FEATURES OF THERAPY FOR PANIC DISORDER, ASSOCIATED WITH THE SARS-COV-2 PANDEMIC

Vestnik ◽  
2021 ◽  
pp. 313-318
Author(s):  
Л.Б. Куанова ◽  
Г.М. Жуламанова
Keyword(s):  
Panic Disorder ◽  
Rating Scale ◽  
Panic Attacks ◽  
Qtc Interval ◽  
Obsessive Compulsive ◽  
Significant Similarity ◽  
Therapy Regimen ◽  
Compulsive Disorder ◽  
History Of ◽  
First Time

Введение. В силу существенной схожести симптомов острого респираторного синдрома SARS-CoV-2 и панического расстройства (ПР), диагностика представляет значительные трудности. ПР имеют тенденцию развиваться хронически, с рецидивами на протяжении всей жизни. Цель работы: выявить особенности клинического проявления ПА/ПР на фоне COVID-19 и обосновать оптимальную схему терапии. Методы. Проведен анализ данных 86 пациентов, у которых диагностировано ПР при обращении на консультативный неврологический прием КФ UMC с мая 2020 г по май 2021 г. Скрининг панического расстройства проведен по Шкале тревоги Шихана (Sheehan Anxiety Rating Scale, ShARS). Результаты. Среди пациентов было 54 (62,8%) женщины и 32(37,2%) мужчины. По шкале ShARS тяжелым тревожное расстройство (80 баллов и выше) определено у 39 (45,3%), у остальных тревога (от 30 до 80 баллов) - клинически выраженная. Диагноз ПР у 21(24,4%) был диагностирован ранее заражения ковидной инфекцией. У остальных, выставлен впервые 26 (30,2%) пациентам, ранее не обращавшихся к неврологу и 39 (45,3%) пациентам, обращавшихся к неврологу с диагнозами соматоформная вегетативная дисфункция, сосудистая цефалгия, мигрень, обсессивно-компульсивное расстройство. Бронхиальная астма отмечалась в анамнезе в 13 (15,1%) случаях. Разновидности панических приступов были расценены как большие (развернутые) ПР (4 симптома и более) - у 55 (64%), в остальных случаях как симптоматически бедные. Особенность течения ПР на фоне SARS-CoV-2 определяется возникновением на фоне ипохондрических фобий. В то же время агорафобии и избегающего поведения, характерных для ПР, не отмечалось. Заключение. Использование бензодиазепинов для анксиолитических целей, противоастматических препаратов может быть контрпродуктивным в лечении тревожных расстройств. Ятрогенный риск наслаивается на возможную гипокалиемию, удлинение интервала QTc, артериальную гипертензию, вызванную COVID-19. Оценка результатов проведённого нейрофармакологического анализа и назначения препаратов анксиолитического действия Бифрен, в более тяжелых случаях ПР Прегабина показала клинический положительный эффект. Introduction. Due to the significant similarity between the symptoms of SARS-CoV-2 acute respiratory syndrome and panic disorder (PD), diagnosis presents significant difficulties. PD tend to develop chronically, with lifelong relapses. Purpose of the work: to identify the features of the clinical manifestation of PD in the presence of COVID-19 and to substantiate the optimal therapy regimen. Methods. We analyzed the data of 86 patients who were diagnosed with PD when they applied for a consultative neurological appointment CF UMC from May 2020 to May 2021. Panic disorder was screened according to the Sheehan Anxiety Rating Scale (ShARS). Results. Among the patients there were 54 (62.8%) women and 32 (37.2%) men. On the ShARS scale, severe anxiety disorder (80 points and higher) was identified in 39 (45.3%), in the rest anxiety (from 30 to 80 points) was clinically expressed. The diagnosis of PD in 21 (24.4%) was diagnosed earlier than contracting a covid infection. The rest were exposed for the first time to 26 (30.2%) patients who had not previously visited a neurologist and 39 (45.3%) patients who visited a neurologist with diagnoses of somatoform autonomic dysfunction, vascular cephalgia, migraine, obsessive-compulsive disorder. A history of bronchial asthma was observed in 13 (15.1%) cases. The types of panic attacks were regarded as large (extensive) PR (4 symptoms or more) - in 55 (64%), in other cases as symptomatically poor. The peculiarity of the course of PR against the background of SARS-CoV-2 is determined by the occurrence of hypochondriac phobias against the background. At the same time, agoraphobia and avoidant behavior characteristic of PD were not observed. Conclusion. The use of benzodiazepines for anxiolytic purposes, anti-asthma drugs may be counterproductive in the treatment of anxiety disorders. The iatrogenic risk is superimposed on possible hypokalemia, prolongation of the QTc interval, arterial hypertension caused by COVID-19. Evaluation of the results of the neuropharmacological analysis and the appointment of drugs with anxiolytic action Bifren, in more severe cases of Pregabin in PR showed a clinical positive effect.

