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World Journal of Psychiatry Jun 2021Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present...
BACKGROUND
Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.
AIM
To investigate the psychological characteristics of panic disorder patients related to bipolarity.
METHODS
A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics.
RESULTS
Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, = 126). The BP+ group were more likely to be unmarried (single 56.2% 44.4%, = 0.008) and younger (30.78 ± 0.59 37.11 ± 3.21, 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score.
CONCLUSION
The result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.
PubMed: 34168971
DOI: 10.5498/wjp.v11.i6.242 -
Journal of Experimental Pharmacology 2021Several effective pharmacological therapies for panic disorder (PD) are available, but they have some drawbacks, and unsatisfactory outcomes can occur. Expanding the... (Review)
Review
Several effective pharmacological therapies for panic disorder (PD) are available, but they have some drawbacks, and unsatisfactory outcomes can occur. Expanding the variety of anti-panic medications may allow for improving PD treatment. The authors performed an updated systematic review of preclinical and clinical (Phase I-III) pharmacological studies to look for advances made in the last six years concerning novel-mechanism-based anti-panic compounds or using medications approved for nonpsychiatric medical conditions to treat PD. The study included seven published articles presenting a series of preclinical studies, two Phase I clinical studies with orexin receptor (OXR) antagonists, and two clinical studies investigating the effects of D-cycloserine (DCS) and xenon gas in individuals with PD. The latest preclinical findings confirmed and expanded previous promising indications of OXR1 antagonists as novel-mechanism-based anti-panic compounds. Translating preclinical research into clinical applications remains in the early stages. However, limited clinical findings suggested the selective OXR1 antagonist JNJ-61393115 may exert anti-panic effects in humans. Overall, OXR1 antagonists displayed a favorable profile of short-term safety and tolerability. Very preliminary suggestions of possible anti-panic effects of xenon gas emerged but need confirmation with more rigorous methodology. DCS did not seem promising as an enhancer of cognitive-behavioral therapy in PD. Future studies, including objective panic-related physiological parameters, such as respiratory measures, and expanding the use of panic vulnerability biomarkers, such as hypersensitivity to CO panic provocation, may allow for more reliable conclusions about the anti-panic properties of new compounds.
PubMed: 33889031
DOI: 10.2147/JEP.S261403 -
The World Journal of Biological... Dec 2023Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based...
OBJECTIVES
Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA).
METHODS
The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS).
RESULTS
The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression.
CONCLUSIONS
Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.
Topics: Humans; Female; Cohort Studies; Anxiety Disorders; Panic Disorder; Anxiety
PubMed: 34842503
DOI: 10.1080/15622975.2021.2011409 -
Psychiatry Research Sep 2020Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk...
Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Panic Disorder; Risk Factors; Sleep; Sleep Wake Disorders; Suicidal Ideation; Suicide, Attempted
PubMed: 32763542
DOI: 10.1016/j.psychres.2020.113280 -
European Neuropsychopharmacology : the... Apr 2020In the DSM-5, separation anxiety disorder (SAD) is newly classified in the chapter on anxiety, renewing research efforts into its etiology. In this narrative review, we... (Review)
Review
In the DSM-5, separation anxiety disorder (SAD) is newly classified in the chapter on anxiety, renewing research efforts into its etiology. In this narrative review, we summarize the current literature on the genetic, endocrine, physiological, neural and neuropsychological underpinnings of SAD per se, SAD in the context of panic disorder, separation anxiety symptoms, and related intermediate phenotypes. SAD aggregates in families and has a heritability of ~43%. Variants in the oxytocin receptor, serotonin transporter, opioid receptor µ1, dopamine D4 receptor and translocator protein genes have all been associated with SAD. Dysregulation of the hypothalamus-pituitary-adrenal axis, dysfunctional cortico-limbic interaction and biased cognitive processing seem to constitute further neurobiological markers of separation anxiety. Hypersensitivity to carbon dioxide appears to be an endophenotype shared by SAD, panic disorder and anxiety sensitivity. The identification of biological risk markers and its multi-level integration hold great promise regarding the prediction of SAD risk, maintenance and course, and in the future may allow for the selection of indicated preventive and innovative, personalized therapeutic interventions.
Topics: Anxiety, Separation; Carbon Dioxide; Diagnostic and Statistical Manual of Mental Disorders; Humans; Panic Disorder
PubMed: 32046934
DOI: 10.1016/j.euroneuro.2020.01.009 -
Psychiatrike = Psychiatriki 2020Panic disorder (PD) is a common anxiety disorder with severe social and health consequences in the lives of individuals who suffer from it. General population studies...
Panic disorder (PD) is a common anxiety disorder with severe social and health consequences in the lives of individuals who suffer from it. General population studies that attempt to measure the prevalence of this disorder across the world suggest that a 1.7% to 4.7 % of adults and adolescents suffer from Panic Disorder. In Greece, research analyzing the abovementioned matters is limited, and previous studies were put forward in small samples. The aim of the present study was to describe the prevalence and sociodemographic associations of panic disorder (PD) and related subthreshold panic symptoms in the general population of Greece and to appraise the comorbidity, use of services and impact on quality of life of these syndromes. This was a secondary analysis of the 2009-2010 psychiatric morbidity survey carried out in a representative sample of the Greek general population (4894 participants living in private households, 18-70 years, response rate 54%). Psychiatric disorders were assessed with the computerized version of the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D generic instrument. The utilization of health services was examined by making relevant questions. Finally, direct questions were used to assess sociodemographic and socioeconomic factors According to our findings, 1.87% of the participants (95% confidence interval [CI]: 1.50-2.26%) met criteria for PD and 1.61% met criteria for subclinical PD (95% CI: 1.26-1.96%). There was a clear female preponderance for both PD (p=0.001) and Sub-PD (p=0.01). In addition, 3.48% of the participants reported having experienced panic attacks during the past week (95% confidence interval [CI]: 2.98-4.01%). PD or subclinical PD was independently associated with a limited number of sociodemographic and socioeconomic variables especially after the adjusted analysis. Both panic related conditions involved significant reductions in quality of life and elevated utilization of health services for both medical and psychological reasons in comparison to healthy participants. In conclusion, PD and subclinical panic symptoms were common in the general Greek population with substantial comorbidity and impaired quality of life. The observed use of the general and psychological health services among adults with panic symptoms and its temporal and economic consequences calls for more efficient diagnostic and treatment policies.
