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     

有无广场恐怖的惊恐障碍患者防御方式研究

目的:探讨伴与不伴广场恐怖的惊恐障碍患者的防御方式。方法:采用防御方式问卷(DSQ)对21例不伴广场恐怖的惊恐障碍患者、26例伴广场恐怖的惊恐障碍患者和37名健康对照者评估其防御方式。结果:与对照组比较,伴或不伴广场恐怖患者退缩和躯体化及伴无能之全能和交往倾向得分均显著增高,而幽默得分显著降低;伴广场恐怖的惊恐患者投射、分裂得分和不成熟防御方式总分,以及反作用形成、理想化、假性利他等得分及中间型防御方式总分也显著高于对照组,而成熟防御方式总分显著低于对照组。结论:伴与不伴广场恐怖的患者使用不成熟和中间防御方式增多,而使用成熟防御方式减少;伴广场恐怖患者尤其使用防御方式不当,且与其对场所恐怖的严重程度及病程无关。     

焦虑症与恐惧症的人格和临床特征的比较

目的探讨焦虑症和恐惧症的人格及临床特征的差异。方法研究对象为符合CCMD-3及DSM-IV的焦虑症(广泛性焦虑和惊恐障碍)和恐惧症(社交恐惧症和惊恐障碍伴广场恐怖),共74例。采用明尼苏达多相人格测定问卷(MMPI)和症状自评量表(SCL-90)对其人格特点和症状特征进行测评,并进行组间比较。结果①社交恐惧症组的MMPI精神分裂症和社会内向分显著高于广泛性焦虑、惊恐障碍和惊恐障碍伴广场恐怖组,②社交恐惧症组的SCL90强迫分和人际关系分、偏执分显著高于广泛性焦虑、惊恐障碍和惊恐障碍伴广场恐怖组,其焦虑分和总分显著高于广泛性焦虑组;广泛性焦虑组的恐怖分显著低于惊恐障碍和惊恐障碍伴广场恐怖组。结论①广泛性焦虑、惊恐障碍和惊恐障碍伴广场恐怖有着共同的人格基础,而与社交恐惧症有所不同;②社交恐惧症的症状评分最高,而广泛性焦虑症状评分最低。     

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。     

不同性别惊恐障碍患者的临床症状比较

目的 了解惊恐障碍患者临床症状的性别差异。方法 对连续门诊的54例男性惊恐障碍患者和46例女性惊恐障碍患者的临床症状进行对照比较。结果 在头晕/步态不稳或晕厥,震颤或发抖,恶心或腹部不适等3项症状上,在性别存在显著的差异(P<0 .05)。结论 惊恐障碍可能存在男、女不同的亚型。     

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     

单独应用丙咪嗪治疗惊恐症

目前认为自发性惊恐发作或是焦虑性神经症的一部份,或与广场恐怖症有关。Zitrin等发现广场恐怖病人的自发性惊恐和焦虑性神经症病人的惊恐发作有共同的特点,从而得出“从诊断角度看,这些患者属于焦虑性神经症”的结论。DSM-Ⅲ将不伴回避行为的自发性惊恐发作单独列为一项,称为惊恐症。过去用三环类药物结合心理治     

惊恐障碍患者血清胆固醇水平及与抗惊恐治疗关系的

研究惊恐障碍患者中的血清胆固醇水平及其与药物之间的关系。方法对３０例惊恐障碍患者与３０例年龄，性别相匹配的正常人治疗前后的胆固醇水平进行对照比较。男性惊恐障碍患者的血清胆固醇水平明显高于男性正常对照者；男性惊恐障碍患者在抗惊恐治疗后的胆固醇水平下降最为显著。     

惊恐发作与DST

三环抗抑郁剂和单胺氧化酶抑制剂(MAOI)对自发性惊恐发作有效。因为抑郁心境常伴有惊恐发作,所以抗抑郁剂有抑郁作用同时兼有抗惊恐发作的作用,因此认为惊恐发作与重性抑郁症有着相同的生物学改变。为进一步说明这种看法,本文选择了门诊51例诊断为伴有惊恐发作的广场恐怖的患者进行地塞米松抑制试验(DST)。方法:对51例惊恐发作患者用药物双盲试验方法进行研究。51例中女34,男17,年龄在21～61岁,平均37.6±10.3岁,首先接     

