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Journal of Affective Disorders Jan 2015Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be...
BACKGROUND
Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be grief-related. The present study examines the presence and impact of grief-related panic symptoms in CG.
METHODS
Individuals with CG (n=146, 78% women, mean (SD) age=52.4(15.0)) were assessed for CG, DSM-IV diagnoses, work and social impairment, and with the Panic Disorder Severity Scale modified to assess symptoms "related to or triggered by reminders of your loss" and anticipatory worry.
RESULTS
Overall, 39.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and 32.2% reported some level of anticipatory worry about grief-related panic. Of interest, 17% met DSM criteria for PD. Among those without PD, 34.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and this was associated with higher CG symptom severity (t=-2.23, p<0.05), and functional impairment (t=-3.31, p<0.01). Among the full sample, controlling for CG symptom severity and current PD, the presence of at least one full or limited-symptom grief-related panic attack was independently associated with increased functional impairment (B(SE)=4.86(1.7), p<0.01).
LIMITATIONS
Limitations include a lack of assessment of non-grief-related panic symptoms and examination of a sample of individuals seeking treatment for CG.
CONCLUSIONS
Grief-related panic symptoms may be prevalent among individuals with CG and independently contribute to distress and functional impairment.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anxiety; Diagnostic and Statistical Manual of Mental Disorders; Female; Grief; Humans; Male; Middle Aged; Panic Disorder; Social Behavior; Young Adult
PubMed: 25254619
DOI: 10.1016/j.jad.2014.08.028 -
Psychiatria Danubina Jun 2017Comorbidity of anxiety and depression (both current and lifetime) is associated with greater chronicity and an increased risk of suicidality. We wished to ascertain...
BACKGROUND
Comorbidity of anxiety and depression (both current and lifetime) is associated with greater chronicity and an increased risk of suicidality. We wished to ascertain which symptom clusters had the strongest association with suicidality. Our aims were (1) to examine the presence of current comorbidity and suicidality in patients diagnosed with panic disorder/agoraphobia (PD/A) and major depression (MD), and their relationship with duration of psychiatric treatment and frequency of hospital admission; and (2) to examine which coexisting symptoms were most strongly predictive of suicidality in sub-groups and the overall group.
SUBJECTS AND METHODS
The study sample comprised 100 patients with PD/A and MD. The following assessment instruments were applied: the Panic and Agoraphobia Scale, the Beck Anxiety Inventory, the Beck Depression Inventory-II, the Beck Scale for Suicide Ideation, the Obsessive-Compulsive Inventory-Revised, the Liebowitz Social Anxiety Scale and the Whiteley Index of Hypochondriasis.
RESULTS
High rates of current comorbidity were seen in both groups. Patients with MD had significantly higher suicidality scores, but were also older, with a longer duration of psychiatric treatment and more frequent hospitalizations. In the overall group, psychiatric comorbidity was correlated with duration of psychiatric treatment and frequency of hospitalizations (with the exception of hypochondriasis which was not correlated with frequency of hospitalization). In both sub-groups and the overall group, suicidality was correlated with scores for all examined comorbidity (with the exception of hypochondriasis in the PD/A group): however, after multiple regression only obsessive-compulsive symptomatology predicted suicidality in all sub-groups and the overall group, as well as depression in the overall group. Depression supposed as dependent variable and obsessive-compulsive symptomatology as a mediator explained around 37% of the variance in suicidal ideation.
CONCLUSION
Patients with PD/A or MD show high rates of current comorbidity. The effect of depression on suicidality was significant, but a non-trivial impact was also mediated by obsessive-compulsive symptomatology.
Topics: Adult; Agoraphobia; Comorbidity; Cross-Sectional Studies; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Panic Disorder; Psychiatric Status Rating Scales; Psychometrics; Risk Factors; Serbia; Statistics as Topic; Suicidal Ideation
PubMed: 28636577
DOI: 10.24869/psyd.2017.186 -
L'Encephale Jun 2020Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific... (Review)
Review
Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).
