Diurnal Rhythms and Symptom Severity in Panic Disorder

1992 ◽  
Vol 161 (4) ◽  
pp. 512-516 ◽  
Author(s):  
Marilla F. Geraci ◽  
Thomas W. Uhde
Keyword(s):  
Panic Disorder ◽  
Panic Attacks ◽  
Diurnal Rhythms ◽  
Diurnal Changes ◽  
Phobic Anxiety ◽  
Early Afternoon ◽  
History Of ◽  
History Of Depression ◽  
Normal Controls ◽  
Or History

Diurnal changes in the frequency of panic attacks and symptoms of generalised anxiety, phobic anxiety and phobic avoidance in 34 panic-disorder patients and 40 normal controls were evaluated. The panic-disorder patients had significant diurnal changes in generalised and phobic anxiety, but not phobic avoidance. Increased severity of symptoms and prominent diurnal changes were most evident in the panic-disorder patients with a history of depression. Although panic attacks were distributed throughout the 24–hour period, patients with a current episode or history of depression tended to have more frequent panic attacks in the morning or early afternoon. These observations challenge the traditional belief that ‘anxious neurotic’ patients are relatively asymptomatic upon awakening in the morning and then develop more severe symptoms of anxiety later in the day.

Thyroid Hormone Levels in Panic Disorder*

1987 ◽  
Vol 32 (6) ◽  
pp. 467-469 ◽  
Author(s):  
Vikram K. Yeragani ◽  
John M. Rainey ◽  
Robert Pohl ◽  
Aurelio Ortiz ◽  
Paula Weinberg ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Thyroid Dysfunction ◽  
Clinical History ◽  
Panic Attacks ◽  
P Value ◽  
Mean Values ◽  
Trh Stimulation ◽  
History Of ◽  
The Mean ◽  
Normal Controls

A history of thyroid dysfunction has been reported in patients with phobic disorders. There is also evidence of a blunted TSH response to TRH stimulation in patients with panic disorder. In this study, values of T3, T4 and T7 were compared between 26 patients with panic attacks and 20 normal controls. Patients were diagnosed according to DSM-III criteria and those with a clinical history of thyroid dysfunction were excluded. Patients were not on any medication when the blood samples were drawn. The mean values of T3, T4 and T7 did not significantly differ between the two groups, suggesting no evidence of hypo or hyperthyroidism; however, the variance of distribution of T3, T4 and T7 values was significantly different between the two groups (Fmax values for T3: 2.55, p value < 0.05; T4: 3.15, p value < 0.01; T7: 2.55, p value < 0.05).

scholarly journals Fear of body symptoms and sensations in patients with panic disorders and patients with somatic diseases

2009 ◽  
Vol 137 (11-12) ◽  
pp. 659-663 ◽  
Author(s):  
Milan Latas ◽  
Danilo Obradovic ◽  
Marina Pantic
Keyword(s):  
Myocardial Infarction ◽  
General Population ◽  
Panic Disorder ◽  
Somatic Symptoms ◽  
The Body ◽  
Panic Attacks ◽  
Somatic Illness ◽  
History Of ◽  
Body Sensations ◽  
High Level

Introduction. A cognitive model of aetiology of panic disorder assumes that people who experience frequent panic attacks have tendencies to catastrophically interpret normal and benign somatic sensations - as signs of serious illness. This arise the question: is this cognition specific for patients with panic disorder and in what intensity it is present in patients with serious somatic illness and in healthy subjects. Objective. The aim of the study was to ascertain the differences in the frequency and intensity of 'catastrophic' cognitions related to body sensations, and to ascertain the differences in the frequency and intensity of anxiety caused by different body sensations all related to three groups of subjects: a sample of patients with panic disorder, a sample of patients with history of myocardial infarction and a sample of healthy control subjects from general population. Methods. Three samples are observed in the study: A) 53 patients with the diagnosis of panic disorder; B) 25 patients with history of myocardial infarction; and C) 47 healthy controls from general population. The catastrophic cognitions were assessed by the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). These questionnaires assess the catastrophic thoughts associated with panic and agoraphobia (ACQ) and the fear of body sensations (BSQ). All study subjects answered questionnaires items, and the scores of the answers were compared among the groups. Results. The results of the study suggest that: 1) There is no statistical difference in the tendency to catastrophically interpret body sensations and therefore to induce anxiety in the samples of healthy general population and patients with history of myocardial infarction; 2) The patients with panic disorder have a statistically significantly more intensive tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in comparison to the sample of patients with the history of serious somatic illness (myocardial infarction) and the sample of healthy general population. Conclusion. The tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in patients with panic disorder, confirms the cognitive aetiology model of panic disorder and suggests that it should be the focus of prophylactic and therapeutic management of patients with panic disorder.