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.

Insight in obsessive–compulsive disorder: a study of an Italian sample

2002 ◽  
Vol 17 (7) ◽  
pp. 407-410 ◽  
Author(s):  
Donatella Marazziti ◽  
Liliana Dell’Osso ◽  
Elena Di Nasso ◽  
Chiara Pfanner ◽  
Silvio Presta ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Clinical Features ◽  
Rating Scale ◽  
Clinical Impression ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
History Of ◽  
Bipolar Patients ◽  
Italian Sample ◽  
Global Clinical Impression

SummaryInsight is a complex phenomenon that can be interpreted according to a dimensional model. Given the controversial data of insight in obsessive–compulsive disorder (OCD), our study aimed to investigate insight in an Italian sample of patients with OCD by means of the specific item on the Yale–Brown obsessive–compulsive scale (Y-BOCS) and to explore the possible correlations between it and clinical features. One hundred and seventeen out-patients with a DSM-IV diagnosis of OCD and different comorbid psychiatric disorders were included in the study and assessed by means of the Y-BOCS, Hamilton rating scale for depression (HRSD) and the global clinical impression. The results showed that almost 50% of the patients had an excellent level of insight and 15% had a little or no insight. No correlation between levels of insight and clinical features was observed, except for a negative trend with the presence of somatic obsessions. In addition, a trend towards a lower level of insight was observed in those bipolar patients with a positive history of repeated manic or hypomanic episodes. Further studies seem to be necessary in order to establish whether or not OCD patients with poor insight represent a distinct sub-group of patients.

Is Hypochondriasis Related to Obsessive-Compulsive Disorder, Panic Disorder, or Both? An Empirical Evaluation

2008 ◽  
Vol 22 (2) ◽  
pp. 115-127 ◽  
Author(s):  
Brett Deacon ◽  
Jonathan S. Abramowitz
Keyword(s):  
Panic Disorder ◽  
Obsessive Compulsive Disorder ◽  
Cognitive Biases ◽  
Function Analysis ◽  
Intolerance Of Uncertainty ◽  
Panic Attacks ◽  
Self Report ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Body Vigilance

Although hypochondriasis (HC) is considered a somatoform disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision), some authors have pointed out that the symptoms of HC overlap with certain anxiety disorders, namely, panic disorder (PD) and obsessive-compulsive disorder (OCD). Few studies have empirically addressed this overlap. In the present investigation, we used discriminant function analysis to explore how patients with a principal diagnosis of HC, OCD, or PD varied with respect to cardinal symptoms of these disorders (i.e., health anxiety, obsessions and compulsions, and panic-related anxiety and avoidance) and key cognitive biases (i.e., intolerance of uncertainty, anxiety sensitivity, and body vigilance). Fifty treatment-seeking individuals with PD, 21 with OCD, and 23 with HC completed self-report measures of symptoms and cognitions during their clinic visit. Results indicated that whereas individuals with HC experience panic attacks, obsessions, and compulsions, these symptoms are markedly less pronounced than among those with PD and OCD. Conversely, overlaps were found in terms of cognitive biases, with HC patients demonstrating elevated levels of intolerance of uncertainty, body vigilance, and fear of cardiovascular symptoms. Implications for the conceptualization and treatment of HC are discussed.

Panic Attacks and Anxiety Disorders

2020 ◽  
Author(s):  
Curtis Wittmann
Keyword(s):  
Emergency Department ◽  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Stress Disorder ◽  
Acute Stress ◽  
Panic Attacks ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

This review discusses the acute diagnosis and management of panic and anxiety disorders. Anxiety disorders are among the most common psychiatric disorders in the country and are a relatively common cause of presentation to the emergency department. Most anxiety disorders can be conceptualized as fear- or phobia-based disorders, including panic disorder, specific phobia, social phobia, acute stress disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Each of these disorders is discussed, including prevalence and common clinical presentations. The initial evaluation of patients with a suspected or diagnosed anxiety disorder will be based on their current symptoms. Some patients may be highly agitated and may require deescalation or sedation to perform a reasonable history and physical examination. To achieve this, providers should ensure their own safety first, with attention to the physical layout of the emergency department, ensuring that they are closer to the room exit than the patient (so that they cannot be trapped). The presence of police or security may be necessary to provide optimal care and an appropriate evaluation. Typical treatment of acute exacerbations of anxiety disorders includes medical management, most often benzodiazepines, which can provide immediate relief. Psychiatric consultation may be necessary in certain cases. For most patients, outpatient management rather than inpatient admission will lead to the most effective management of their anxiety.   Key words: anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, stress disorder This review contains 1 highly rendered figure, 17 tables, and 29 references.

