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Deutsches Arzteblatt International Jul 2014Anxiety disorders (panic disorder/agoraphobia, generalized anxiety disorder, social phobia, and specific phobias) are the most common mental illnesses. For example, the... (Review)
Review
BACKGROUND
Anxiety disorders (panic disorder/agoraphobia, generalized anxiety disorder, social phobia, and specific phobias) are the most common mental illnesses. For example, the 12-month prevalence of panic disorder/agoraphobia is 6%.
METHOD
This guideline is based on controlled trials of psychotherapy and pharmacotherapy, retrieved by a systematic search for original articles that were published up to 1 July 2013. Experts from 20 specialty societies and other organizations evaluated the evidence for each treatment option from all available randomized clinical trials and from a synthesis of the recommendations of already existing international and German guidelines.
RESULTS
403 randomized controlled trials were evaluated. It was concluded that anxiety disorders should be treated with psychotherapy, psychopharmacological drugs, or both. Response rates to initial treatment vary from 45% to 65%. Cognitive behavioral therapy is supported by higher-level evidence than any other psychotherapeutic technique. Psychodynamic therapy is recommended as a second-line treatment. Among anxiolytic drugs, the agents of first choice are selective serotonin reuptake inhibitors and serotoninnorepinephrine reuptake inhibitors. The patient's preference should be considered in the choice of treatment. Drug treatment should be continued for 6 to 12 months after remission. If psychotherapy or drug treatment is not adequately effective, then the treatment should be switched to the other form, or to a combination of both.
CONCLUSION
The large amount of data now available from randomized controlled trials permits the formulation of robust evidence-based recommendations for the treatment of anxiety disorders. Future work should more closely address the necessary duration of psychotherapy and the efficacy of combined psychotherapy and drug treatment.
Topics: Anxiety Disorders; Humans; Neurology; Practice Guidelines as Topic; Psychotherapy; Psychotropic Drugs; Risk Factors
PubMed: 25138725
DOI: 10.3238/arztebl.2014.0473 -
BMC Psychiatry Jun 2022The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale - Self-Report (PDSS-SR) and to examine psychometric properties of...
BACKGROUND
The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale - Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version.
METHODS
A sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial.
RESULTS
The French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach's alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change.
CONCLUSIONS
The French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.
Topics: Adult; Canada; Humans; Panic Disorder; Reproducibility of Results; Self Report; Severity of Illness Index
PubMed: 35761266
DOI: 10.1186/s12888-022-03989-x -
Respiratory Care May 2013There is a growing interest in the role of comorbid anxiety in patients with COPD. Comorbid anxiety has a major impact on physical functioning, health-related quality of... (Review)
Review
BACKGROUND
There is a growing interest in the role of comorbid anxiety in patients with COPD. Comorbid anxiety has a major impact on physical functioning, health-related quality of life, and healthcare utilization. However, the prevalence of clinical anxiety, particularly specific anxiety diagnoses, in patients with COPD remains unclear.
OBJECTIVE
We performed a systematic review of studies that report the prevalence of clinical anxiety and specific anxiety disorders in patients with COPD.
METHODS
We searched for articles in CINAHL, EMBASE, MEDLINE, and PsycINFO, from 1966 to January 31, 2012, with a focus on studies that utilized clinical interviews for a robust psychiatric diagnosis in patients with COPD.
RESULTS
Of 410 studies identified, 10 met the inclusion criteria for review. The studies had small to modest sample sizes (n = 20-204) and included mainly male COPD subjects (71% male). The prevalence of clinical anxiety ranged from 10-55% among in-patients and 13-46% among out-patients with COPD. The reported prevalence of specific anxiety disorders ranged considerably, and included generalized anxiety disorder (6-33%), panic disorder (with and without agoraphobia) (0-41%), specific phobia (10-27%), and social phobia (5-11%). Women were significantly more likely to have a clinical anxiety disorder, particularly specific phobia and panic disorder.
CONCLUSIONS
There is a high prevalence of clinical anxiety in patients with COPD. Social phobia and specific phobia appear to be particularly prevalent, yet they have received little attention within existing literature. Further research into effective management and screening for clinical anxiety disorders is warranted.