Platelet serotonin binding and plasma cortisol in panic disorder before and after alprazolam plus behavioral guidance treatment

1991 ◽  
Vol 6 (1) ◽  
pp. 31-37
Author(s):  
A Tobeña ◽  
X Sanchez ◽  
J Masana ◽  
MJ Martinez de Osaba
Keyword(s):  
Panic Disorder ◽  
Treatment Period ◽  
Plasma Cortisol ◽  
Panic Attacks ◽  
Platelet Serotonin ◽  
Before And After ◽  
Anxious State ◽  
Cortisol Levels ◽  
Normal Controls

SummaryIn 32 patients with panic disorder with or without agoraphobia, Bmax measures of 5-HT binding in platelets did not differ from normal controls at baseline. Plasmatic cortisol levels were significantly higher than controls in the morning and in the evening measures as well as in post-dexamethasone assays. Following an 8-week treatment period with alprazolam plus behavioral guidance encouraging exposure, Bmax values did not alter but cortisol measures diminished significantly. Measures of phobic avoidance were negatively correlated with 5-HT Bmax values. Plasmatic cortisol correlated positively with the number of situational panic attacks in the month before treatment. There were no correlations between cortisol and 5-HT Bmax measures. A possible link between serotonin function and phobic avoidance is discussed. Cortisol changes were interpreted as being related to the global severity of the anxious state.

Trouble Panique et Alcoolisme: Influence de la Comorbidité

1993 ◽  
Vol 38 (7) ◽  
pp. 485-493 ◽  
Author(s):  
J.M. Chignon ◽  
J.P. Lépine
Keyword(s):  
Alcohol Abuse ◽  
Panic Disorder ◽  
Clinical Studies ◽  
Affective Disorders ◽  
Related Disorder ◽  
Addictive Disorders ◽  
Lifetime History ◽  
High Prevalence ◽  
History Of ◽  
History Of Depression

Both epidemiological and clinical studies have demonstrated a high prevalence of panic disorder among alcoholic patients. In contrast, little attention has been given to studying alcohol abuse and/or dependence in patients suffering from panic disorder. One hundred and fifty-five consecutive referrals for treatment for panic disorder were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia—Lifetime Version, modified for the study of anxiety disorders. Thirty-two patients (20.7%) had a lifetime history of alcohol abuse and/or dependence. Although the lifetime comorbidity rate of either agoraphobia and/or social phobia seems without any influence on the risk of alcohol-related disorder, alcoholic patients suffering from panic disorder appear to be more likely to have a history of depression and other addictive disorders. The majority of patients with primary alcoholism were male, and those who became alcoholics after they developed panic disorder were more likely to be female. The comparison between patients with primary and secondary alcoholism did not indicate any difference in the comorbidity rate with other psychiatric disorders nor the severity of panic disorder.

The Effects of Childhood Parental Death and Divorce on Six-Month History of Anxiety Disorders

1989 ◽  
Vol 154 (6) ◽  
pp. 823-828 ◽  
Author(s):  
J. Lindsey Tweed ◽  
Victor J. Schoenbach ◽  
Linda K. George ◽  
Dan G. Blazer
Keyword(s):  
Panic Disorder ◽  
Maternal Death ◽  
Parental Death ◽  
Panic Attacks ◽  
Parental Separation ◽  
Generalised Anxiety Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
History Of ◽  
Socio Demographic Factors

