Panic Disorder With Nocturnal Panic Attacks: Symptoms and Comorbidities

2007 ◽  
Vol 23 (3) ◽  
pp. 195-200 ◽  
Author(s):  
Gökhan Sarísoy ◽  
Ömer Böke ◽  
Ali C. Arík ◽  
Ahmet R. Şahin
Keyword(s):  
Panic Disorder ◽  
Beck Depression Inventory ◽  
Panic Attack ◽  
Respiratory Symptoms ◽  
Psychiatric Symptoms ◽  
Panic Attacks ◽  
Symptom Checklist ◽  
Scale Scores ◽  
Dsm Iv ◽  
The Relationship

AbstractThe aim of this study was to determine the relationship between nocturnal panic attacks and comorbidities, clinical variables and panic attack symptoms. One hundred and six consecutive patients with DSM-IV panic disorder were enrolled in the study. The patients were divided into two groups depending on the presence of nocturnal panic attacks. Comorbidities were diagnosed with the help of SCID-I and SCID-II. The groups were compared using the Beck Depression Inventory, State-Trait Anxiety Inventory and Symptom Checklist. Nocturnal panic attacks were not related to comorbidities or age at the onset of the disease. The scores from the Beck Depression Inventory, general scores from the Symptom Checklist, somatization, obsession-compulsion, interpersonal sensitivity and anger-hostility sub-scale scores were higher in the nocturnal panic attack group. Patients with nocturnal panic attacks experience more frequent respiratory symptoms, suggesting that nocturnal panic attacks may be related to respiratory symptoms. Our findings demonstrate that patients with nocturnal panic attacks have more respiratory symptoms of panic, depressive and other psychiatric symptoms than the no nocturnal panic group.

scholarly journals Coronavirus disease-19 Pandemic-Induced Panic Disorder

2021 ◽  
Vol 9 (T3) ◽  
pp. 237-239
Author(s):  
Muhammad Surya Husada ◽  
Mustafa M. Amin ◽  
Munawir Saragih
Keyword(s):  
Infectious Disease ◽  
Case Report ◽  
Panic Disorder ◽  
Panic Attack ◽  
Respiratory Symptoms ◽  
Panic Attacks ◽  
Psychosocial Burden ◽  
Her Family ◽  
Common Diagnosis ◽  
The Individual

Background: COVID-19 is a newly emerging infectious disease which is found to be caused by SARS-2. COVID-19 pandemic has spread worldwide causing a rapidly increasing number of mental disorders cases, primarily anxiety disorder. Since majority of panic disorder patients are present with great anxiety in response to their physical or respiratory symptoms, support and encouragement from psychiatrist or therapist are fundamental to alleviate the severity of the symptoms. Case Report: We reported a case of COVID-19 induced panic disorder in a woman, 52 years old, batak tribe who started to experience multiple panic attacks since one of her family members was confirmed to be Covid-10 positive. Conclusion: In general, panic disorder is a common diagnosis, but this case appeared to be interesting as it is induced by COVID-19 pandemic. As in this case, the individual who experienced multiple panic attack is not even a COVID-19 patient but has one of her family member affected by the virus. A wide body of evidence has shown that this pandemic massively contributes to worsening of psychosocial burden in nationwide.

scholarly journals Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

2009 ◽  
Vol 35 (7) ◽  
pp. 698-708 ◽  
Author(s):  
Aline Sardinha ◽  
Rafael Christophe da Rocha Freire ◽  
Walter Araújo Zin ◽  
Antonio Egidio Nardi
Keyword(s):  
Panic Disorder ◽  
Respiratory Symptoms ◽  
Behavioral Therapy ◽  
Respiratory Physiology ◽  
Panic Attacks ◽  
Hyperventilation Syndrome ◽  
Therapeutic Implications ◽  
Challenge Tests ◽  
Respiratory Challenge ◽  
The Relationship

Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.

Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?

2010 ◽  
Vol 38 (3) ◽  
pp. 275-289 ◽  
Author(s):  
David Berle ◽  
Vladan Starcevic ◽  
Denise Milicevic ◽  
Anthony Hannan ◽  
Karen Moses
Keyword(s):  
Panic Disorder ◽  
Anxiety Disorders ◽  
Panic Attack ◽  
Symptom Checklist ◽  
Symptom Interpretation ◽  
The Relationship

Background: There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. Aims: We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. Method: The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Results: Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. Conclusions: These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

scholarly journals Impact of alcohol intoxication and withdrawal syndrome on social phobia and panic disorder in alcoholic inpatients

