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PubMed1998

The impact of comorbidity on the treatment of panic disorder.

Panic disorder comorbid with other psychiatric conditions appears to be more common than panic disorder alone. Depression is the most frequently associated disorder. This article reviews the detrimental effects of comorbidity on the severity and course of panic disorder. The presence of comorbidity results in more severe anxiety and depressive symptoms, a higher rate of suicide attempts, a higher frequency of other comorbid conditions, and a poorer response and compliance to treatment. Thus, it is important for physicians to be aware of the possibility of comorbidity in patients with panic disorder in order to select the most appropriate therapy to target all components of their condition.

Agoraphobia↗

PubMed2004

Cholecystokinin- and cholecystokinin-B-receptor gene polymorphisms in panic disorder.

Panic disorder like other neuropsychiatric disorders is believed to be caused by multiple psychosocial and biological factors. Several lines of evidence point to a role for the peptide neurotransmitter cholecystokinin in the pathogenesis of panic disorder. We therefore determined the allele and genotype frequencies of a single nucleotide polymorphism in the CCK gene (-36C>T) and one CT repeat polymorphism in the CCK-B-receptor gene in a German panic disorder sample (n = 115 for CCK gene polymorphism, n = 111 for CCK-B-receptor polymorphism) and compared them with gender and age matched controls. The length of the polymorphic CT repeat alleles varies between 146 bp and 180 bp. We first analysed the results by a permutation test which provided evidence for heterogeneity between patients and controls (p=0.002). We then analysed the data as a di-allelic polymorphism with a short (146-162bp) and a long (164-180bp) allele and as a tetra-allelic polymorphism with 4 alleles (146-154bp, 156-162bp, 164-170bp, 172-180bp). In the di-allelic analysis as well as in the tetra-allelic analysis there was an excess of the longer allele (p = 0.001) or the two longer alleles (p = 0.041) respectively in patients with panic disorder. No difference between groups was observed for the -36C > T polymorphism. Our findings are consistent with the notion that genetic variation in the CCK neurotransmitter system contributes to the pathogenesis of panic disorder.

Adult↗

PubMed1998

Comorbidity of major depression and panic disorder.

Panic disorder and major depression frequently coexist in the clinical setting. Patients with overlapping symptoms of depression and panic disorder may have more severe symptoms, may require earlier treatment, earlier and more frequent hospitalization, and may have worse outcomes. In addition, such patients are at greater risk for suicide than those having either disorder alone. In light of the importance of these clinical consequences, the authors will review the available literature on the prevalence and prognosis of comorbid depression and panic disorder and will highlight the major clinical characteristics of panic disorder in depressed patients and the treatment strategies most often used.

Comorbidity↗

PubMed2000

New developments in panic disorder.

Panic disorder is a distressing and disabling disorder characterized by recurring panic attacks; anticipatory anxiety about having additional attacks; and agoraphobic fear and avoidance of situations in which attacks have occurred, ready escape is difficult, or help is unavailable in the event of an attack. It is typically associated with impairment in social, emotional, and vocational functioning, as well as excessive utilization of the medical care system. A number of pharmacologic agents and cognitive-behavioral treatments have proven effective for the treatment of panic disorder. Selective serotonin reuptake inhibitors are becoming first-line pharmacotherapy because of their favorable side effect profile and greater spectrum of efficacy in comparison with older classes of agents. In this article, we provide an overview of the prevalence, associated health care utilization, impairment in quality of life, and treatment of panic disorder.

Cognitive Behavioral Therapy↗

PubMed1983

Panic disorder.

Panic disorder is a subtype of anxiety manifested by discrete periods of apprehension or fear and at least four of the following somatic symptoms: dyspnea, palpitations, chest pain, choking, dizziness, depersonalization or derealization experience, paresthesias, hot and cold flashes, sweating, faintness, trembling, and fear of dying, going crazy, or doing something uncontrolled during an attack. Because the patient with panic disorder often selectively focuses on one of these somatic symptoms and may minimize or deny psychosocial distress, panic disorder is frequently misdiagnosed. As a result of the frightening nature of the symptoms, a pattern of overutilization of medical care systems frequently ensues. Panic disorder is usually precipitated by stressful life events, most commonly separation or loss, in a patient with a genetic or acquired vulnerability. As with other psychophysiologic illness (depression, duodenal ulcer) resolution of the acute stressful life event may not lead to resolutions of the physiologic changes. Two specific tricyclic antidepressants, imipramine and desipramine, have been shown to be effective therapeutic agents in treating panic disorder.

Adolescent↗

PubMed1996

[Prognostic aspects of panic disorder].