阿普唑仑血浓度与惊恐症疗效

阿普唑仑治疗惊恐相关障碍有效,但剂量范围较宽。这由多种原因造成,如①药物动力学差异;②惊恐相关障碍严重程度差异;③个体对阿普唑仑反应差异;④患者是否自服其他苯二氮(艹卓)类药。其中个体对阿普唑仑的药物动力学差异可能是主要因素。本文采用安慰剂对照实验,研究阿普唑仑剂量、血浓度与惊恐症疗效之间的关系。方法:入组对象为符合DSM-Ⅲ惊恐症和广场恐怖症伴惊恐发作诊断标准的患者,共96例,70%为女性,30%为男性,平均年龄37.1岁。患者随机分为三组:安慰剂组35     

Panic disorder with and without agoraphobia: comorbidity within a half-year of the onset of panic disorder

The present study was performed to compare the clinical features of patients with panic disorder with and without agoraphobia. The subjects were 233 outpatients with panic disorder (99 males and 134 females) diagnosed according to DSM-IV criteria. Sixty-three patients met the criteria for panic disorder without agoraphobia, and 170 met the criteria for panic disorder with agoraphobia. Patients with agoraphobia showed a significantly longer duration of panic disorder and higher prevalence of generalized anxiety disorder. However, there were no significant differences in prevalence of major depressive episodes, in current severity of panic attacks, or in gender ratio between the two groups. The second aim of the present study was to investigate the effects of onset age and sex differences on the development of agoraphobia within a half-year. The subjects were divided into two groups according to their self-report: patients who did or did not develop agoraphobia within 24 weeks of onset of panic disorder. A total of 40.6% of the patients developed agoraphobia within 24 weeks of the onset of panic disorder, and onset age and sex differences had no robust effect on the development of agoraphobia within 24 weeks.     

DSM-III-R Axis I and II disorders in agoraphobic patients with and without panic disorder

Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and II disorders, using the Structured Clinical Interview for DSM-III-R Disorders, and completed a set of self-report instruments. They were divided into 3 groups: (a) those who met the criteria for panic disorder with agoraphobia (n= 57), (b) those who met the criteria for agoraphobia without a history of panic disorder (n= 21), and (c) those who met criteria for other anxiety disorders, but not for panic/agoraphobia (n= 14). On Axis I, more of the panic with agoraphobia than of the agoraphobia without panic patients had obsessive-compulsive disorder. On Axis II, no significant differences between the agoraphobic patients with and without panic occurred. However, the number of hysterical traits was related to the presence of panic disorder among the agoraphobic patients. Avoidant and dependent traits were related to symptom severity.     

Panic disorder and suicidal ideation and behavior: discrepant findings in psychiatric outpatients

OBJECTIVE: Previous investigators found that persons who had ever met criteria for panic disorder or panic attacks reported more lifetime suicide attempts and ideation than persons who had ever met criteria for other psychiatric disorders. To determine whether outpatients with current panic disorders also report such differences, this study examined the suicide attempt rates, levels of suicidal ideation, and levels of hopelessness among four groups of psychiatric outpatients. METHOD: Structured clinical interviews were used to assign diagnoses to 900 consecutive psychiatric outpatients. These patients were administered the Scale for Suicide Ideation and the Beck Hopelessness Scale and were also questioned in detail about previous suicide attempts and past and present suicidal ideation. RESULTS: None (0.0%) of the 73 patients with primary panic disorder without agoraphobia reported having made suicide attempts during their lifetimes. One (1.3%) of the 78 patients who had panic disorder with agoraphobia, 34 (7.0%) of the 485 patients who had mood disorders, and four (1.5%) of the 264 patients who had other psychiatric disorders reported suicide attempts. The mean scores on the Scale for Suicide Ideation and the Beck Hopelessness Scale of the patients with panic disorders and other disorders were significantly lower than the mean scores of the patients with mood disorders. CONCLUSIONS: The rates of suicidal ideation and behavior for psychiatric outpatients who had panic disorders were discrepant with those reported by the earlier group of investigators for a random community sample of persons who reported ever having had panic attacks or met criteria for panic disorders.     