Duke Epidemiologic Catchment Area (ECA) data were used to examine the relationships between: (a) early childhood maternal death, paternal death, and parental separation/divorce, and (b) six-month DIS/DSM-III diagnoses of agoraphobia with and without panic attacks, simple phobia, social phobia, panic disorder, generalised anxiety disorder, and obsessive-compulsive disorder. Associations were found between: (a) maternal death and agoraphobia with panic attacks, and (b) parental separation/divorce and agoraphobia with panic attacks and panic disorder. The associations could not be explained by the effects of potentially confounding socio-demographic factors.

scholarly journals Depression with Panic Episodes and Coronary Vasospasm

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Mladen I. Vidovich ◽  
Aneet Ahluwalia ◽  
Radmila Manev
Keyword(s):  
Chest Pain ◽  
Cardiac Event ◽  
Negative Impact ◽  
Myocardial Necrosis ◽  
Coronary Vasospasm ◽  
Panic Attacks ◽  
Prior History ◽  
History Of ◽  
St Elevation ◽  
History Of Depression

Variant (Prinzmetal's) angina is an uncommon cause of precordial pain caused by coronary vasospasm and characterized by transient ST elevation and negative markers of myocardial necrosis. This is the case of a female patient with a prior history of depression and panic attacks who presented with recurrent symptoms including chest pain. A cardiac event monitor positively documented coronary vasospasm associated with anxiety-provoking chest pain, whereas the coronary arteries were angiographically normal. We noted that the frequency of angina attacks apparently increased during the period that coincided with the introduction of Bupropion SR for treatment of the patient's depression. Considering the possibility of bupropion-associated negative impact on coronary vasospasm, the antidepressant therapy was adjusted to exclude this drug. Although Prinzmetal's angina is relatively uncommon, we suspect that a routine use of cardiac event monitors in subjects with panic disorder might reveal a greater incidence of coronary vasospasm in this patient population.

Chest Pain in Generalized Anxiety Disorder

1992 ◽  
Vol 22 (3) ◽  
pp. 291-298 ◽  
Author(s):  
Cameron S. Carter ◽  
Richard J. Maddock
Keyword(s):  
Chest Pain ◽  
Anxiety Disorder ◽  
Panic Disorder ◽  
Generalized Anxiety Disorder ◽  
Panic Attacks ◽  
Medical Utilization ◽  
Generalized Anxiety ◽  
Common Diagnosis ◽  
History Of ◽  
Pain Patients

Objectives: The objectives of the current study were to evaluate the prevalence of chest pain and related medical utilization in patients with generalized anxiety disorder and to investigate the possible relationship between the occurrence of chest pain in these patients and the episodes of excessive worry which characterize this disorder. Method: The presence of a history of chest pain in patients with generalized anxiety disorder was investigated in an outpatient psychiatric sample using a structured interview which also assessed related medical utilization and the relationship of chest pain to panic attacks and episodes of excessive worry. Results: Of fifty sequentially evaluated patients meeting DSM-IIIR criteria for G.A.D., twenty-four (48%) reported a history of chest pain. Seven of these patients also had a history of panic attacks, however, four of the seven reported that their pain occurred independently of their panic attacks. Sixteen patients with G.A.D. reported that their chest pain episodes were associated with episodes of excess worry. Eleven had sought medical evaluation for their pain. Patients with chest pain and normal coronary arteries are frequently found to have panic disorder. The pattern of utilization of medical care was comparable in this sample of patients with G.A.D. and a group of patients with panic disorder recruited in a similar manner. Conclusions: These results suggest that in addition to panic disorder, G.A.D. may also be a common diagnosis in chest pain patients with no demonstrable coronary disease. Future studies of coronary artery disease negative patients with chest pain should include assessments for the presence of G.A.D. Our results also suggest that chest pain may be a common symptom in G.A.D. The possibility that chest pain should be included in the diagnostic criteria for this disorder should be the subject of further investigation.

