惊恐发作的临床及误诊

对28例符合CCMD－2惊恐发作诊断标准的患者进行临床分析，并对误诊原因做了探讨。     

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。     

艾司西酞普兰致惊恐发作1例报道

<正>1 病例患者,男性,65岁,个体,因情绪低落,兴趣减退1年,加重1个月于2018年6月住我院。既往体健,无精神病史;个性急躁、敏感,做事特别认真;无精神疾病家族史。入院查体:生命体征平稳,心肺及腹部查体阴性,神经系统未及阳性体征。精神检查:意识清,愁眉苦脸,接触交谈被动,情绪显低落,有明显能力减退感,兴趣减退,愉悦感缺失,有消极意念。否认既往及病中有过明显兴奋、话多、吹牛及乱花钱等现象。否认幻觉妄想,智能定向可。自知力存在。辅助     

疑病症与惊恐发作关系研究

目的 了解疑病症与惊恐发作并存情况;方法 研究对象门诊随机取样入组,符合CCMD-2-R疑病症、惊恐发作诊断标准,门诊随访6个月;结果 疑病症与惊恐发作并存率为34％,显著高于惊恐发作终生患病率3.6％、惊恐障碍终生患病率1.5％;结论 疑病症与惊恐发作并存率很高,二者可能有共同的生物精神病学基础:5-TH功能障碍、植物神经功能应激性增高及心理认知功能障碍。     

惊恐发作患者的心脏超声与动态心电监测

对25例惊恐发作的住院病人,进行心脏超声诊断和24小时动态心电图监测。结果发现25例惊恐发作病人的心脏超声表明各腔室内径、各瓣膜形态及活动,以及心功能均基本属正常范围,无二尖瓣脱垂发生。24小时动态心电图监测,19例病人有心脏早搏现象,但早搏次数基本在正常许可范围内。     

颖病症与惊恐发作关系研究

目的 了解颖病症与惊恐发作并存情况;方法 研究对象门诊随机取样入组,符合ＣＣＭＤ－２－Ｒ颖病症、惊恐发作诊断标准,门诊随访６个月;结果 颖病症与惊恐发作并存率为３４％,显著高于惊恐发作终生患病率３．６％、惊恐障碍终生患病率１．５％;结论 颖病症与惊恐发作并存率很高,二者可能有共同的生物精神病学基础：５－ＴＨ功能障碍、植物神经功能应激性增高及心理认知功能障碍。     

惊恐障碍病因及发病机制的研究进展

惊恐障碍（panicdisorder，PD）是以反复惊恐发作为特征的一种急性焦虑障碍。PD年患病率可达2．7％，而终生患病率可高达4．7％，占全球疾病负担的比重日益增加，有关PD的基础与临床研究日益成为神经精神领域关注的焦点。[第一段]     

惊恐障碍患者就医情况调查

惊恐障碍（PD）患者初次至专科医院就诊的很少,误诊或漏诊较多。我们就惊恐障碍患者就医情况进行调查。     

焦虑敏感性和惊恐障碍

焦虑敏感性（AS）是由个体对焦虑产生的消极后果的恐惧产生的,是一个有倾向性的变量,大部分用焦虑敏感性指数（ASI）测量。本文对国外焦虑敏感性做了一个总结,主要涉及到焦虑敏感性的定义、测量、焦虑敏感性与精神病以及惊恐发作的关系等几个方面,而在焦虑敏感性的临床应用上,研究表明认知行为疗法和丙咪嗪都能够降低惊恐患者的焦虑敏感性,但认知行为疗法能防止复发。     

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。     

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 disorders 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. Depression and Anxiety 9:19–26, 1999. © 1999 Wiley-Liss, Inc.     

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.     

Coping behavior in patients with panic disorder

The purpose of the present paper was to investigate the role of coping behavior in patients with panic disorder (PD). This was done by evaluating three items of coping behavior (seeking of social support, wishful thinking and avoidance) in the Ways of Coping Checklist. The subjects consisted of 30 patients with PD (26 with agoraphobia). Coping behavior and the severity of PD was investigated at baseline and at 24 months (the final outcome). At baseline there were no gender differences in coping behavior. The severity of panic attacks significantly correlated with that of agoraphobia. The baseline severity of PD (panic attacks and agoraphobia) did not correlate with coping behavior. At the outcome assessment there was no significant correlation between the severity of panic attack and coping behavior. The severity of agoraphobia at final outcome and the coping behavior (seeking of social support) at baseline were significantly correlated. In the group that had remission in agoraphobia (the good outcome group), the severity of agoraphobia at baseline was significantly lower and the seeking of social support coping behavior was significantly higher than that of the poor outcome group. No significant difference in panic attack severity was noted between the good and poor outcome groups. Discriminant analysis revealed that seeking of social support coping behavior was a significant discriminant factor of agoraphobia. Although these are preliminary data, special coping behavior might be related to improvement of agoraphobia in patients with PD.     

