Defining the Optimal Threshold Score for Panic Agoraphobic Spectrum - Short Version (PAS-SV) Questionnaire in Clinical and General Population

Panic disorder and subthreshold panic in the light of comorbidity: a follow-up study

PurposeThe Eating Attitude Test-26 (EAT-26) is a screening tool for eating disorders (EDs) in clinical and non-clinical samples. The cut-off score was suggested to be varied according to target population. However, no studies have examined the appropriateness of the originally proposed score of 20 for screening DSM-5 eating disorders in Japan. This study aimed to identify an appropriate cut-off score to better differentiate clinical and non-clinical samples in Japan for EDs.MethodsThe participants consisted of 54 patients with anorexia nervosa restricting type, 58 patients with anorexia nervosa binge-eating/purging type, 37 patients with bulimia nervosa diagnosed according to DSM-5 criteria, and 190 healthy controls (HCs). Welch’s t test was used to assess differences in age, body mass index (BMI), and total EAT-26 scores between HCs and patients with EDs. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal cut-off score.ResultsThe HCs had significantly higher BMI and lower total EAT-26 mean scores than patients with EDs. The area under the ROC curve was 0.925, indicating that EAT-26 had excellent performance in discriminating patients with EDs from HCs. An optimal cut-off score of 17 was identified, with sensitivity and specificity values of 0.866 and 0.868, respectively.ConclusionsThe result supports the suggestions that optimal cut-off score should be different according to target populations. The newly identified cut-off score of 17 would enable the identification of patients with EDs who have been previously classified as non-clinical samples in the EAT-26 test.Level of evidence: III: evidence obtained from case–control analytic study.

a spectrum model of psychopathology has allowed, in recent years, to recognize the subclinical or sub-threshold symptomatology that may be associated with full-blown mental disorders. The conceptualization of a panic - agoraphobic spectrum was developed in consideration of the substantial clinical heterogeneity revealed by studies on panic disorder with or without agoraphobia. The current study aims to determine the psychometric properties of the Panic Agoraphobic Spectrum - Short Version (PAS-SV), a new questionnaire designed to identify the spectrum of panic - agoraphobic symptoms. 42 subjects with panic disorder or agoraphobia (PAD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 41 subjects with autism spectrum disorder (ASD), and 60 healthy controls (HC) were recruited from the Psychiatric Clinic of the University of Pisa and assessed with the SCID-5, the Panic Disorder Severity Scale (PDSS) and the PAS-SV. PAS-SV demonstrated a high level of internal consistency and the test-retest reliability for total and domain scores was excellent. PAS-SV domain scores were positively and significantly correlated with each other (p < 0.001), with Pearson's coefficients ranging from 0.771 to 0.943. All the PAS-SV domain scores were highly correlated with the PAS-SV total score. The correlation coefficients between PAS-SV and alternative measures of panic - agoraphobic symptoms appeared all significant and positive. Significant differences among diagnostic groups on both PAS-SV domains and total scores were found. PAS-SV total score increased significantly and progressively from HC, to the ASD up to the PA group. The PAS-SV showed excellent internal consistency and test-retest reliability and strong convergent validity with alternative dimensional measures of PA. The questionnaire performed differently among the three diagnostic groups, with an increasing score gradient from HC to patients with ASD to the PA group.

Chest pain is a common symptom in primary care settings, associated with considerable morbidity and health care utilization. Failure to recognize panic disorder as the source of chest pain leads to increased health care costs and inappropriate management. To identify characteristics of the chest pain associated with the presence of panic disorder, review the consequences and possible mechanisms of chest pain in panic disorder, and discuss the recognition of panic disorder in patients presenting with chest pain. Potential studies were identified via a computerized search of MEDLINE and PsycINFO databases and review of bibliographies. MeSH headings used included panic disorder with chest pain, panic disorder with coronary disease or cardiovascular disorders or heart disorders, and panic disorder with cholesterol or essential hypertension or tobacco smoking. The diagnosis of panic disorder in eligible studies was based on DSM criteria, and studies must have used objective criteria for coronary artery disease and risk factors. Only case control and cohort studies were included. Although numerous chest pain characteristics (believed to be both associated and not associated with coronary artery disease) have been reportedly linked to panic disorder, only nonanginal chest pain is consistently associated with panic disorder (relative risk = 2.03, 95% CI = 1.41 to 2.92). Chest pain during panic attacks is associated with increased health care utilization, poor quality of life, and phobic avoidance. Because the chest pain during panic attacks may be due to ischemia, the presence of panic attacks may go unrecognized. Ultimately, the diagnosis of panic disorder must be based on DSM criteria. However, once panic disorder is recognized, clinicians must remain open to the possibility of co-occurring coronary artery disease.

