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     

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。     

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。     

惊恐障碍的临床研究进展

本介绍了近年来国外有关惊恐障碍临床研究的一些进展,着重介绍了惊恐谱系障碍的概念以及诊断与鉴别诊断。     

50例惊恐障碍的临床特征分析

惊恐障碍(panic disorder,PD)病人的临床表现均以躯体症状为主述,故常首诊于综合医院的各科,由于医生对此症了解较少,常因处理不当而贻误诊断。为此,现就我院收集的50例惊恐障碍病人的临床特点及治疗作一分析,现报道于后。     

认知行为疗法配合药物治疗惊恐障碍临床疗效比较

惊恐障碍起病急,恐惧症状明显,发作后心有余悸。在药物控制急性症状后仍存在认知障碍,常曲解其躯体感受或心理体验。需及时加以疏导。本文运用认知行为疗法配合药物治疗惊恐障碍,并与单用药物治疗进行了疗效比较,现报告如下：     

惊恐障碍30例临床分析

作者总结了３０例惊恐障碍患者的临床资料，多见于青年无明显发病诱因，女多于男。并对症状特点、诊断问题、发病机制、治疗等提出讨论。     

惊恐障碍患者心率变异性的研究进展

惊恐障碍是一种常见的精神障碍,常伴有自主神经系统功能失调。心率变异性是评估自 主神经系统功能的重要指标,该指标降低被认为是自主神经系统功能异常的体现。本文总结了惊恐障 碍患者与健康人群、其他焦虑障碍患者和心血管疾病患者在心率变异性方面的差异,回顾了药物和心 理治疗对惊恐障碍患者心率变异性的影响,旨在为有效治疗惊恐障碍提供参考。     

惊恐障碍患者的血脂浓度研究

血胆固醇(Tch)浓度过高是引起心血管疾病的主要危险因素之一,许多研究表明急性应激状态可使血清Tch和游离脂肪酸水平升高。Hayward等(1989)也发现,患惊恐障碍或广场恐怖症的女病人,其Tch值高于正常水平,在她们之中发生心血管疾病的危险性较大。为进一步研究惊恐障碍患者的血清脂质浓度,本文测定30例惊恐障碍患者的血脂浓度,并与正常对照者作一比较。     

Clinical Characteristics of the Respiratory Subtype in Panic Disorder Patients

Objective

Panic disorder has been suggested to be divided into the respiratory and non-respiratory subtypes in terms of its clinical presentations. The present study aimed to investigate whether there are any differences in treatment response and clinical characteristics between the respiratory and non-respiratory subtypes of panic disorder patients.

Methods

Among the 48 patients those who completed the study, 25 panic disorder patients were classified as the respiratory subtype, whereas 23 panic disorder patients were classified as the non-respiratory subtype. All patients were treated with escitalopram or paroxetine for 12 weeks. We measured clinical and psychological characteristics before and after pharmacotherapy using the Panic Disorder Severity Scale (PDSS), Albany Panic and Phobic Questionnaire (APPQ), Anxiety Sensitivity Index-Revised (ASI-R), State-Trait Anxiety Inventory (STAI-T, STAI-S), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D).

Results

The prevalence of the agoraphobia was significantly higher in the respiratory group than the non-respiratory group although there were no differences in gender and medication between the two groups. The respiratory group showed higher scores on the fear of respiratory symptoms of the ASI-R. In addition, after pharmacotherapy, the respiratory group showed more improvement in panic symptoms than the non-respiratory group.

Conclusion

Panic disorder patients with the respiratory subtype showed more severe clinical presentations, but a greater treatment response to SSRIs than those with non-respiratory subtype. Thus, classification of panic disorder patients as respiratory and non-respiratory subtypes may be useful to predict clinical course and treatment response to SSRIs.     