Topics: Comorbidity; Female; Greece; Humans; Male; Mental Health Services; Middle Aged; Panic Disorder; Patient Acceptance of Health Care; Prevalence; Quality of Life; Risk Factors; Socioeconomic Factors; Symptom Assessment
PubMed: 33099461
DOI: 10.22365/jpsych.2020.313.201 -
Geriatrie Et Psychologie... Oct 2021Panic disorder in the elderly is an understudied disorder, despite being associated with substantial functional impairment, a diminished quality of life and an increased...
Panic disorder in the elderly is an understudied disorder, despite being associated with substantial functional impairment, a diminished quality of life and an increased suicide risk in this population. This disorder is likely to be underdiagnosed and sometimes inadequately treated due to the absence of national and international guidelines for this vulnerable population. Few therapeutic trials have specifically focused on the efficacy and tolerability of pharmacological and psychotherapy treatments for panic disorder in the elderly and current approaches to detect and manage this disorder are mainly based on expert opinions or extrapolation from data available on younger adults. This report aims to provide a summary of current knowledge on pharmacological and psychotherapeutic treatments for panic disorder in the elderly and to propose a medical treatment algorithm, which should be viewed as a tool that may contribute to the choice of treatment, especially for treatment-resistant older patients with panic disorder. The main results here are the emphasis on antidepressant treatment, such as selective serotonin reuptake inhibitor (SSRI), restricted benzodiazepine usage, awareness of drug interactions and the importance of psychotherapy such as cognitive behavioural therapy (CBT).
PubMed: 34612816
DOI: 10.1684/pnv.2021.0965 -
BMJ Military Health Feb 2020
Topics: Civil Defense; Emergencies; Humans; Mass Media; Panic; Social Media; United Kingdom
PubMed: 29540545
DOI: 10.1136/jramc-2018-000929 -
Brain Research Mar 2020Orexin has been implicated in a number of physiological functions, including arousal, regulation of sleep, energy metabolism, appetitive behaviors, stress, anxiety,... (Review)
Review
Orexin has been implicated in a number of physiological functions, including arousal, regulation of sleep, energy metabolism, appetitive behaviors, stress, anxiety, fear, panic, and cardiovascular control. In this review, we will highlight research focused on orexin system in the medial hypothalamic regions of perifornical (PeF) and dorsomedial hypothalamus (DMH), and describe the role of this hypothalamic neuropeptide in the behavioral expression of panic and consequent fear and avoidance responses, as well as sympathetic regulation and possible development of chronic hypertension. We will also outline recent data highlighting the clinical potential of single and dual orexin receptor antagonists for neuropsychiatric conditions including panic, phobia, and cardiovascular conditions, such as in hypertension.
Topics: Animals; Brain; Humans; Hypertension; Hypothalamus, Middle; Neural Pathways; Orexin Receptor Antagonists; Orexins; Panic; Phobic Disorders; Stress, Psychological
PubMed: 30205108
DOI: 10.1016/j.brainres.2018.09.010 -
Therapeutic Advances in... 2021As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are... (Review)
Review
BACKGROUND
As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are needed. We aimed to firstly review data regarding use of antipsychotic and non-benzodiazepine anticonvulsant medication in PD patients with or without comorbidities; secondly, to review data concerning reduction of panic symptoms during treatment of another psychiatric disorder with the same medications; and thirdly, to examine reports of anticonvulsant- or antipsychotic-induced new-onset panic symptomatology.
METHODS
We performed a PubMed search (last day: 28 April 2020) of English-language studies only, combining psychopathological terms (e.g. 'panic disorder') and terms referring either to categories of psychotropic medications (e.g. 'anticonvulsants') or to specific drugs (e.g. 'carbamazepine'). All duplications were eliminated. All studies included in the review met certain inclusion/exclusion criteria. The level of evidence for the efficacy of each drug was defined according to widely accepted criteria.
RESULTS
In treatment-resistant PD, beneficial effects have been reported after treatment (mostly augmentation therapy) with a range of anticonvulsant (carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbamazepine, valproate, vigabatrin, tiagabine) and antipsychotic (aripiprazole, olanzapine, risperidone, sulpiride) medications: overall, most medications appear generally well tolerated. Additionally, bipolar patients receiving valproate or quetiapine-XR (but not risperidone or ziprasidone) demonstrated reductions of comorbid panic-related symptoms. There are case reports of new-onset panic symptoms associated with clozapine, haloperidol, olanzapine and topiramate, in patients with conditions other than PD. The small-to-modest sample size, the lack of control groups and the open-label and short-term nature of most of the reviewed studies hinder definitive conclusions regarding either the short-term and long-term efficacy of antipsychotic and anticonvulsant medications or their potential long-term side effects.
CONCLUSION
Some atypical antipsychotic and anticonvulsant medications may have a role in the treatment of some PD patients, mostly when more conventional approaches have not been successful, but the quality of supporting evidence is limited.
PubMed: 33815761
DOI: 10.1177/20451253211002320