Panic disorder is considered as a qualitatively distinct form among the anxiety disorders. Follow-up studies have demonstrated that the course of panic disorder may be chronic. Only one out of ten patients remains completely free of symptoms within an observational period of 3 to 7 years. The majority of patients suffer long-standing anxiety symptoms which do not significantly interfere with working performance or social relationships. Another ten percent of the patients are continuously impaired in everyday living by severe symptoms. Long duration and severe degree of symptoms at the initial assessment, as well as coexistent depression are associated with a poor outcome. There is evidence of an increased mortality in patients with panic disorder. Suicides are overrepresented among the causes of death. It is not clear whether this is due to the frequent comorbidity between panic disorder, major depression, and substance abuse.

Activities of Daily Living↗

PubMed2003

Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorder.

Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications. This is a review of the literature about the long-term effectiveness of CBT. We searched for follow-up studies of panic disorder using CBT. Of the 78 citations produced in the initial search, most had major methodological flaws, including ignoring losses to follow-up, not accounting for interval treatment, and unclear reporting. Three papers met strict methodological criteria, and two of these demonstrated a modest protective effect of CBT in panic disorder patients. We make recommendations for well-designed studies involving comparisons of medications and cognitive behavior therapy.

Agoraphobia↗

PubMed1996

Panic attacks and panic disorder.

Panic disorder is a devastating condition with a higher prevalence in female patients and young adults. Panic disorders is frequently associated with major depression, agoraphobia, substance abuse, suicide attempts, and impaired quality of life. Only one half of the subjects with panic disorder seek care for their attacks, and those who do seek care tend to present to primary care and emergency department settings. If treated appropriately, panic disorder has a favorable prognosis.

Emergency Service, Hospital↗

PubMed2005

The pharmacotherapy of panic disorder.

Panic disorder is common and associated with significant morbidity and dysfunction. The pharmacologic treatment of panic disorder is aimed at reducing or eliminating panic attacks, avoidance behavior, anticipatory anxiety, and comorbid conditions--and substantially improving and normalizing overall function and quality of life. Antidepressants and benzodiazepines remain the current mainstays of pharmacotherapy for panic disorder, although other novel agents and strategies are becoming available and may add effective alternatives to the therapeutic armamentarium.

Anticonvulsants↗

PubMed1992

The assessment and management of panic disorder.

Panic disorder affects approximately 1.5 percent of the general population in the United States, and individuals with this disorder are seen frequently in primary care settings. Recognition of panic disorder is complicated by the fact that patients tend to focus exclusively on the physical symptoms of the illness. Left untreated, patients with panic disorder suffer considerable impairment in functioning and are at increased risk for substance abuse, depression and suicide. This article provides clinicians with the information necessary to recognize and manage this illness. A detailed description of the disorder, including onset, course, complications, differential diagnosis and management, is presented in this article.

Clinical Protocols↗

PubMed2006

Lack of association between the corticotrophin-releasing hormone receptor 2 gene and panic disorder.

Panic disorder is classified as an anxiety disorder and affects 1-3% of the population. An individual suffering from such a disorder may experience unexpected recurrent panic attacks and fear of future attacks. Twin and family studies have pointed towards a strong heritability of the disorder. Stress response and anxiety are thought to be mediated, at least in part, by the corticotrophin-releasing hormone (CRH), which is known to be a regulator of the hypothalamic-pituitary-adrenal pathway. To search for markers conferring genetic susceptibility to panic disorder, we typed three polymorphisms of the CRHR2 gene - CRHR2(CA), CRHR2(GT), and CRHR2(GAT) - in 466 individuals, 183 of whom had DSM-IV panic disorder. Seventy-five case-controls and 101 triad families plus 13 siblings were examined. Case-control association analyses using chi(2) tests yielded no difference in the distribution of the alleles. Linkage analysis using the Transmission Disequilibrium Test showed no preferential transmission of alleles for any of the three markers. Haplotype analysis indicated that allele 7 of CRHR2 (GAT) and 8 of CRHR2 (GT) are in almost complete linkage disequilibrium (P = 0.000 000 1). Although both neurobiology and chromosomal location point to the CHRH2 receptor gene as a candidate for panic disorder, our study indicates that the CRHR2 polymorphisms examined do not confer susceptibility to panic disorder. Further studies investigating additional polymorphisms in this gene and other components of the CRH signalling system may prove useful.

Base Sequence↗

PubMedDate not supplied

A cognitive approach to panic disorder.

Panic disorder can be a chronic and disabling problem, with sufferers frequently using of medical and psychiatric services. In this paper, the nature of panic attacks and panic disorder is outlined, and a cognitive model of panic disorder described. Treatment is outlined, and a case example given.

Adult↗

PubMed2006

Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder.

