Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation

Objective

The epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.

Method

We used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).

Result

The prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.

Conclusion

The findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.     

强迫障碍对患者生活质量影响的研究

目的探讨强迫障碍对患者生活质量的影响。方法采用TDL生活质量量表评估强迫障碍患者的生活质量。结果强迫障碍组的身体方面、心理方面、社会方面、尽职的能力、自我健康意识及TDL量表总分均显著地低于对照组(P<0.05)。结论强迫障碍对患者的生活质量影响很大,应积极治疗。     

Relationship between depression and quality of life in Nigerian outpatients with heart failure

OBJECTIVE: Our objective was to evaluate the relationship between depression and health-related quality of life (QoL) in Nigerian outpatients with heart failure (HF). METHODS: We used a cross-sectional study in which outpatients with HF (n=100) completed the WHO Quality of Life Scale-Brief Version to assess their subjective QoL. The patients were also assessed for the diagnosis of major depressive disorder (MDD) in accordance with the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition. RESULTS: The factors independently associated with poor QoL include disability due to illness, presence of MDD, younger age, and longer duration of illness. Patients with MDD had worse QoL than patients without MDD on dimensions of physical health, psychological health, and environment. CONCLUSION: Depression adversely affects the QoL of patients with HF. Programs designed to improve the QoL of patients with HF need to incorporate the early identification and treatment of depression. Future studies are warranted to investigate the impact of improved depression management on QoL in patients with HF.     

Panic disorder patients have reduced cyclic AMP in platelets.

Little is known about the intracellular mechanisms involved in the pathophysiology of panic disorder (PD). Abnormalities in the cyclic AMP system have been described in several psychiatric disorders but there are no studies in panic patients. We evaluated not only the levels of platelet cyclic AMP, but also cyclic GMP and nitric oxide synthase (NOS) activity in patients with PD at baseline and after treatment with clomipramine and in healthy volunteers. Platelet cyclic AMP was determined by enzymeimmunoassay, cyclic GMP by radioimmunoassay and NOS activity by the conversion of (3)H-arginine to (3)H-citruline in 17 PD patients before treatment with clomipramine, after remission of panic attacks and in 22 healthy volunteers. Average baseline cyclic AMP of PD patients was lower than after remission of panic attacks (P<0.005) and lower than in healthy volunteers (P<0.005). Average cyclic AMP after remission of panic attacks was not significantly different than in healthy volunteers. There were no significant differences in cyclic GMP and NOS analysis. Our results suggest that PD patients without treatment have lower platelets cyclic AMP levels than healthy volunteers and that this decrease may be corrected by clomipramine.     

Panic disorder among Vietnamese refugees attending a psychiatric clinic: prevalence and subtypes

This study surveys Vietnamese refugees attending two psychiatric clinics to determine both the prevalence of panic disorder (PD) as well as panic attack subtypes in those suffering PD. A culturally valid adaptation of the SCID-panic module (the Vietnamese Panic Disorder Survey or VPDS) was administered to 100 Vietnamese refugees attending two psychiatric clinics. Utilizing culturally sensitive panic probes, the VPDS provides information regarding both the presence of PD and panic attack subtypes during the month prior to interview. Of 100 patients surveyed, 50 (50%) currently suffered PD. Among the 50 patients suffering PD, the most common panic attack subtypes during the previous month were the following: “orthostatic dizziness” (74% of the 50 panic disorder patients [PDPs]), headache (50% of PDPs), wind-induced/temperature-shift-induced (24% of PDPs), effort-induced (18% of PDPs), gastro-intestinal (16% of PDPs), micturition-induced (8% of PDPs), out-of-the-blue palpitations (24% of PDPs), and out-of-the-blue shortness of breath (16% of PDPs). Five mechanisms are adduced to account for this high PD prevalence as well as the specific profile of subtypes: 1) a trauma-caused panic attack diathesis; 2) trauma-event cues; 3) ethnic differences in physiology; 4) catastrophic cognitions generated by cultural syndromes; and 5) a modification of Clark’s spiral of panic.     

Panic disorder and idiopathic cardiomyopathy

OBJECTIVE: This study investigated whether, among a population of cardiac patients, there is a preferential association between idiopathic cardiomyopathy (CMP) and Panic Disorder (PD). METHODS: A total of 93 patients with cardiac failure, 50 of them with CMP, 43 with other cardiac diseases, underwent a standard psychiatric examination using the MINI neuropsychiatric interview. RESULTS: While half of the subjects met the criteria for a psychiatric disorder, PD was no more prevalent in the CMP group compared to other patients. CONCLUSION: This study confirms the high prevalence of psychiatric pathology, particularly anxiety, mood, and alcohol-related disorders, in patients with cardiac failure. However, previous findings on the specific association between CMP and PD could not be replicated.     

Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder

Interest in the assessment of quality of life in the anxiety disorders is growing. The present study examined quality of life impairments in individuals with generalized anxiety disorder (GAD), social phobia, and panic disorder. Results showed that individuals with these disorders reported less satisfaction with their quality of life than non-anxious adults in the community. However, the degree of quality of life impairment is similar across these three disorders. Additionally, comorbid depression, but not anxiety, was found to negatively impact quality of life in these individuals. Finally, diagnostic symptom severity was not found to influence quality of life, indicating that subjective measures of quality of life offer unique information on the effects of anxiety disorders.     

Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder

Subtyping panic disorder by predominant symptom constellations, such as cognitive or respiratory, has been done for some time, but criteria have varied considerably between studies. We sought to identify statistically symptom dimensions from intensity ratings of 13 DSM-IV panic symptoms in 343 panic patients interviewed with the Anxiety Disorders Interview Schedule for DSM-IV Lifetime Version. We then explored the relation of symptom dimensions to selected illness characteristics. Ratings were submitted to exploratory maximum likelihood factor analysis with a Promax rotation. A three-factor solution was found to account best for the variance. Symptoms loading highest on the first factor were palpitations, shortness of breath, choking, chest pain, and numbness, which define a cardio-respiratory type (with fear of dying). Symptoms loading highest on the second factor were sweating, trembling, nausea, chills/hot flashes, and dizziness, which defines a mixed somatic subtype. Symptoms loading highest on the third factor were feeling of unreality, fear of going crazy, and fear of losing control, which defines a cognitive subtype. Subscales based on these factors showed moderate intercorrelations. In a series of hierarchical multiple regression analyses, the cardio-respiratory subscale was a strong predictor of panic severity, frequency of panic attacks, and agoraphobic avoidance, while the cognitive subscale mostly predicted worry due to panic. In addition, patients with comorbid asthma had higher scores on the cardio-respiratory subscale. We conclude that partly independent panic symptom dimensions can be identified that have different implications for severity and control of panic disorder.     

Autistic spectrum disorder,attention deficit hyperactivity disorder,and psychiatric comorbidities: A nationwide study

Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are both frequently comorbid with other psychiatric disorders, but the comorbid effect of ASD and ADHD relative to the comorbid risk of other psychiatric disorders is still unknown. Using the Taiwan National Health Insurance Research Database, 725 patients with ASD-alone, 5694 with ADHD-alone, 466 with ASD + ADHD, and 27,540 (1:4) age-/gender-matched controls were enrolled in our study. The risk of psychiatric comorbidities was investigated. The ADHD + ASD group had the greatest risk of developing schizophrenia (hazard ratio [HR]: 95.89; HR: 13.73; HR: 174.61), bipolar disorder (HR: 74.93; HR: 19.42; HR: 36.71), depressive disorder (HR: 17.66; HR: 12.29; HR: 9.05), anxiety disorder (HR: 49.49; HR: 50.92; HR: 14.12), disruptive behavior disorder (HR: 113.89; HR: 93.87; HR: 26.50), and tic disorder (HR: 8.95; HR: 7.46; HR: 4.87) compared to the ADHD-alone, ASD-alone, and control groups. Patients with ADHD + ASD were associated with the greatest risk of having comorbid bipolar disorder, depressive disorder, anxiety disorder, disruptive behavior disorder, and tic disorder. The diagnoses of ASD and ADHD preceded the diagnoses of other psychiatric comorbidities. A comprehensive interview scrutinizing the psychiatric comorbidities would be suggested when encountering and following patients with both ASD and ADHD in clinical practice.     

Panic-agoraphobic spectrum symptoms in complicated grief

Little is known about the presence and role of subclinical anxiety symptoms and traits in complicated grief (CG). Data from adults with CG (n=28) suggest that they experience more panic-spectrum symptoms (PSS) than bereaved controls (n=44), and that the presence of greater PSS is independently associated with poorer quality of life.     

Heart rate variability in chronic heart failure

The analysis of heart rate variability (HRV) provides information about autonomic cardiovascular control in healthy subjects. In the past 15 years, several articles have been published regarding HRV and chronic heart failure (CHF). The results of these papers substantially demonstrated that HRV is significantly different in CHF patients compared to controls. Moreover, some variables derived from HRV analysis showed significant independent prognostic capacity. In particular, the reduction of variance (expressed as SDNN) and low-frequency spectral component of HRV (ranging from 0.03 to 0.15 Hz) seem related to an increased mortality in CHF. Nevertheless, these variables are not yet considered in clinical practice. A better understanding of the physiopathological basis of the reported alterations of HRV in CHF patients is required in order to permit its use as a clinical tool for prognosis and tailored therapy in individual CHF patients.     