The relationship between panic disorder/agoraphobia and personality disorders

This selective review of the relationship between panic disorder/agoraphobia and DSM-III personality disorders points to a preponderance of dependent, avoidant, and histrionic features and reveals a certain degree of covariation between severity of Axis I disorder and personality functioning. However, the link between panic/agoraphobia and Axis II disorders does not appear to be specific because (1) general features such as neuroticism, stress, dysphoric mood, and interpersonal sensitivity, rather than duration and severity of panic attacks and phobias, emerge as unique predictors or determinants of personality disorder; and (2) similar personality profiles are obtained in a heterogenous population of psychiatric outpatients or patients with social phobia, obsessive-compulsive disorder, and major depression.     

Moderators and mediators among panic, agoraphobia symptoms, and suicidal ideation in patients with panic disorder

Objectives

The most important change of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is the use of dimensional approach to assess the severity of symptoms across different diagnosis. There are 2 purposes in this study: the first purpose was to identify the proportion of outpatients with panic disorder who have suicidal ideation. The second aim was to examine the relationships among panic, agoraphobic symptoms, and suicidal ideation in patients with panic disorder, adjusting by age, social support, and alcohol use.

Methods

Sixty patients with panic disorder were recruited from outpatient psychiatric clinics in southern Taiwan. Suicidal ideation in the preceding 2 weeks was measured. The Panic and Agoraphobic Symptoms Checklist, Social Support Scale, Questionnaire for Adverse Effects of Medication for Panic Disorder, and Social Status Rating Scale were used to understand the severity of panic and agoraphobia, social support, drug adverse effects, and social status. Significant variables from the univariate analysis were included in a forward regression model. Then, we used structural equation modeling to fit the model.

Results

We found that 31.7% of outpatients with panic disorder had had suicidal ideation in the preceding 2 weeks. Multiple regression analysis showed that younger age, current alcohol use, more severe panic symptoms, and less social support were associated with suicidal ideation. In addition, the structural equation model illustrated the recursive model from panic to agoraphobia and suicidal ideation. Agoraphobia had no association with suicidal ideation. Panic symptom was a mediator to suicidal ideation but not agoraphobic symptoms.

Conclusions

A high proportion of patients with panic disorder had suicidal ideation. We found that panic symptoms, social support, age, and alcohol use affected suicide and could be identified. The 3-level model from panic to agoraphobia revealed that panic was a predictor of agoraphobia and agoraphobia was not a predictor of panic. This verified the evolution of the diagnostic view of the DSM. Panic symptom was a mediator to suicidal ideation. With the dimensional model in DSM-V, panic symptoms can be used as a marker for greater morbidity and severity.     

Age at onset, precipitating events, sex distribution, and co-occurrence of anxiety disorders.

178 outpatients were administered to a structured interview evaluating diagnostic, illness history, and sociodemographic data of DSM-III-R anxiety disorders. Patients with panic disorder with agoraphobia were a more severely ill subgroup than patients with panic disorder without agoraphobia. Simple and social phobia had the earliest age at onset, panic disorder the latest age at onset. Conjugal stress was the most frequent event preceding the onset of the anxiety disorders. Female patients showed more severe impairment suffering more frequently from concomitant phobic avoidance, generalized anxiety, and depression compared to male patients.     

