Diagnosis of panic disorder in prepubertal children

Few reports on panic disorder in children are available, despite the retrospectively documented onset in childhood of about 20% of the cases of adult panic disorder. The authors report on six prepubertal children, aged 8 to 13 years, who met DSM-III-R criteria for adult-type panic disorder. Hyperthyroidism, cardiologic, and respiratory problems were excluded as well as abuse of caffeine or other drugs. The first panic attack occurred between 5 to 11 years of age, with an average interval of 3 years between onset of the disorder and diagnosis. Mitral valve prolapse was documented in two cases. Family history was always positive for panic disorder. Although not common, panic disorder should be considered in children with school phobia and positive family history. As it is in adults, mitral valve prolapse may be associated with panic disorder in children.     

Life events and the onset of panic disorder

The authors examined the number, type, and effect of life events during the year before the onset of panic attacks in 44 patients with a Research Diagnostic Criteria diagnosis of panic disorder and 44 healthy control subjects matched for age, sex, and time of retrospection. The patients had significantly more life events, and these events had a more adverse impact on them. Furthermore, the types of events experienced by the patients were more typically distressing than those experienced by the control subjects. The patients reported events involving moves to other neighborhoods and/or cities far more frequently than did the control subjects.     

Interpersonal problem areas and onset of panic disorder

BACKGROUND: Numerous studies indicate that stressful life events are key precipitants of psychological disturbances. Severe stress often precedes the onset or exacerbation of illness in vulnerable individuals and may be of primary importance in the genesis of some mental disorders. Several authors have suggested that major life events play a role in the development of panic-related symptoms. The aim of this study was to examine the presence of stressful life events, in particular events focused in the interpersonal psychotherapy problem areas (grief, role disputes, role transitions, interpersonal deficits), in patients suffering from panic disorder. METHODS: We interviewed 55 patients suffering from panic disorder, with or without agoraphobia, in accordance with the diagnostic criteria specified in MINI PLUS. The panic attack profile was evaluated with the Panic Attack and Anticipatory Anxiety Scale. We assessed the ability to adapt to and derive satisfaction from the social environment with the Social Adjustment Scale Self Report and interpersonal problems with Interpersonal Questionnaire. RESULTS: Using the Interpersonal Questionnaire we found that all subjects had had relevant interpersonal problems in the year preceding the onset of PD: 92.7% had experienced a role transition, 85.5% interpersonal deficits, 74.5% a role dispute and 38.2% had suffered the loss of a relative or significant other. These results were confirmed by Paykel's scale, on which the whole sample reported a high frequency of life events in the 6 months before onset of illness. These preliminary data suggest a rationale for the therapeutic strategies of interpersonal psychotherapy in individuals with panic disorder.     

Chronology of panic and avoidance,age of onset in panic disorder,and prediction of treatment response

Summary The relevance of the chronology between panic disorder and avoidance behavior and of an early, medium or late onset of panic disorder was tested. Groups from the sample of the cross-national collaborative panic study (CNCPS) were compared for differences in basic characteristics and for the ability to predict treatment response. Patients who developed avoidance behavior before the full syndrome of panic disorder had less often a full agoraphobia but were not different in their response to treatment. Patients with an early onset of panic disorder suffered more often from agoraphobia. The treatment response was similar in the groups with early, medium or late onset of panic disorder. Neither the chronology between panic disorder and avoidance behavior nor the age of onset of panic disorder predicted outcome in short-term treatment with alprazolam or impiramine.     

Gender-related differences in the onset of panic disorder

OBJECTIVE: To investigate gender-related differences in premorbid conditions and in the role of triggering events in the onset of panic disorder (PD). METHOD: One hundred and eighty-four out-patients with a principal diagnosis of PD (DSM-IV) were evaluated with a semi-structured interview to generate Axis I and Axis II diagnoses according to DSM-IV, to collect family history of psychiatric disorders and life events. The statistical analysis was performed comparing men and women. RESULTS: Men and women showed similar age at onset of PD. A family history of mood disorders characterized females. Men had higher rates of cyclothymia, body dysmorphic disorder and depersonalization disorder preceding PD, while women had higher rates of bulimia nervosa. Dependent and histrionic PDs were more common among women, while borderline and schizoid PDs were more common among men. Life events showed a significant role in precipitating PD onset in women. CONCLUSION: Premorbid clinical conditions of PD seem to differentiate between males and females in the role of precipitating events.     