Topics: Anxiety; Anxiety Disorders; Betacoronavirus; COVID-19; Catastrophization; Comorbidity; Coronavirus Infections; Dyspnea; Female; Humans; Hypokalemia; Male; Pandemics; Panic Disorder; Pneumonia, Viral; Psychotropic Drugs; Renin-Angiotensin System; Respiration; SARS-CoV-2; Stress, Psychological; Terminology as Topic; Torsades de Pointes
PubMed: 32507556
DOI: 10.1016/j.encep.2020.05.010 -
BMJ Case Reports Mar 2023Panic attacks have been associated with hypophosphatemia, which can lead to numerous complications if unrecognised. Here, we present the case of an otherwise-healthy man...
Panic attacks have been associated with hypophosphatemia, which can lead to numerous complications if unrecognised. Here, we present the case of an otherwise-healthy man in his 20s who experienced a panic attack accompanied by hypophosphatemia and hypokalaemia and subsequently developed rhabdomyolysis. This trajectory highlights the clinical significance of panic attack-associated metabolic derangements and their potential for medical complications such as rhabdomyolysis.
Topics: Male; Humans; Panic Disorder; Hypokalemia; Hypophosphatemia; Panic
PubMed: 36948522
DOI: 10.1136/bcr-2022-254362 -
Revista Brasileira de Psiquiatria (Sao... 2017To compare prey and snake paradigms performed in complex environments to the elevated plus-maze (EPM) and T-maze (ETM) tests for the study of panic attack- and... (Review)
Review
Critical neuropsychobiological analysis of panic attack- and anticipatory anxiety-like behaviors in rodents confronted with snakes in polygonal arenas and complex labyrinths: a comparison to the elevated plus- and T-maze behavioral tests.
OBJECTIVE:
To compare prey and snake paradigms performed in complex environments to the elevated plus-maze (EPM) and T-maze (ETM) tests for the study of panic attack- and anticipatory anxiety-like behaviors in rodents.
METHODS:
PubMed was reviewed in search of articles focusing on the plus maze test, EPM, and ETM, as well as on defensive behaviors displayed by threatened rodents. In addition, the authors' research with polygonal arenas and complex labyrinth (designed by the first author for confrontation between snakes and small rodents) was examined.
RESULTS:
The EPM and ETM tests evoke anxiety/fear-related defensive responses that are pharmacologically validated, whereas the confrontation between rodents and snakes in polygonal arenas with or without shelters or in the complex labyrinth offers ethological conditions for studying more complex defensive behaviors and the effects of anxiolytic and panicolytic drugs. Prey vs. predator paradigms also allow discrimination between non-oriented and oriented escape behavior.
CONCLUSIONS:
Both EPM and ETM simple labyrinths are excellent apparatuses for the study of anxiety- and instinctive fear-related responses, respectively. The confrontation between rodents and snakes in polygonal arenas, however, offers a more ethological environment for addressing both unconditioned and conditioned fear-induced behaviors and the effects of anxiolytic and panicolytic drugs.
Topics: Animals; Anxiety Disorders; Behavior, Animal; Fear; Instinct; Maze Learning; Panic Disorder; Predatory Behavior; Rats; Rats, Wistar; Snakes
PubMed: 28177062
DOI: 10.1590/1516-4446-2015-1895 -
Neuroscience and Biobehavioral Reviews May 2017Panic patients experience recurrent panic attacks. Two main neurochemical hypotheses have been proposed to explain this vulnerability. The first suggests that panic... (Review)
Review
Panic patients experience recurrent panic attacks. Two main neurochemical hypotheses have been proposed to explain this vulnerability. The first suggests that panic patients have deficient serotonergic inhibition of neurons localized in the dorsal periaqueductal gray matter of the midbrain that organizes defensive reactions to cope with proximal threats as well as of sympathomotor control areas of the rostral ventrolateral medulla that generate neurovegetative symptoms of the panic attack. The second proposes that endogenous opioids buffer panic attacks in normal subjects, and their deficit results in heightened sensitivity to suffocation and separation anxiety in panic patients. Experimental results obtained in rat models of panic indicate that serotonin interacts synergistically with endogenous opioids in the dorsal periaqueductal gray through 5-HT1A and μ-opioid receptors to inhibit proximal defense and, supposedly, panic attacks. These findings allow reconciliation of the serotonergic and opioidergic hypotheses of panic pathophysiology. They also indicate that endogenous opioids are likely to participate in the panicolytic action of antidepressants and suggest that exogenous opioids may be useful for treating panic patients resistant to conventional pharmacotherapy.