Cognitive-behavior therapy for Japanese patients with panic disorder: acute phase and one-year follow-up results

Aim:  The aim of this paper is to report the outcomes and follow-up data of our cognitive behavioral therapy program for Japanese patients with panic disorder and to examine the baseline predictors of their outcomes.
Methods:  Seventy outpatients with panic disorder with or without agoraphobia were treated with manualized group cognitive behavioral therapy.
Results:  Fourteen patients (20%) did not complete the program. Among the completers, the average Panic Disorder Severity Scale score fell from 12.8 at baseline to 7.1 post-therapy (44.7% reduction). This effectiveness was sustained for 1 year. While controlling for the baseline severity, the duration of illness and the baseline social dysfunction emerged as significant predictors of the outcome.
Conclusions:  Our data suggest that group cognitive behavioral therapy for panic disorder can bring about as much symptom reduction among Japanese patients with panic disorder as among Western patients.     

The relationships among separation anxiety disorder,adult attachment style and agoraphobia in patients with panic disorder

Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to examine these questions. A sample of 141 adult outpatients with panic disorder participated in the study. Participants completed standardized measures of separation anxiety, attachment style, agoraphobia, panic disorder severity and quality of life. Patients with ASAD (49.5% of our sample) had greater panic symptom severity and more impairment in quality of life than those without separation anxiety. We found a greater rate of symptoms suggestive of anxious attachment among panic patients with ASAD compared to those without ASAD. However, the relationship between ASAD and attachment style is not strong, and adult ASAD occurs in some patients who report secure attachment style. Similarly, there is little evidence for the idea that separation anxiety disorder is a form of agoraphobia. Factor analysis shows clear differentiation of agoraphobic and separation anxiety symptoms. Our data corroborate the notion that ASAD is a distinct condition associated with impairment in quality of life and needs to be better recognized and treated in patients with panic disorder.     

Association Study between 5-HT1A Receptor Gene C(-1019)G Polymorphism and Panic Disorder in a Korean Population

Objective

Serotonergic dysfunction is quite evident in panic disorder. We investigated whether the C(-1019)G polymorphism of 5-HT1A receptor gene may play a role in the pathogenesis of panic disorder in a Korean population.

Methods

The 5-HT1A receptor genotype for the single nucleotide polymorphism (SNP) C(-1019)G was analyzed in 94 patients and 111 healthy controls. The severity of the patients'' symptoms was examined using the Spielberger State-Trait Anxiety Inventory (STAI), Panic Disorder Severity Scale (PDSS), Anxiety sensitivity index (ASI), Acute Panic Inventory (API) and Hamilton''s Rating Scale for Anxiety (HAM-A).

Results

The distribution of the genotypes of the C/G polymorphism did not differ significantly from those predicted by Hardy-Weinberg equilibrium in patients as well as the controls. No association between the C(-1019)G polymorphism and panic disorder was detected in either the allele frequency or genotype distribution. There was no significant association with genotype distribution in the panic disorder with agoraphobia. However, there was a significant difference of symptom severity between C/C, C/G, and G/G genotype or between C and G allele in panic disorder patients without agoraphobia. PDSS scores were significantly higher in subjects with the G/G genotype or with G allele in patients without agoraphobia, not in total patients or patients with agoraphobia.

Conclusion

Although there were no significant differences in the genotype and allele distributions, we found a significant association between panic symptom severity and the serotonin 1A receptor gene. This result suggests that the serotonin 1A receptor and serotonin may play a role in the pathogenesis of panic disorder.     

Pathological worry, anxiety disorders and the impact of co-occurrence with depressive and other anxiety disorders

The Penn State Worry Questionnaire (PSWQ) was administered to 123 outpatients with principal diagnoses of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with agoraphobia, and panic disorder without agoraphobia (PD) to examine the specificity of pathological worry for GAD. The mean PSWQ scores in patients with GAD and SAD were significantly higher than the mean PSWQ scores in patients with PD, while not differing significantly in the subgroups without any co-occurring depressive or anxiety disorders. Patients with any co-occurring depressive or anxiety disorder scored significantly higher on the PSWQ. In a logistic regression analysis, high PSWQ scores independently predicted only GAD and SAD diagnoses. The study suggests that pathological worry is specific not only for GAD, and indicates that a significant relationship exists between pathological worry, GAD and SAD, and that depressive and anxiety disorders co-occurrence increases levels of pathological worry in patients with anxiety disorders.