2004 ◽  
Vol 59 (4) ◽  
pp. 187-192 ◽  
Author(s):  
Mauro Barbosa Terra ◽  
Ivan Figueira ◽  
Helena Maria Tannhauser Barros
Keyword(s):  
Panic Disorder ◽  
Social Phobia ◽  
Withdrawal Syndrome ◽  
Psychiatric Symptoms ◽  
Alcohol Intoxication ◽  
Panic Attacks ◽  
The Social ◽  
Dsm Iv ◽  
The Impact ◽  
Withdrawal Phase

PURPOSE: To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD: A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV) and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval). RESULTS: Only 1 (2.4%) patient presented panic disorder throughout life, and 9 (21.9%) had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39%) alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION: Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.

Panic Disorder With and Without Agoraphobia

2009 ◽  
Author(s):  
Vladan Starcevic, MD, PhD
Keyword(s):  
Panic Disorder ◽  
Panic Attack ◽  
Empirical Support ◽  
Classification Systems ◽  
Panic Attacks ◽  
Anticipatory Anxiety ◽  
Symptom Profile ◽  
Intense Fear ◽  
History Of ◽  
The Relationship

Panic disorder is characterized by two components: recurrent panic attacks and anticipatory anxiety. Panic attacks within panic disorder are not caused by physical illness or certain substances and they are unexpected, at least initially; later in the course of the disorder, many attacks may be precipitated by certain situations or are more likely to occur in them. Anticipatory anxiety is an intense fear of having another panic attack, which is present between panic attacks. Some patients with panic disorder go on to develop agoraphobia, usually defined as fear and/or avoidance of the situations from which escape might be difficult or embarrassing or in which help might not be available in case of a panic attack; in such cases, patients are diagnosed with panic disorder with agoraphobia. Those who do not develop agoraphobia receive a diagnosis of panic disorder without agoraphobia. Components of panic disorder are presented in Figure 2—1. Patients with agoraphobia who have no history of panic disorder or whose agoraphobia is not related at least to panic attacks or symptoms of panic attacks are relatively rarely encountered in clinical practice. The diagnosis of agoraphobia without history of panic disorder has been a matter of some controversy, especially in view of the differences between American and European psychiatrists (and the DSM and ICD diagnostic and classification systems) in the conceptualization of the relationship between panic disorder and agoraphobia. The conceptualization adhered to here has for the most part been derived from the DSM system, as there is more empirical support for it. Although panic disorder (with and without agoraphobia) is a relatively well-defined psychopathological entity whose treatment is generally rewarding, there are important, unresolved issues. They are listed below and discussed throughout this chapter. …1. Are there different types of panic attacks based on the absence or presence of the context in which they appear (i.e., unexpected vs. situational attacks)? Should the ‘‘subtyping’’ of panic attacks be based on other criteria (e.g., symptom profile)? 2. Because panic attacks are not specific for panic disorder, should they continue to be the main feature of panic disorder? Can panic attacks occurring as part of panic disorder be reliably distinguished from panic attacks occurring as part of other disorders or in the absence of any psychopathology? 3. What is the relationship between panic attacks, panic disorder, and agoraphobia?

Subtyping of Panic Disorder by Symptom Profile

1993 ◽  
Vol 163 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Andrew C. Briggs ◽  
David D. Stretch ◽  
Sydney Brandon
Keyword(s):  
Treatment Outcome ◽  
Statistical Analysis ◽  
Panic Disorder ◽  
Panic Attack ◽  
Respiratory Symptoms ◽  
Demographic Variables ◽  
Panic Attacks ◽  
Symptom Profile ◽  
Choice Of Treatment ◽  
Cross National

During Phase II of the Cross-National Panic Study, descriptions of the patient's last severe panic attack were collected for 1168 patients. Statistical analysis indicated that patients could be divided into two groups, characterised by the presence or absence of prominent respiratory symptoms. The two groups did not differ on demographic variables or coexisting diagnoses, but they did differ on psychopathology on entry to the study and treatment outcome. The group with prominent respiratory symptoms suffered more spontaneous panic attacks and responded to imipramine, whereas the group without prominent respiratory symptoms suffered more situational panic attacks and responded more to alprazolam. It is important to distinguish spontaneous and situational panic attacks, to aid choice of treatment.