Topics: Analgesics, Opioid; Animals; Humans; Opioid Peptides; Panic; Panic Disorder; Periaqueductal Gray; Serotonin
PubMed: 28073587
DOI: 10.1016/j.neubiorev.2016.10.013 -
Journal of Cognitive Psychotherapy Feb 2023acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) are empirically supported treatments for anxiety and panic disorder (PD), though they...
acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) are empirically supported treatments for anxiety and panic disorder (PD), though they differ in their putative vulnerability and maintenance processes. The present study examined the incremental validity of several of these models' proposed core processes, including anxiety sensitivity (AS), dispositional avoidance, experiential avoidance (EA), cognitive fusion (CF), and mindfulness, as well as the interaction of the processes within each model, in the prediction of anxiety and panic symptomology. a sample of US adults ( = 316) completed self-report measures of AS, dispositional avoidance, EA, CF, mindfulness, anxiety, and PD symptoms. A series of hierarchical multiple regression analyses were conducted. hierarchical regression analyses indicated that AS, dispositional avoidance, and EA predicted anxiety and panic symptoms even after controlling for one another, CF, mindfulness, and demographic variables. Although mindfulness and CF was correlated with anxiety and panic at the univariate level, they did not predict either outcome above and beyond AS, dispositional avoidance, and EA. When interaction terms were added to the models, the interaction between AS and -dispositional avoidance was a significant predictor of panic and anxiety symptoms, whereas the interaction between EA and CF only predicted panic symptoms. None of the interactions that included mindfulness were significant predictors. these findings provide support the independent and interactive predictive value of traditional CBT (AS, dispositional avoidance, and AS-dispositional avoidance) and ACT (EA) processes for anxiety and panic symptoms, but raise questions about the incremental predictive utility of CF and mindfulness.
Topics: Adult; Humans; Acceptance and Commitment Therapy; Anxiety; Cognitive Behavioral Therapy; Anxiety Disorders; Panic Disorder
PubMed: 36788001
DOI: 10.1891/JCPSY-D-20-00056 -
Journal of Affective Disorders Apr 2020This review aimed to evaluate whether patients with panic disorder (PD) exhibit different heart rate variability (HRV) compared to healthy controls and to determine... (Review)
Review
BACKGROUND
This review aimed to evaluate whether patients with panic disorder (PD) exhibit different heart rate variability (HRV) compared to healthy controls and to determine whether HRV is different in patients with PD after treatment.
METHODS
Literature databases were searched for studies comparing resting-state HRV between drug-naïve patients with PD and healthy controls. Parameters from the short-term frequency-domain and long-term time domain were included.
RESULTS
In the low frequency (LF) analysis, no significant association was found between LF and PD (standardised mean difference [SMD] = -0.0443, 95% confidence interval [CI]: -0.1765 to 0.0879). In the high frequency (HF) analysis, no significant association was found between HF and PD (SMD = -0.1269, 95% CI: -0.2598 to 0.0059). In the LF/HF analysis, a significantly higher LF/HF ratio was found in cases than in controls, but the effect was moderate (SMD = 0.1390, 95% CI: 0.0180 to 0.2600). For the standard deviation of normal-to-normal intervals, a significantly lower value was observed in cases than in controls (SMD = -0.3133, 95% CI: -0.5459 to -0.0808).
LIMITATIONS
Limited sample size in the time-domain and treatment effect analyses.