Topics: Anxiety Disorders; Humans; Prevalence; Pulmonary Disease, Chronic Obstructive; Sex Factors
PubMed: 22906542
DOI: 10.4187/respcare.01862 -
Revista Brasileira de Psiquiatria (Sao... Oct 2008Panic disorder is a chronic and recurrent condition that impairs an individual's psychosocial functioning and quality of life. Despite the efficacy of... (Review)
Review
OBJECTIVE
Panic disorder is a chronic and recurrent condition that impairs an individual's psychosocial functioning and quality of life. Despite the efficacy of psychopharmacological treatment in reducing panic attacks, many patients fail to respond adequately to these interventions. Cognitive behavioral therapy provides an alternative and efficacious method for treating panic disorder and agoraphobic avoidance. The objective of the study is to describe the use of cognitive behavioral therapy for panic disorder.
METHOD
Narrative review of data collected from Medline, SciELO and PsycInfo and specialized textbooks.
RESULTS
We describe the cognitive-behavioral model for the treatment of panic disorder, and review both short and long-term efficacy findings. We also discuss the role of combined treatment (cognitive behavioral therapy and psychopharmacology).
CONCLUSIONS
Cognitive behavioral therapy, either individual or in group, can be used as first-line therapy for panic disorder. This treatment modality can also be indicated as a next step for patients failing to respond to other treatments.
Topics: Agoraphobia; Antimetabolites; Cognitive Behavioral Therapy; Cycloserine; Humans; Panic Disorder; Recurrence; Treatment Outcome
PubMed: 19039448
DOI: 10.1590/s1516-44462008000600005 -
Psychological Medicine Oct 2022Few factor analyses and no network analyses have examined the structure of DSM phobic fears or tested the specificity of the relationship between panic disorder and...
BACKGROUND
Few factor analyses and no network analyses have examined the structure of DSM phobic fears or tested the specificity of the relationship between panic disorder and agoraphobic fears.
METHODS
Histories of 21 lifetime phobic fears, coded as four-level ordinal variables (no fear to fear with major interference) were assessed at personal interview in 7514 adults from the Virginia Twin Registry. We estimated Gaussian Graphical Models on individual phobic fears; compared network structures of women and men using the Network Comparison Test; used community detection to determine the number and nature of groups in which phobic fears hang together; and validated the anticipated specific relationship between panic disorder and agoraphobia.
RESULTS
All networks were densely and positively inter-connected; networks of women and men were structurally similar. Our most frequent and stable solution identified four phobic clusters: (i) blood-injection, (ii) social-agoraphobia, (iii) situational, and (iv) animal-disease. Fear of public restrooms and of diseases clustered with animal and not, respectively, social and blood-injury phobias. When added to the network, the three strongest connections with lifetime panic disorder were all agoraphobic fears: being in crowds, going out of the house alone, and being in open spaces.
CONCLUSIONS
Using network analyses applied to a large epidemiologic twin sample, we broadly validated the DSM-IV typography but did not entirely support the distinction of agoraphobic and social phobic fears or the DSM placements for fears of public restrooms and diseases. We found strong support for the specificity of the relationship between panic disorder and agoraphobic fears.
Topics: Female; Humans; Agoraphobia; Fear; Phobic Disorders; Twins
PubMed: 33298223
DOI: 10.1017/S0033291720004493 -
Canadian Family Physician Medecin de... Oct 2007To describe for family physicians screening, diagnosis, and treatment of panic disorder with or without agoraphobia (PD/A). (Review)
Review
OBJECTIVE
To describe for family physicians screening, diagnosis, and treatment of panic disorder with or without agoraphobia (PD/A).
QUALITY OF EVIDENCE
Articles were identified through PsycLIT, PsyINFO, and MEDLINE (1985 to 2006) using the terms panic disorder, psychotherapy, psychosocial treatment, treatment, and pharmacotherapy. Recommendations on treatment choices and guidelines are based on data from high-quality studies only. Information about assessment and diagnosis of PD/A is supported by the most recent epidemiologic studies, as well as expert consensus and opinion.