Clinical Experience with Mirtazapine in the Treatment of Panic Disorder

Data from treatment trials and biological challenge studies implicate involvement of both the serotonergic and the noradrenergic neurotransmitter systems in the pathophysiology of panic disorder. Mirtazapine, a newer antidepressant with a novel mechanism of action enhancing both norepinephrine and serotonin levels without reuptake inhibition, is a good candidate for the treatment of panic disorder. Ten adult outpatients with a primary diagnosis of panic disorder were treated openly with mirtazapine. Starting dose and titration were determined by individual clinical characteristics. Data on emergent side effects and clinical response were obtained at all follow-up visits, which typically occurred biweekly for 16 weeks. At the first follow-up visit (week 2–3), 4 of 10 patients met the criteria for response. Based on all available data, seven of the original sample demonstrated an acute response (defined as CGI = 2 or 3) by weeks 5–7, and six continued to have a positive long-term response at the 16-week end point. Side effects were reported by seven patients, with increased appetite and weight gain the most common. Prominent antihistaminic side effects such as sedation, enhanced appetite, and anxiolysis were often desired in the initial phase of treatment.     

Orbito-Frontal Cortex Volumes in Panic Disorder

Objective

Given the association between the pathophysiology of panic disorder and prefrontal cortex function, we aimed to perform a volumetric MRI study in patients with panic disorder and healthy controls focusing on the in vivo neuroanatomy of the OFC.

Methods

Twenty right-handed patients with panic disorder and 20 right-handed healthy control subjects were studied. The volumes of whole brain, total white and gray matters, and OFC were measured by using T1-weighted coronal MRI images, with 1.5-mm-thick slices, at 1.5T. In addition, for psychological valuation, Hamilton Depression Rating (HDRS) and Panic Agoraphobia Scales (PAS) were administered.

Results

Unadjusted mean volumes of the whole brain volume, total white and gray matter were not different between the patients and healthy controls while the patient group had significantly smaller left (t=-6.70, p<0.0001) and right (t=-5.86, p<0.0001) OFC volumes compared with healthy controls.

Conclusion

Our findings indicate an alteration of OFC morphology in the panic disorder and suggest that OFC abnormalities may be involved in the pathophysiology of panic disorder.     

Panic Disorder, Panic Attacks and Panic Attack Symptoms across Race-Ethnic Groups: Results of the Collaborative Psychiatric Epidemiology Studies

The current study investigates race-ethnic differences in rates of panic disorder, panic attacks and certain panic attack symptoms by jointly combining three major national epidemiological databases. The compared groups were White, African American, Latino and Asian. The White group had significantly higher rates of panic disorder, and of many panic symptoms, including palpitations, as compared to the African American, Asian and Latino groups. Several expected race-ethnic differences were not found. An explanation for these findings are adduced, and suggestions are given for future studies so that possible ethnic-racial differences in panic disorder, panic attacks and panic attack symptoms can be investigated in a more rigorous manner.     

Panic Disorder in Clinically Referred Children and Adolescents

The present study examined the frequency and characteristics of panic disorder in children and adolescents who had been referred to a pediatric psychopharmacology clinic. Of the 280 children and adolescents evaluated in this clinic, 35 were diagnosed with panic disorder using a semi-structured clinical interview (K-SADS) and other objective measures. Approximately half of the youngsters with panic disorder also met criteria for the diagnosis of agoraphobia. There was extensive comorbidity between panic disorder and other internalizing and externalizing disorders. Parents reported clinically significant levels of child symptomatology on the CBCL. Teacher-and child-reported symptomatology on the CBCL was within the normal range. At the same time, it was notable that no child had been referred specifically for evaluation or treatment of panic disorder or agoraphobia. Implications for clinical assessment/identification and treatment are discussed. This paper was presented at the 39th Annual Convention of the Association for Behavioral and Cognitive Therapies, November 18, 2005, Washington, DC.     

Functional Impairment in Patients with Panic Disorder

Objective Anxiety and depression and sociodemographic factors such as age, gender, education level, income, and marital status among people with panic disorder (PD) are associated with functional impairment in the areas of work, social, and family. Although both PD-specific scales such as the Panic Disorder Severity Scale (PDSS) and Anxiety Sensitivity Inventory-Revised (ASI-R) and early trauma have been investigated, their relationship with functional impairment in PD patients has not been clarified. Methods This study included 267 PD patients. The PDSS, Beck Depression Inventory (BDI), ASI-R, and Early Trauma Inventory were used. Pearson’s correlation and multiple linear regression analyses were performed. The Sheehan Disability Scale (SDS) was administered to assess the functional impairment level in PD patients. Results Our findings showed that high levels of PDSS, BDI, and ASI-R were significantly correlated with the functional impairment among PD patients. Multiple regression analyses showed that PDSS, BDI, and ASI-R can predict the functional impairment levels, and PDSS and ASI-R were significantly associated with lost and underproductive days in PD patients. Conclusion Panic-specific symptoms, depression, and AS are associated with functional impairment level in PD patients. Elevated symptom severity can play a role by affecting productivity and daily responsibilities in PD patients.     