惊恐障碍患者血清脂质水平的初步研究

采用酶法测定在性别、年龄上相匹配的３０例惊恐障碍患者、３０例抑郁症患者及３０例正常对照者的血清脂质水平。结果显示：惊恐障碍患者的血清胆固醇（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，焦虑障碍史与高血清Ｔｃｈ水平明显有关。提示惊恐障碍患者的高血清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。     

The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using Actor-Partner Interdependence Model

Background

Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient-spouse dyads using an innovative dyadic analysis technique, the Actor-Partner Interdependence Model (APIM).

Method

A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% ±11, 43% in New York Heart Association III-IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL.

Result

Depressive symptoms exhibited actor effect of both patients (P<.001) and spouses (P<.001) and only partner effect of patients (P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms.

Conclusion

Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses.     

不同症状群强迫症患者的生活质量比较

目的探讨强迫症患者的症状群对其生活质量的影响。方法收集78例门诊强迫症患者（病例组）及60名正常对照,采用世界卫生组织生存质量测定量表简表（WHOQOL-BREF）中文版调查生活质量。对强迫症患者的耶鲁-布朗强迫症状检查提纲评分进行分析。结果病例组WHOQOL-BREF量表的生理领域、心理领域、社会关系领域、环境领域得分[分别为（64.7±10.3）分、（47.6±11.5）分、（53.1±12.2）分、（63.7±10.6）分]均低于正常对照组[分别为（79.2±9.6）分、（71.2±10.4）分、（74.1±9.8）、（75.1±10.3）分],差异有统计学意义（t值分别为-8.3、-12.5、-10.9、-6.3,P值均〈0.001）。根据患者的主要症状分为洗涤组、检查组、贮物组、对称组。方差分析显示4组患者WHOQOL-BREF各领域得分均存在差异（P〈0.05）。结论强迫症患者生活质量低于正常人群。不同症状群强迫症患者的生活质量受损害的领域存在差异。     

焦虑症患者的生命质量与焦虑症状的相关性研究

目的 探讨焦虑症患者的生命质量以及与焦虑症状的关系.方法 采用生命质量量表(LQS)及Hamilton焦虑量表(HAMA)对60例焦虑症患者进行了问卷调查,并与60例正常对照者比较.结果 焦虑症患者的生命质量总分及各因子评分均明显低于正常对照者(P＜0.01).焦虑症患者的生命质量总分及各因子评分与HAMA总分及因子分均呈显著性负相关(P＜0.01).结论 焦虑症患者的生命质量较差,且与焦虑症状有关,即焦虑症状越重,其生命质量越差.     

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.     

农村社区情感性精神障碍患者生活质量研究

使用英国Ｏｌｉｖｅｒ编制的生活质量概况表，在四川省新津县农村社区调查４８例情感性精神障碍患者生活质量，发现绝大多数患者均参加劳动，家庭关系较好，但经济状况和居住情况较差，主观生活满意度以“一般”居多，其中闲暇活动满意度，法律与安全满意度和家庭关系满意度较好，而经济状况满足度则较低，不同情感状态的患者间除与情感状态关系密切相关项目外，多数项目差异无显著性，多因素分析表明，经济状况及其主观满意度是影响     

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     

Neutrophil Gelatinase-Associated Lipocalin and depression in patients with chronic heart failure

Depression adversely affects prognosis in heart failure (HF) patients. Inflammation is indicated as potential biological pathway in this co-morbidity. Since increased levels of the cytokine Neutrophil Gelatinase-Associated Lipocalin (NGAL) are predictive for HF prognosis, and recently indicated in patients with major depression, this study examined the association of serum NGAL levels with symptoms of depression in patients with HF. Serum NGAL levels were measured in 104 patients with HF (left ventricular ejection fraction, LVEF ⩽ 40). Depression, evaluated using the Beck Depression Inventory (BDI; total score, somatic and cognitive component), and the Hamilton Depression Rating scale (HAMD), at baseline and 12 months follow-up, was associated with NGAL levels using mixed model analysis. Analyses were adjusted for demographics measures, disease severity indicators, inflammation, comorbidity and medication. Increased serum NGAL levels were significantly associated with depression measured by HAMD (baseline: r = 0.25, p < .05) and BDI (baseline: r = 0.22, p < .05; 12 months: r = 0.37, p < .01). This association remained significant after adjustment for covariates; age, sex, time, LVEF, and creatinine (HAMD, t = 2.01, p = .047; BDI, t = 2.28, p = .024). NGAL was significantly associated with somatic- (p = 0.004), but not cognitive depressive symptoms (p = 0.32). NGAL levels were associated with the experienced HF-related functional limitations (6 min walk test), rather than the severity of cardiac dysfunction (LVEF). This study indicates that depression in patients with chronic HF is associated with elevated NGAL levels, independent of clinical severity of the underlying disease.