The DSM-IV panic disorder field trial: Panic attack frequency and functional disability

Anxiety ◽  
1996 ◽  
Vol 2 (4) ◽  
pp. 157-166 ◽  
Author(s):  
Abby J. Fyer ◽  
Wayne Katon ◽  
Michael Hollifield ◽  
Hilary Rassnick ◽  
Salvatore Mannuzza ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Field Trial ◽  
Panic Attack ◽  
Functional Disability ◽  
Attack Frequency ◽  
Dsm Iv

scholarly journals Double-blind clonazepam vs placebo in panic disorder treatment

2000 ◽  
Vol 58 (4) ◽  
pp. 1025-1029 ◽  
Author(s):  
ALEXANDRE MARTINS VALENÇA ◽  
ANTONIO EGIDIO NARDI ◽  
ISABELLA NASCIMENTO ◽  
MARCO A. MEZZASALMA ◽  
FABIANA L. LOPES ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Rating Scale ◽  
Panic Attacks ◽  
Fixed Dose ◽  
Fisher Exact Test ◽  
Double Blind ◽  
Exact Test ◽  
Dsm Iv ◽  
Disorder Treatment ◽  
Hamilton Rating Scale

OBJECTIVE: To assess the effectiveness of clonazepam, in a fixed dose (2 mg/day), compared with placebo in the treatment of panic disorder patients. METHOD: 24 panic disorder patients with agoraphobia were randomly selected. The diagnosis was obtained using the structured clinical interview for DSM-IV . All twenty-four subjects were randomly assigned to either treatment with clonazepam (2 mg/day) or placebo, during 6 weeks. Efficacy assessments included: change from baseline in the number of panic attacks; CGI scores for panic disorder; Hamilton rating scale for anxiety; and panic associated symptoms scale. RESULTS: At the therapeutic endpoint, only one of 9 placebo patients (11.1%) were free of panic attacks, compared with 8 of 13 (61.5%) clonazepam patients (Fisher exact test; p=0,031). CONCLUSION: the results provide evidence for the efficacy of clonazepam in panic disorder patients.

Fear of Autonomic Arousal and Use of Coping Strategies as Predictors of Agoraphobic Avoidance in Panic Disorder

1998 ◽  
Vol 15 (4) ◽  
pp. 228-236 ◽  
Author(s):  
Patricia Rayment ◽  
Jeff Richards
Keyword(s):  
Panic Disorder ◽  
Coping Strategies ◽  
Significant Proportion ◽  
Panic Attacks ◽  
Autonomic Arousal ◽  
Negative Cognitions ◽  
Considerable Controversy ◽  
Dsm Iv ◽  
Panic Symptoms ◽  
Behavioural Strategies

Despite the very significant proportion of people with panic disorder who have accompanying agoraphobia, there is considerable controversy about the variables that influence the development of this avoidance behaviour. This study investigated whether degree of avoidance is a function of extent of fear and prevalence of negative cognitions about autonomic arousal symptoms and whether the use of, and confidence in, behavioural strategies to cope with panic sensations also influences agoraphobic avoidance. Thirty-nine people who met DSM-IV criteria for panic disorder completed questionnaires measuring fear and negative cognitions about autonomic arousal and panic sensations, and a questionnaire measuring their use of largely behavioural strategies to cope with panic attacks. Fear of autonomic arousal and negative cognitions in response to the occurrence of these arousal symptoms were jointly related to situational avoidance. There was little relationship between the use of, and confidence in, panic coping strategies and less agoraphobic avoidance, although simply allowing panic symptoms to develop and pass predicted less avoidance. The results were interpreted as providing an empirical basis for treatment that reduces fear of panic sensations and allows their experience to be tolerated while preventing escape and avoidance of situations in which panic occurs. There was little evidence that additional teaching of behavioural coping strategies would be useful in reducing agoraphobic avoidance.

Recurrent episodes of intense fear, shortness of breath, racing heart, and sweating

2021 ◽  
pp. 111-118
Author(s):  
Christina L. Macenski
Keyword(s):  
Panic Disorder ◽  
Gold Standard ◽  
Panic Attack ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Shortness Of Breath ◽  
Intense Fear ◽  
Therapy Intervention ◽  
Norepinephrine Reuptake

Panic disorder consists of recurrent, unexpected panic attacks accompanied by persistent worry about future attacks and/or a maladaptive change in behavior related to the attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes that occurs in conjunction with several other associated symptoms such as palpitations, sweating, trembling, shortness of breath, and chest pain. Features of panic disorder that are more common in adolescents than in adults include less worry about additional panic attacks and decreased willingness to openly discuss their symptoms. All patients with suspected panic disorder should undergo a medical history, physical examination, and laboratory workup to exclude medical causes of panic attacks. Cognitive behavioral therapy (CBT) including interoceptive exposures is the gold standard therapy intervention. Medications including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can also help reduce symptoms.

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