Relationship between Personality and Insomnia in Panic Disorder Patients

Objective

Panic disorder (PD) is frequently comorbid with insomnia, which could exacerbate panic symptoms and contribute to PD relapse. Research has suggested that characteristics are implicated in both PD and insomnia. However, there are no reports examining whether temperament and character affect insomnia in PD. Thus, we examined the relationship between insomnia and personality characteristics in PD patients.

Methods

Participants were 101 patients, recruited from 6 university hospitals in Korea, who met the DSM-IV-TR criteria for PD. We assessed sleep outcomes using the sleep items of 17-item Hamilton Depression Rating Scale (HAMD-17)(item 4=onset latency, item 5=middle awakening, and item 6=early awakening) and used the Cloninger''s Temperament and Character Inventory-Revised-Short to assess personality characteristics. To examine the relationship between personality and insomnia, we used analysis of variance with age, sex, and severity of depression (total HAMD scores minus sum of the three sleep items) as the covariates.

Results

There were no statistical differences (p>0.1) in demographic and clinical data between patients with and without insomnia. Initial insomnia (delayed sleep onset) correlated to a high score on the temperamental dimension of novelty seeking 3 (NS3)(F_1,96=6.93, p=0.03). There were no statistical differences (p>0.1) in NS3 between patients with and without middle or terminal insomnia.

Conclusion

The present study suggests that higher NS3 is related to the development of initial insomnia in PD and that temperament and character should be considered when assessing sleep problems in PD patients.     

Frontoparietal Cortical Thinning in Respiratory-Type Panic Disorder: A Preliminary Report

ObjectiveMany evidences raise the possibility that the panic disorder (PD) patients with respiratory subtype (RS) may have characteristic structural abnormalities. We aimed to explore the structural differences between PD patients with and without the respiratory symptoms.MethodsPatients with PD were recruited from the Department of Psychiatry at Korea University Anam Hospital. Respiratory subtype (RS) was diagnosed when at least 4 out of 5 of the following respiratory symptoms were present during the panic attack: fear of dying, chest pain/discomfort, shortness of breath, paresthesias, and a choking sensation. We acquired high-resolution MRI scans and used FreeSurfer to obtain a measure of cortical thickness for each patient.ResultsCluster based analysis revealed significantly decreased cortical thickness in the left hemisphere in the caudal-middle-frontal, superior frontal, and posterior parietal areas in the RS group. No significant difference was observed in any of the limbic areas.ConclusionRespiratory symptoms of panic disorder were associated with a reduction in cortical thickness in the left frontal and parietal areas. This finding leads to the assumption that the frontoparietal network is the crucial component in a larger cortical network underlying the perception of dyspnea in RS.     

The Effect of Agoraphobia on Oxidative Stress in Panic Disorder

We aimed to investigate whether agoraphobia (A) in panic disorder (PD) has any effects on oxidative and anti-oxidative parameters. We measured total antioxidant capacity (TAC), paraoxonase (PON), arylesterase (ARE) antioxidant and malondialdehyde (MDA) oxidant levels using blood samples from a total of 31 PD patients with A, 22 PD patients without A and 53 control group subjects. There was a significant difference between the TAC, PON, ARE and MDA levels of the three groups consisting of PD with A, PD without A and the control group. The two-way comparison to clarify the group creating the difference showed that the TAC, PON, and ARE antioxidants were significantly lower in the PD with A group compared to the control group while the MDA oxidant was significantly higher. There was no significant difference between the PD without A and control groups for TAC, PON, ARE and MDA levels. We clearly demonstrated that the oxidative stress and damage to the anti-oxidative mechanism are significantly higher in the PD group with A. These findings suggest that oxidative/anti-oxidative mechanisms may play a more important role on the pathogenesis of PB with A.     

Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder

Objective

Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

Methods

We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

Results

There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

Conclusion

IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.