Cognitive Behavioral Treatment of Panic Disorder in Elderly Adults: Two Case Studies

1996 ◽  
Vol 10 (4) ◽  
pp. 271-280 ◽  
Author(s):  
Jill H. Rathus ◽  
William C. Sanderson
Keyword(s):  
Panic Disorder ◽  
Elderly Patients ◽  
Behavioral Treatment ◽  
White Male ◽  
Panic Attacks ◽  
Cognitive Behavioral ◽  
White Female ◽  
Cognitive Behavioral Treatment ◽  
History Of

Cognitive behavioral treatment (CBT) has been repeatedly proven efficacious in the treatment of panic disorder (PD); however, information about the efficacy of this treatment with geriatric patients is lacking. The current paper outlines treatment course and outcome for two elderly PD patients receiving CBT. J. B. was a 70-year-old White male with a 51-year history of PD; A. B. was a 69-year-old White female with a 25-year history of PD. Diagnoses were made on the basis of the Structured Clinical Interview for DSM-III-R patient version (SCID-P). Both subjects received manual-driven CBT. Four primary treatment components consisted of psychoeducation, cognitive restructuring, breathing retraining, and systematic exposure. Subjects completed symptom measures before and after treatment and at a follow-up evaluation. Results support the efficacy of the treatment for both patients, as panic attacks, fear and avoidance, and general symptomatology were substantially reduced at post- and follow-up assessments. Results are discussed in terms of the utility of CBT with elderly patients and the nuances of treating elderly patients with this treatment procedure.

Improving the Recognition of Anxiety Disorders in Depressed Patients

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S1) ◽  
pp. 2-4
Author(s):  
Iwona Chelminski
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Panic Attacks ◽  
Depressed Patients ◽  
Increased Risk ◽  
History Of ◽  
Primary Care Patients

There is considerable symptom overlap and high levels of comorbidity between anxiety disorders and depression. The recognition of this comorbidity has both academic interest and clinical significance. Epidemiological studies have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. These individuals also tend to have a more chronic course of depression, as observed in psychiatric patients, primary care patients, and epidemiological samples. Van Valkenberg and colleagues reported that depressed patients with anxiety had poorer outcome and greater psychosocial impairment than those without an anxiety disorder. In the National Institute of Mental Health Collaborative Depression Study, the presence of panic attacks predicted a lower rate of recovery during the first 2 years of the follow-up interval. Similarly, Grunhaus found poorer outcome in depressed patients with comorbid panic disorder than in depressed patients without panic. In an 8-month follow-up study, depressed primary care patients with a history of generalized anxiety disorder (GAD) or panic disorder were less likely to have recovered from their depressive episode.Gaynes and colleagues prospectively followed primary care patients with major depressive disorder (MDD) every 3 months for 1 year after their initial diagnostic evaluation. At baseline, half of the original 85 patients had a coexisting anxiety disorder, the most frequent being social phobia (n=38). Twelve months after intake, 68 of the patients were available for the final interview. Those with a comorbid anxiety disorder were significantly more likely to still be in an episode of depression (82% vs 57%; risk ratio=1.44; 95% CI 1.02-2.04), and they experienced more disability days during the course of the 12 months than the depressed patients without an anxiety disorder (67.1 days vs 27.5 days).

Comparison Between the Panic Disorder with Agoraphobia Patients and Normal Controls on the Basis of Cognitions Affect and Physiology

1993 ◽  
Vol 21 (3) ◽  
pp. 199-217 ◽  
Author(s):  
Nigar G. Khawaja ◽  
Tian P. S. Oei ◽  
Larry Evans
Keyword(s):  
Panic Disorder ◽  
Normal Population ◽  
Ambulatory Monitoring ◽  
Low Frequency ◽  
Panic Attacks ◽  
High Anxiety ◽  
Negative Cognitions ◽  
Anxiety Levels ◽  
Sampling Procedures ◽  
Normal Controls

Research using ambulatory monitoring and cognitive sampling procedures has revealed the importance of negatively biased cognitions in panic attacks and panic disorder. However, the normal population has never been investigated on the basis of these procedures and it is still unclear how patients deviate from them on the basis of negative cognitions and their interaction with affect and physiology. The present study investigated these issues by comparing 15 panic disorder patients with an equal number of normal controls. The results revealed that, although the pattern of reporting cognitions was similar, the two groups differed on type and content of the cognitions. In general, there were significant differences between the two groups for neutral and negative cognitions. Patients experienced high anxiety levels that were associated with cognitions of negative affect. There was a low frequency of reported panic attacks in the patients group. Possible reasons for the limited number of panic attacks are discussed.

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