BACKGROUND: There is increasing evidence that subthreshold forms of psychopathology are both common and clinically relevant. To enable classification of these subthreshold forms of psychopathology, it may be useful to distinguish not only a threshold for illness but also for health. Our aim was to investigate this with regard to panic. METHOD: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), which is based on a large representative sample of the adult general population (18-65 years) of The Netherlands (n=7076). The Composite International Diagnostic Interview was used as a diagnostic instrument. By defining two thresholds, three groups were formed: panic disorder, subthreshold panic disorder and no-panic. These groups were compared using multinomial regression analysis, chi2 and analysis of variance. RESULTS: The 12-month prevalence of panic disorder was 2.2% while that of subthreshold panic disorder was 1.9%. Symptom profiles and risk indicators associated with panic disorder and subthreshold panic disorder were similar, and half of the risk indicators were more strongly associated with panic disorder than with subthreshold panic disorder. Subthreshold panic disorder occupied an intermediate position between panic disorder and no-panic with regard to the number of symptoms, the percentage of subjects with co-morbidity, and functioning. CONCLUSIONS: Subthreshold panic disorder is common, and seems clinically relevant, but is milder than panic disorder. These results thus support the use of a double threshold in panic. Further research should focus on the positioning of the thresholds, the course of subthreshold panic disorder and its treatment options.

Adult↗

PubMed1996

An assessment tool to identify panic disorder.

Panic disorder is a psychiatric condition that is infrequently diagnosed correctly. People with untreated panic are most often seen in primary care settings. Panic is a debilitating condition that affects approximately 10% of the population and is eminently treatable when identified. Without treatment, clients are at risk for complications such as phobias, substance abuse, and depression. The purpose of this research study was to develop a valid, reliable tool to assist health care practitioners in identifying and assessing persons who have panic disorder. With the use of the Anxiety Inventory, information can be elicited to identify these people. In addition, data regarding the presence of phobias and depression and self-medication for any of the aforementioned behaviors can be collected. The tool also addresses any familial history of anxiety, panic attacks, depression, and drug and alcohol abuse. With the use of the Anxiety Inventory, practitioners can diagnose panic disorder in their clients and refer them for appropriate treatment.

Female↗

PubMed2004

Changes in lymphocyte subsets after short-term pharmacotherapy in patients with panic disorder.

Panic disorder is associated with a high frequency of comorbid immunological diseases, such as allergies and asthma, although the psychoneuroimmunology of panic disorder is relatively unexplored. The objective of this study was to determine whether panic patients have different immunological findings compared with normal healthy subjects and whether changes in immune function are associated with short-term pharmacotherapy. We also examined whether immunological variables were associated with clinical severity and serum catecholamine levels. Patients with panic disorder (n=26) and healthy control subjects (n=26) were recruited for this study. All patients were treated with paroxetine for 3 months. We measured the lymphocyte subsets, psychopathological characteristics and serum catecholamine (norepinephrine and epinephrine) levels. Panic patients did not differ initially from control subjects in peripheral lymphocyte phenotypic markers. After drug therapy, however, percentages of circulating CD3+, CD4+ and CD8+ T lymphocytes were significantly increased, while the percentage of CD19+ B lymphocytes was significantly decreased in the patients. The difference in the percentage of CD8+ T lymphocytes before and after treatment was negatively correlated with pretreatment Global Clinical Impression scores. The lymphocyte subsets were not significantly associated with serum catecholamine levels in panic patients. In conclusion, panic patients showed increased CD3+, CD4+ and CD8+ T lymphocyte proportions and a decreased B lymphocyte proportion after 3 months of drug therapy. This finding suggests that pharmacological treatment may affect immune function in panic patients.

Adult↗

PubMed2005

Neurobiology and etiology of panic disorder.

Panic disorder entered the psychiatric nomenclature a quarter-century ago, and an explosion of studies followed. Defining the core phenomenology of panic disorder can be advanced by an understanding of its pathophysiology and exploration of its etiology. The lessons learned can guide the delivery of treatments to enhance the likelihood of achieving remission and the discovery of novel treatments for panic disorder.

Amygdala↗

PubMed1989

Panic disorder.

Panic disorder affects an estimated 1.4 percent of the general population. Nearly 70 percent of patients with panic disorder may also suffer from a major depressive disorder at some time in their lives. Both disorders respond to tricyclic antidepressants and monoamine oxidase inhibitors. Alprazolam is also an effective antipanic agent. Because avoidance behaviour (agoraphobia) often follows the onset of panic disorder, behavioral interventions are an important adjunct to management.

Antidepressive Agents↗

PubMedDate not supplied

Generalized anxiety disorder and panic disorder in the elderly: a review.

Practicing psychiatrists frequently encounter elderly patients with generalized anxiety disorder or panic disorder. Unfortunately, the empirical literature regarding the assessment, diagnosis, and treatment of these illnesses in older individuals is sparse, despite the attention directed to them in younger patients. In this paper studies of generalized anxiety and panic disorders among the elderly are reviewed and compared to similar investigations among younger adults to assess our current understanding of the epidemiology, etiology, diagnosis, and treatment of these conditions. Articles were selected from those retrieved by Index Medicus (papers in English, published in 1992 or later; search terms "anxiety," "anxiety disorders," "panic disorder," and "elderly").

Aged↗