Sleepwalking and night terrors: psychopathological and psychophysiological correlates

Sleepwalking and night terrors are considered to be manifestations of the same nosologic continuum. It has been proposed that a sudden arousal from non-rapid eye movement (NREM) sleep is the cause of these disorders. Benign forms of NREM arousal parasomnias occur frequently in childhood and attenuate in teen years; however, they can persist into or begin in adulthood. The available literature documents high levels of psychopathology in adult patients. Sleepwalking and night terrors are most likely to manifest during the first episode of slow wave sleep, but may also appear any time during NREM sleep. The hypersynchronous delta activity, previously considered to be a hallmark of somnambulism, has proven to be unspecific. Post-arousal EEG activity reveals altered consciousness during sleepwalking and sleep terror episodes. Pathophysiology of NREM arousal parasomnias consists of predisposing factors, which may be a genetically determined tendency for deep sleep, facilitating factors which deepen sleep and increase slow wave sleep, and triggering factors which increase sleep fragmentation, such as stress, environmental or endogenous stimuli, and stimulants. Recently published data on low delta power in the first sleep cycle and slow decline of delta power in successive sleep cycles suggest a chronic inability to sustain slow wave sleep.     

Thyroid hormones in panic disorder, panic disorder with agoraphobia, and generalized anxiety disorder

Fifty-two patients with generalized anxiety disorder who had symptoms persisting for at least 6 months, 41 patients suffering from either panic disorder (32 patients) or panic disorder with agoraphobia (9 patients), and 14 control subjects were screened for thyroid disease. Total serum thyroxine (TT4), serum-free thyroxine index (FT4I), and triiodothyronine resin uptake (T3RU), were examined for the entire sample, using a one-way analysis of variance (ANOVA). No significant differences were found in TT4 (p = .24), FT4I (p = .24), and T3RU (p = .19). Thyroid-stimulating hormone (TSH) was examined in a subsample of 10 patients with generalized anxiety disorder, 11 with panic disorder or panic disorder with agoraphobia, and 10 controls. One-way ANOVA again showed no significant differences, although there was a trend (p = .07). This is the first report that compares generalized anxiety disorder patients, panic disorder patients, and patients with panic disorder and agoraphobia with controls on measures of thyroid function. It is also the first to report normal values in the thyroid indices of generalized anxiety disorder patients.     

Late-life onset of panic disorder with agoraphobia in three patients

Although the onset of panic disorder with agoraphobia is usually thought to occur in early adulthood, the authors describe three cases in which onset occurred after age 65.     

Simultaneous panic and depressive disorder: response to antidepressant treatments

Recent publications have stressed the relevance of the simultaneous panic disorder and major depressive disorder (MDD) diagnosis from various aspects, including clinical, therapeutic and prognostic, incidence of family psychopathology, and biologic differences. Treatment outcome measures (Hamilton Depression Rating Scale scores and treatment response) were compared in two groups of patients; one group had MDD alone (N = 8) and the other had simultaneous panic disorder and MDD (N = 8). Patients with MDD alone responded significantly better to antidepressant treatment.     

Separation anxiety disorder, panic disorder, and school refusal

Studies attest to the chronic nature of anxiety in youth. Consequently, there is a growing literature examining causative pathways to these disorders and efficacious treatments for them. This review examines separation anxiety disorder, a commonly occurring childhood anxiety disorder, and panic disorder, a more rare anxiety disorder in youth. Finally, school refusal, which may be tied to an internalizing or externalizing disorder or no disorder at all, is examined.     

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.     

Simultaneous major depression and panic disorder: treatment with electroconvulsive therapy.

BACKGROUND: Major depression and panic disorder commonly occur together. Patients with simultaneous depression and panic disorder may have a higher lifetime rate of suicide attempts and an overall worse prognosis than patients with either depression or panic disorder alone. In addition, preliminary work suggests that some of these patients may not respond satisfactorily to antidepressants. In this report, we describe the clinical courses of eight consecutive patients with simultaneous major depression and panic disorder who were referred for ECT at our institution. METHOD: Eight consecutive patients who met DSM-III-R criteria for simultaneous major depression and panic disorder received ECT. All eight patients were evaluated by a structured clinical interview and the patients' major depression and panic disorder were evaluated with a 7-point Clinical Global Impressions severity rating scale. RESULTS: Before ECT was begun, each subject's panic disorder and depression were rated as at least markedly ill. After receiving ECT, all eight showed improvement in their depression. In addition, none of the eight patients reported having a panic attack from the time of their fourth ECT treatment until discharge. CONCLUSION: In this report, eight consecutive patients with simultaneous major depression and panic disorder improved with ECT. Further work is required which examines the potential utility of ECT in treating these patients.     

Hoigne's syndrome,kindling, and panic disorder

A review of Hoigne's syndrome (HS) is presented, and 47 cases of putative procaine penicillin-induced HS are discussed within the context of kindling models of human psychopathology. Sixty percent of the individuals with HS in our retrospective study reported a lifetime history of panic disorder. The risk factors and causal relationships among repeated injection of procaine penicillin, HS, and anxiety disorders, particularly panic disorder, require further investigation. Depression and Anxiety 4:139–143, 1996/1997.© 1997 Wiley-Liss, Inc.