Can cannabis trigger recurrent panic attacks in susceptible patients?

Cannabis has been reported to produce acute psychiatric reactions, among these panic anxiety and derealization, which are self-limited. We report on three patients who experienced an initial panic attack during cannabis intake. Anxiety attacks reoccurred after the cessation of intake. Two of these patients had a current depressive disorder, one of them had a single Grand Mal seizure before the onset. We suggest that cannabis may trigger the emergence of recurrent panic attacks and uncover latent panic disorders in vulnerable persons.     

Semiology and subtyping of panic disorders

To date, the quantitative psychopathology of panic disorder (PD) has been less well studied than that of other psychiatric conditions such as schizophrenia or major depression. The aim of the present study was to assess the frequency and factorial grouping of symptoms in a naturalistic sample of PD patients. A total of 274 consecutive cases of PD who contacted an out-patient clinic in Barcelona, Spain were assessed by two experienced interviewers. The assessment instruments included the Structured Clinical Interview for DSM-III-R Upjohn version (SCID-UP-R) and an inventory of panic attack symptoms based on DSM-III-R. Of the patients who presented at the unit during the assessment period, 8.5% presented with PD. Palpitations, shortness of breath, fear of dying and dizziness were the most frequent and intense symptoms reported by the PD patients. Principal-component analysis revealed four factors which accounted for 57% of the variance, including‘cardiorespiratory’(26.1%) and‘vestibular’(15.1%) factors, and two additional factors with mixed symptoms. The frequency of presentation of symptoms was similar to that reported in other studies. However, some discrepancies were observed that may be attributed to transcultural differences as well as to terminological problems and the range of symptoms assessed. These factors may also explain some of the differences found in factor analysis groupings in previous studies. Our findings support the symptom subtyping of PD.     

Continuous monitoring of panic

Data on naturally occurring panic attacks were gathered through continuous self-monitoring for 94 patients suffering from panic disorder with agoraphobia. A total of 1276 panic attacks were collected. In this article various aspects of panic attacks, including severity, duration and time of onset and situations in which panic occurs are addressed. In addition, the symptoms of panic were investigated, examining the (in)variability of attacks within each patient and the patterning of symptoms in the entire group of patients. The most important findings were as follows: attacks occurred predominantly in nonphobic situations; nocturnal panic attacks were generally more severe than attacks during the day; symptom patterns across various attacks, stemming from the same patient, were rather variable; and finally, a substantial number of the attacks (40%) did not meet the DSM-III-R criteria for number of symptoms.     

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.     

Differences in symptom structure between panic attack and limited symptom panic attack: A study using cluster analysis

Abstract We had investigated the clinical characteristics of panic disorder (PD) in a Japanese outpatient population comprised of more than 250 patients diagnosed as having PD during a 13-year study period and observed that some PD patients had both panic attacks (PA) and limited symptom panic attacks (LPA). In the criteria for PD based on the Diagnostic and Statistics Manual of Mental Disorders , third edition-revised ( DSM-III-R ), episodes involving four or more symptoms are classified as PA, while those involving fewer than four symptoms are described as LPA. Therefore, LPA is identified as part of an episode of PA, since the difference between the two episodes is only in the number of symptoms. However, some recent research suggests that there is a distinct subgroup of individuals who suffer LPA. Using cluster analysis, we investigated the differences between PA and LPA groups in terms of the structures of several panic symptoms, which included anticipatory anxiety, agoraphobia and 13 clinical symptoms based on the DSM-III-R at the time of panic attacks, in 247 patients with PD. Cluster analysis revealed clusters of three and four panic symptoms in the PA group and LPA group, respectively, and there were also differences in symptom structure between the two groups. These results suggest that there may be a subgroup of individuals who show LPA among PD patients.     

Lactate-induced panic attacks: possible involvement of serotonin reuptake stimulation

In panic disorder patients, panic attacks can be precipitated with great regularity by intravenous infusion of lactate. The mechanism behind this effect, as well as the mechanism behind the spontaneously occurring panic attacks, are unknown, however. The author draws attention to the fact that lactate as well as pyruvate stimulate serotonin uptake in human blood platelets, and suggests that lactate infusion may stimulate serotonin reuptake also in central serotonergic neurons, thereby decreasing serotonergic activity. This may possibly induce anxiety by reducing the inhibitory serotonergic influence on locus ceruleus. This mechanism--which may not be the only one involved in lactate-induced panic attacks--would easily explain the effect of tricyclic antidepressants, like imipramine, against lactate-induced panic.