the G331A polymorphism was higher in panic disorder patients than in controls (p = 0.01). When male and female patients were analyzed separately, the association was observed in female patients only (p = 0.0009), with an odds ratio of 3.5. No differences between groups were observed for the PROGINS polymorphism. In conclusion, these data suggest that the G331A polymorphism in the progesterone receptor gene may influence the risk for panic disorder in women.     

Heightened embarrassability discriminates between panic disorder patients with and without agoraphobia

Embarrassability refers to an individual's general susceptibility to becoming embarrassed and is closely linked to another personality characteristic known as fear of negative evaluation. To find out if panic disorder patients with and without agoraphobia differ in terms of embarrassability and fear of negative evaluation 100 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia, 30 patients with a DSM-III-R diagnosis of uncomplicated panic disorder and 80 controls were administered the Embarrassability Scale and the 12-item version of the Fear of Negative Evaluation Scale. Depressive mood in the clinical group was assessed with the help of the Beck Depression Inventory. Comparisons between these three groups, between patients with mild, moderate, and severe phobic avoidance and between male and female subjects were carried out. Patients with agoraphobic avoidance showed significantly higher scores on both scales than patients with uncomplicated panic disorder and controls and women generally showed higher embarrassability scores than men. We conclude that heightened embarrassability is an important characteristic of patients suffering from panic disorder with agoraphobia.