Objective To develop a short Chinese version of the center for epidemiological studies depression scale(CES-D). Method A stratified random nationwide sample with 30801 normal people and a mentally ill sample with 415 patients were tested. Items in the short version were chosen according to both the result of independent t-test in current study and the result of reliance and validity. Cut-off scores were offered to check up depressions. Result The internal consistency reliability of the 9-item Chinese version CES-D ranged from 0.85 to 0.88.The test-retest reliability was 0.49(P<0.001). All item-total correlations were higher than 0.5.The correlation between sumscores of the original scale and sumscores of the Chinese short version ranged from 0.94 to 0.96(P<0.001) in all the samples.The sum scores of initial diagnosis depression sample were significantly higher than that of treated depression sample and common sample.A two-dimension structure was testified.The cut-off scores of the short version were 10 and 17. Conclusion The 9-item Chinese version of CES-D can be used in various samples with reliable and valid effect. Key words: Epidemiological studies depression scale; Chinese short version; Reliability; Validity

Objective. The aim of the study was to evaluate the association of transmembrane protein 132D (TMEM132D), catechol-O-methyltransferase (COMT), and gamma-aminobutyric acid (GABA) receptor alpha 6 subunit (GABRA6) genotypes with cingulate, frontal cortex and hippocampal emotional processing in panic disorder (PD) and major depressive disorder (MDD). Method. The single nucleotide polymorphisms (SNPs) in TMEM132D, COMT, and GABRA6 were examined in patients with MDD, PD, and healthy controls. Functional magnetic resonance imaging (fMRI) was performed in patients with MDD, PD, and healthy controls. Results. rs4680 in COMT and rs3219151 in GABRA6 showed positive associations with PD and MDD. A dynamic fearful face was shown to the participants during fMRI scanning. In PD patients, responses in the bilateral anterior cingulate were stronger in carriers of the AA genotype of SNP rs11060369 in TMEM132D compared with carriers of the AC + CC genotype, and stronger in CT + TT genotype carriers of SNP rs3219151 in GABRA6 compared with carriers of the CC genotype. The response in the medial orbital frontal cortex was stronger in carriers of the CT + TT genotypes of SNP rs3219151 in PD. In MDD patients, the response in the right parahippocampus of carriers of the GG genotype of rs4680 in COMT was stronger than that of carriers of the AA + AG genotype. Conclusion. These results suggest that TMEM132D, GABRA6, and COMT variants may increase vulnerability to panic.

Altered resting-state cerebellar-cerebral functional connectivity in patients with panic disorder before and after treatment

AGEADJUSTED NORMATIVE DATA AND DISCRIMINATIVE VALIDITY OF COGNITIVE TESTS IN THE UKRAINIAN ADULT PATIENTS WITH MAJOR DEPRESSIVE DISORDER