scholarly journals Suicidal Ideations in Patients With Obsessive-Compulsive Disorder

2022 ◽  
Vol 8 (1) ◽  
pp. 39-48
Author(s):  
Mohammadrasoul Khalkhali ◽  
◽  
Roghaye Zare ◽  
Hassan Farrahi ◽  
Peyvand Shambayati ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Obsessive Compulsive Disorder ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Previous History ◽  
Obsessive Compulsive ◽  
Cross Sectional ◽  
Compulsive Disorder ◽  
First Degree Relatives ◽  
History Of

Background: There are many controversies about the frequency and burden of suicidality in patients with Obsessive-Compulsive Disorder (OCD). Objectives: This study was done to determine the prevalence and risk factors of current suicidal ideations in patients with OCD. Materials & Methods: In this cross-sectional study, 258 outpatients with OCD (Yale-Brawn Obsessive Compulsive Scale, Y-BOCS ≥16) referring to two psychiatry clinics in Guilan, Iran, from March 2018 to September 2019 were evaluated. Suicidality score of the Brief Psychiatric Rating Scale (BPRS) ≥4 was considered for current suicidal ideation at the first visit. Beck Scale for Suicidal Ideation (BSSI) was used to evaluate the intensity of suicidal ideations a week before evaluation. Simple linear and binary logistic regression analyses were used to analyze data by SPSS v. 20. Results: Current suicidal ideation was found in 22.1% of patients. The previous history of suicide attempt (BPRS, P<0.0001 and BSSI, P<0.0001), a history of OCD in first-degree relatives (BPRS: P=0.004 and BSSI: P=0.010), a history of suicide attempts in first-degree relatives (BPRS: P=0.013 and BSSI: P<0.0001), comorbid diagnosis of depressive or body dysmorphic disorder (BPRS, P<0.0001 and BSSI, P<0.0001), and higher Y-BOCS score (BPRS: P=0.043 and BSSI: P<0.0001) were associated with a higher risk of having suicidal ideation. Conclusion: Suicidal thoughts are high in Iranian patients with OCD at their first visit to psychiatry clinics. The previous suicide history, positive history of OCD and suicide attempts in their first-degree relatives, the severity of OCD, and some comorbid psychological disorders are associated with a higher risk of suicidal ideation among OCD patients.

Comorbidity with Axis I Anxiety Disorders in Remitted Psychotic Patients 1 Year After Hospitalization

CNS Spectrums ◽  
2007 ◽  
Vol 12 (12) ◽  
pp. 913-919 ◽  
Author(s):  
Antonio Ciapparelli ◽  
Rosemma Paggini ◽  
Donatella Marazziti ◽  
Claudia Carmassi ◽  
Maria Bianchi ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Rating Scale ◽  
Severity Of Illness ◽  
Psychotic Symptoms ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Comorbid Anxiety ◽  
Axis I

ABSTRACTIntroductionComorbid anxiety disorders are frequently encountered in psychoses and mainly assessed during the hospitalization.MethodsComorbidity was investigated in 98 patients with schizophrenia, schizoaffective, or bipolar disorder, previously hospitalized for psychotic symptoms. Assessments, including Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Brief Psychiatric Rating Scale, and Clinical Global Impressions Scale, were performed during hospitalization (t0) and subsequently in a phase of remission (t1). Comorbidity was assessed at t1 only.ResultsOne or more comorbid anxiety diagnoses were made in 46 (46.9%) patients. Of these, 15 (32.6%) received multiple anxiety diagnoses, while 31 (67.4%) single anxiety diagnoses. Schizophrenic patients had a rate of social anxiety disorder (SAD) higher (P<.05) than the others. Patients assessed with panic disorder or with obsessive-compulsive disorder at t1 showed significantly greater severity of illness at t0; patients with SAD demonstrated greater severity at t1. No significant differences in the rates of individual anxiety disorders were found in patients treated with typical or atypical antipsychotics or with both.ConclusionAnxiety disorders, particularly obsessive-compulsive disorder, panic disorder and SAD, seem to be frequently comorbid in remitted psychotic patients; SAD would be more prevalent in schizophrenia and might negatively impact the course of the illness.