MAIN MESSAGE
Panic disorder with or without agoraphobia is a psychiatric disease frequently encountered in primary care. It appears to be underdiagnosed and undertreated in this medical setting. Early successful screening requires a focus on unexplained symptoms and specific questions aimed at identifying panic attacks and their meaning for patients. The treatment of choice for PD/A is cognitive-behavioral therapy administered by a specialized psychologist or psychiatrist. When such therapy is hard to come by or unavailable, family physicians can prescribe drug therapy.
CONCLUSION
Family physicians can contribute greatly to early detection and treatment of PD/A.
Topics: Agoraphobia; Family Practice; Humans; Panic Disorder; Practice Guidelines as Topic; Psychological Techniques; Selective Serotonin Reuptake Inhibitors
PubMed: 17934032
DOI: No ID Found -
Europe's Journal of Psychology Mar 2018Panic disorder with or without agoraphobia (PD/A) and obsessive-compulsive disorder (OCD) are characterized by major behavioral dysruptions that may affect patients'... (Review)
Review
Panic disorder with or without agoraphobia (PD/A) and obsessive-compulsive disorder (OCD) are characterized by major behavioral dysruptions that may affect patients' social and marital functioning. The disorders' impact on interpersonal relationships may also affect the quality of support patients receive from their social network. The main goal of this systematic review is to determine the association between social or marital support and symptom severity among adults with PD/A or OCD. A systematic search of databases was executed and provided 35 eligible articles. Results from OCD studies indicated a negative association between marital adjustment and symptom severity, and a positive association between accommodation from relatives and symptom severity. However, results were inconclusive for negative forms of social support (e.g. criticism, hostility). Results from PD/A studies indicated a negative association between perceived social support and symptom severity. Also, results from studies using an observational measure of marital adjustment indicated a negative association between quality of support from the spouse and PD/A severity. However, results were inconclusive for perceived marital adjustment and symptom severity. In conclusion, this systematic review generally suggests a major role of social and marital support in PD/A and OCD symptomatology. However, given diversity of results and methods used in studies, more are needed to clarify the links between support and symptom severity among patients with PD/A and OCD.
PubMed: 29899808
DOI: 10.5964/ejop.v14i1.1252 -
European Neuropsychopharmacology : the... Jun 2022Preclinical research suggests that enhancing CB1 receptor agonism may improve fear extinction. In order to translate this knowledge into a clinical application we... (Randomized Controlled Trial)
Randomized Controlled Trial
Cannabidiol enhancement of exposure therapy in treatment refractory patients with social anxiety disorder and panic disorder with agoraphobia: A randomised controlled trial.
Preclinical research suggests that enhancing CB1 receptor agonism may improve fear extinction. In order to translate this knowledge into a clinical application we examined whether cannabidiol (CBD), a hydrolysis inhibitor of the endogenous CB1 receptor agonist anandamide (AEA), would enhance the effects of exposure therapy in treatment refractory patients with anxiety disorders. Patients with panic disorder with agoraphobia or social anxiety disorder were recruited for a double-blind parallel randomised controlled trial at three mental health care centres in the Netherlands. Eight therapist-assisted exposure in vivo sessions (weekly, outpatient) were augmented with 300 mg oral CBD (n = 39) or placebo (n = 41). The Fear Questionnaire (FQ) was assessed at baseline, mid- and post-treatment, and at 3 and 6 months follow-up. Primary analyses were on an intent-to-treat basis. No differences were found in treatment outcome over time between CBD and placebo on FQ scores, neither across (β = 0.32, 95% CI [-0.60; 1.25]) nor within diagnosis groups (β = -0.11, 95% CI [-1.62; 1.40]). In contrast to our hypotheses, CBD augmentation did not enhance early treatment response, within-session fear extinction or extinction learning. Incidence of adverse effects was equal in the CBD (n = 4, 10.3%) and placebo condition (n = 6, 15.4%). In this first clinical trial examining CBD as an adjunctive therapy in anxiety disorders, CBD did not improve treatment outcome. Future clinical trials may investigate different dosage regimens.
Topics: Agoraphobia; Cannabidiol; Extinction, Psychological; Fear; Humans; Implosive Therapy; Panic Disorder; Phobia, Social; Receptor, Cannabinoid, CB1
PubMed: 35561538
DOI: 10.1016/j.euroneuro.2022.04.003 -
NeuroImage. Clinical 2019The neurobiological mechanisms behind panic disorder with agoraphobia (PD/AG) are not completely explored. The functional A/T single nucleotide polymorphism (SNP)...