CONCLUSIONS
Patients with PD had a higher short-term LF/HF ratio, indicating impaired sympathovagal balance. The LF/HF ratio findings were more consistent compared with LF and HF alone, making it a better parameter to interpret the LF and HF in conjunction. HRV may be a promising biomarker for predicting antidepressant response.
Topics: Antidepressive Agents; Heart Rate; Humans; Panic Disorder
PubMed: 32217230
DOI: 10.1016/j.jad.2020.01.132 -
Journal of Psychiatric Research Jun 2021While both direct and indirect exposure to mass trauma are increasing in the United States, relatively little is known about the potential link between mass trauma and...
While both direct and indirect exposure to mass trauma are increasing in the United States, relatively little is known about the potential link between mass trauma and risk of panic disorder early in life. It is also unclear whether history of prior individual trauma increases risk of panic disorder even further among those with exposure to mass trauma. The current study investigated the association between exposure to a mass trauma event (the World Trade Center (WTC) attack) and risk of panic disorder among children, how panic disorder varies by exposure severity and sociodemographic characteristics, and whether there is an interaction between individual and mass trauma exposure in the risk of panic disorder. Data were from an epidemiologic study of probable mental disorders among New York City schoolchildren exposed to the WTC terrorist attack. Severe (adjusted odds ratio [AOR] = 2.0 (1.1, 3.7)) exposure to the WTC disaster was associated with increased odds of probable panic disorder, relative to mild exposure. The prevalence of panic disorder increased with higher level of WTC exposure among all sociodemographic strata. Prior individual trauma exposure was associated with increased odds of panic disorder (AOR = 2.4 (1.6, 3.5)), but there was no evidence of interaction between prior individual trauma exposure and exposure to the WTC disaster. Preventive measures to address the widespread nature of mass disaster exposure at increasingly earlier ages and via media could mitigate the potential impact on mental health.
Topics: Child; Disasters; Humans; New York City; Panic Disorder; September 11 Terrorist Attacks; Stress Disorders, Post-Traumatic
PubMed: 33906123
DOI: 10.1016/j.jpsychires.2021.04.001 -
Progress in Neuro-psychopharmacology &... Apr 2019Depression and panic disorder (PD) share the common pathophysiology from the perspectives of neurotransmitters. The relatively high comorbidity between depression and PD... (Review)
Review
Depression and panic disorder (PD) share the common pathophysiology from the perspectives of neurotransmitters. The relatively high comorbidity between depression and PD contributes to the substantial obstacles to differentiate from depression and PD, especially for the brain pathophysiology. There are significant differences in the diagnostic criteria between depression and PD. However, the paradox of similar pathophysiology and different diagnostic criteria in these two disorders were still the issues needing to be addressed. Therefore the clarification of potential difference in the field of neuroscience and pathophysiology between depression and PD can help the clinicians and scientists to understand more comprehensively about significant differences between depression and PD. The researchers should be curious about the underlying difference of pathophysiology beneath the significant distinction of clinical symptoms. In this review article, I tried to find some evidences for the differences between depression and PD, especially for neural markers revealed by magnetic resonance imaging (MRI). The distinctions of structural and functional alterations in depression and PD are reviewed. From the structural perspectives, PD seems to have less severe gray matter alterations in frontal and temporal lobes than depression. The study of white matter microintegrity reveals more widespread alterations in fronto-limbic circuit of depression patients than PD patients, such as the uncinate fasciculus and anterior thalamic radiation. PD might have a more restrictive pattern of structural alterations when compared to depression. For the functional perspectives, the core site of depression pathophysiology is the anterior subnetwork of resting-state network, such as anterior cingulate cortex, which is not significantly altered in PD. A possibly emerging pattern of fronto-limbic distinction between depression and PD has been revealed by these explorative reports. The future trend for machine learning and pattern recognition might confirm the differentiation pattern between depression and PD based on the explorative results.
Topics: Brain; Depressive Disorder, Major; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Nerve Net; Panic Disorder
PubMed: 29705713
DOI: 10.1016/j.pnpbp.2018.04.013