Obsessive–Compulsive Disorder

1996 ◽  
Vol 169 (1) ◽  
pp. 101-107 ◽  
Author(s):  
P. Lensi ◽  
G. B. Cassano ◽  
G. Correddu ◽  
S. Ravagli ◽  
J. L. Kunovac ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Close Association ◽  
Demographic Data ◽  
Bipolar Disorders ◽  
Panic Attacks ◽  
Obsessive Compulsive ◽  
Axis Ii ◽  
Compulsive Disorder ◽  
History Of ◽  
Axis I

BackgroundDemographic data, family history, psychopathological features, comorbidity and course of obsessive–compulsive disorder (OCD) are investigated and data generated to support the possible existence of two subgroups with gender-related differences of a broader nature.MethodTwo hundred and sixty-three OCD patients, consecutive admissions to the Institute of Psychiatry, University of Pisa over a period of 5 years, not excluding those with comorbid Axis I and Axis II conditions, were studied. Patients were evaluated with a specifically designed semi-structured OCD interview.ResultsWe found a significantly greater history of perinatal trauma in men who also had an earlier onset, greater likelihood of never having been married and a higher frequency of such symptoms as sexual, exactness and symmetry obsessions and odd rituals; by contrast, women suffered a later onset of the disorder, were more likely to be married, had higher rates of associated panic attacks after the onset of OCD and a higher frequency of aggressive obsessions at the onset of their illness, and were less frequently associated with bipolar disorders.ConclusionsPathophysiological mechanisms in OCD seem to differ by gender. Perinatal trauma might predispose to earlier onset in men, whereas in women there is a close association between OCD and panic disorder.

scholarly journals Clomipramine and fluoxetine effects in the treatment of panic disorder

2003 ◽  
Vol 3 (3) ◽  
pp. 27-31 ◽  
Author(s):  
Semra Čavaljuga ◽  
Ifeta Ličanin ◽  
Elvedina Kapić ◽  
Dubravka Potkonjak
Keyword(s):  
Panic Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Panic Attacks ◽  
Duration Of Treatment ◽  
Double Blind ◽  
Psychiatric Interview ◽  
Favourable Response ◽  
Double Blind Clinical Trial ◽  
History Of

Panic disorder (PD) is an acute psychobiologic reaction manifested by intense anxiety and panic attacks, that occur unpredictably with subjective sense of intense apprehension or terror, accompanied by temporary loss of the ability to plan, think, or reason and the intense desire to escape or flee the situation. Panic attacks may last from a few seconds to an hour or longer, Symptoms typically include, among others, palpitations, tachycardia, hypertension, chest pain, dyspnoea, and fear of loosing control or going crazy and vague feeling of imminent doom or death. Since pharmacotherapy of PD includes the administration of selective serotonin reuptake inhibitors and tricyclic antidepressants, the objective of this study was to perform a pilot double blind clinical trial designed to compare the effects of two studied drugs in the treatment of PD.A total number of 40 patients with a history of panic disorder were randomly assigned into two groups of 20 patients each. Hamilton anxiety rating scale and Standard Psychiatric Interview were methods for PD assessment. One group was treated with clomipramine hydrochloride (ANAFRANIL®) 75 mg/day and the other with fluoxetine (OXETIN®) 60 mg/day. Both drugs were administrated by mouth (PO) two times-a-day in equally divided doses for 6 weeks.Both studied agents produced similar antipanic effectiveness. Favourable response was achieved in 95% of patients treated with fluoxetine and 90% of patients treated with clomipramine. The onset of antipanic effects was quicker in all clomipramine treated patients, while fluox-etine produced more-favourable response in male patients. The duration of treatment with both antidepres-sants studied should be at least 10 weeks, instead of 6 weeks.

How athletes coped with COVID-19 restrictions: differences between Switzerland and Italy

2020 ◽  
Keyword(s):  
Psychological Symptoms ◽  
Training Session ◽  
Coping Resources ◽  
Government Officials ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Aggressive Action ◽  
History Of ◽  
Global Threat ◽  
Sport Facilities

The ongoing COVID-19 pandemic is a global crisis of unprecedented scale in modern times. The initial outbreak of COVID-19 in Wuhan spread rapidly, affecting other parts of China and soon other countries becoming a global threat. [1] On 11 March 2020, the WHO has declared the ‘Pandemic state’ calling the governments to take ‘urgent and aggressive action’ to delay and mitigate the peak of infection. To respond to COVID-19 public health experts and government officials are taking several measures, including social distancing, self-isolation, or quarantine; strengthening health facilities to control the disease; and asking people to work at home. To safeguard the health of athletes and others involved all forms of organized sport have been either cancelled or postponed. These range from mass participation events such as marathon races to football league and even to the Olympics and Paralympics that for the first time in the history of the modern games, have been postponed, and will be held in 2021. All sport in Italy had been suspended from early March and from April the lockdown measures had been extended to the training session for professional and non-professional athletes within all sport facilities. Unlike Italy, the Swiss government has not imposed a general curfew so athletes continued to train outdoor although training in a group was forbidden. [2,3] Some athletes in this situation will be able to build on existing coping resources while others athletes may experience psychological symptoms including fear of being infected, anxiety of physical recovery if infected, disturbed sleep, eating disorders, obsessive-compulsive disorder, and family conflicts.

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.

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