INTRODUCTION
The neurobiological mechanisms behind panic disorder with agoraphobia (PD/AG) are not completely explored. The functional A/T single nucleotide polymorphism (SNP) rs324981 in the neuropeptide S receptor gene (NPSR1) has repeatedly been associated with panic disorder and might partly drive function respectively dysfunction of the neural "fear network". We aimed to investigate whether the NPSR1 T risk allele was associated with malfunctioning in a fronto-limbic network during the anticipation and perception of agoraphobia-specific stimuli.
METHOD
121 patients with PD/AG and 77 healthy controls (HC) underwent functional magnetic resonance imaging (fMRI) using the disorder specific "Westphal-Paradigm". It consists of neutral and agoraphobia-specific pictures, half of the pictures were cued to induce anticipatory anxiety.
RESULTS
Risk allele carriers showed significantly higher amygdala activation during the perception of agoraphobia-specific stimuli than A/A homozygotes. A linear group x genotype interaction during the perception of agoraphobia-specific stimuli showed a strong trend towards significance. Patients with the one or two T alleles displayed the highest and HC with the A/A genotype the lowest activation in the inferior orbitofrontal cortex (iOFC).
DISCUSSION
The study demonstrates an association of the NPSR1rs324981 genotype and the perception of agoraphobia-specific stimuli. These results support the assumption of a fronto-limbic dysfunction as an intermediate phenotype of PD/AG.
Topics: Adult; Agoraphobia; Alleles; Anticipation, Psychological; Female; Frontal Lobe; Genetic Variation; Genotype; Humans; Limbic System; Magnetic Resonance Imaging; Male; Nerve Net; Panic Disorder; Perception; Polymorphism, Single Nucleotide; Receptors, G-Protein-Coupled; Risk Assessment
PubMed: 31734525
DOI: 10.1016/j.nicl.2019.102029 -
Medicina (Kaunas, Lithuania) Mar 2021The role of affective temperament in the genesis and outcome of major mood disorders is well studied, but there are only a few reports on the relationship between panic...
The role of affective temperament in the genesis and outcome of major mood disorders is well studied, but there are only a few reports on the relationship between panic disorder (PD) and affective temperaments. Accordingly, we aimed to study the distribution of affective temperaments (depressive (DE); cyclothymic (CT); irritable (IRR); hyperthymic (HT) and anxious (ANX)) among outpatients with PD. Affective temperaments of 118 PD outpatients (80 females and 38 males) with or without agoraphobia but without any other psychiatric disorder at the time of inclusion were evaluated using the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and compared with the affective temperament scores of control subjects. All patients were followed up for at least 1.5 years in order to detect the onset of any major affective disorders, substance use disorders and suicide attempts. Among females, the dominant ANX and DE temperaments were four and three times as common as in a large normative Hungarian sample (for both cases < 0.01). Among male PD patients, only the dominant DE temperament was slightly overrepresented in a non-significant manner. Females with PD obtained significantly higher scores on ANX, DE and CT subscales of the TEMPS-A, whereas males with PD showed significantly higher scores on ANX, DE and HT temperament subscales compared with the members of a large normative Hungarian sample and also with a gender- and age-matched control group. During the follow-up, newly developed unipolar major depression and bipolar spectrum (bipolar I or II and cyclothymic) disorders appeared in 64% and 22% of subjects, respectively. Our preliminary findings suggest that a specific, ANX-DE-CT affective temperament profile is characteristic primarily for female patients, and an ANX-DE-HT affective temperament profile is characteristic for male patients with PD, respectively. These findings are in line with expectations because PD is an anxiety disorder par excellence on the one hand, whereas, on the other hand, it is quite frequently comorbid with mood (including bipolar) disorders.
Topics: Bipolar Disorder; Cyclothymic Disorder; Female; Humans; Hungary; Male; Panic Disorder; Personality Inventory; Surveys and Questionnaires; Temperament
PubMed: 33808711
DOI: 10.3390/medicina57030289