Symptoms of functional dyspepsia (FD) may look like those of peptic ulcers or panic disorders. But, there is no comparative data between the symptoms of peptic ulcers or panic disorders. To evaluate general symptoms, we used the previously validated questionnaires: 1. the Gastrointestinal Symptom Rating Scale (GSRS), 2. the Self-Rating Depression Scale (SDS), 3. the State-Trait Anxiety Inventory (STAI), and 4. the Coping Inventory for Stressful Situations (CISS). Ninety-six patients with FD (ulcer-like, dysmotility-like, and nonspecific: 28.1 %, 41.7 %, and 30.2 %) diagnosed according to the Rome II criteria, 24 peptic ulcer patients, 21 panic disorders, and 50 healthy controls were enrolled in this study. Total GSRS score of FD was higher than controls (12.8 +/- 1.2 vs. 5.9 +/- 0.7), and similar to peptic ulcers. Ratio over than a cut-off SDS score of FD was higher than controls (28 % vs. 11 %), although it was lower than panic disorders (65 %). Ratios over than cut-off scores of state- and trait-anxiety of FD were higher than controls (74 % and 62 % vs. 50 % and 36 %) and tended to be higher than peptic ulcers. Positive ratio of state-anxiety scores of FD was similar to panic disorders. As these scores increased, morbidity rate of FD (FD/FD+control) increased (P for trend <0.01). Among CISS scores, task-oriented coping scores of FD tended to be low compared to controls, but emotion-oriented coping scores of FD and controls were significantly lower than panic disorders. Severity of gastrointestinal symptoms but not anxiety of FD was similar to peptic ulcers. Psychological scales of FD were also similar to panic disorders except for the emotion-oriented coping. These findings suggested that the complicated pathogenesis of FD was similar to but not completely consistent with peptic ulcers or panic disorders.

Autonomic instability is blamed for panic disorder pathophysiology. It has been suggested that this may raise the risk of cardiovascular disease. A new proposal for ventricular depolarization and repolarization impairment is the frontal QRS-T angle. In this cross-sectional study, 61 patients with panic disorder and 73 healthy controls were included. The severity of panic disorder was evaluated using the Severity Measure for Panic Disorder-Adult. Electrocardiography, echocardiography, hemogram, and biochemistry data were recorded. Patients with panic disorder had a greater frontal QRS-T angle than healthy controls. In panic disorder patients, the values for hemoglobin, eosinophil count, and high-density lipoprotein cholesterol were all significantly lower than healthy controls. In comparison to healthy controls, panic disorder patients had significantly higher values for total cholesterol, fasting triglycerides, low-density lipoprotein cholesterol, platelet-to-lymphocyte ratio, and monocyte-to-high-density lipoprotein cholesterol ratio. Significant correlations were found between frontal QRS-T and Severity Measure for Panic Disorder-Adult, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The frontal QRS-T value is positively and significantly predicted by the neutrophil-to-lymphocyte ratio value according to the linear regression analysis for the frontal QRS-T angle [F(6.54) = 8.375, P < .001, adjusted R 2: 0.424]. The current study found that the frontal QRS-T angle increased with the severity of the disease in patients with panic disorder. Frontal QRS-T angle may help to estimate cardiovascular disease risk in patients with panic disorder. This relationship may be necessary in terms of cardiovascular events and inflammatory conditions.

ObjectiveAutism spectrum disorder (ASD) is characterized by high rates of comorbidity with other mental disorders, including anxiety disorders and obsessive–compulsive disorder. Beyond a mere concept of comorbidity, recent literature is speculating the existence of a neurodevelopmental nature of such mental disorders. The aim of the study is to investigate the distribution of social-phobic, obsessive–compulsive and panic-agoraphobic traits within a sample of individuals with ASD, social anxiety disorder (SAD), obsessive–compulsive disorder (OCD) and panic disorder (PD).Methods40 participants with ASD, 40 with SAD, 40 with OCD, 40 with PD and 50 HC were assessed with the Social Anxiety Spectrum—Short Version (SHY-SV) questionnaire, the Obsessive—Compulsive Spectrum—Short Version (OBS-SV) questionnaire and the Panic Agoraphobic Spectrum—Short Version (PAS-SV) questionnaire. Statistical analyses included Kruskal–Wallis test and Chi-square test.ResultsWhen analyzing SHY-SV scores, the SAD group obtained the highest scores, with individuals with ASD following closely, significantly surpassing the scores of the remaining diagnostic groups. In the examination of OBS-SV questionnaire scores, individuals with ASD once again secured the second-highest scores, trailing only the OCD group. These scores were notably higher than those of both the PD group and healthy controls. In the analysis of PAS-SV scores, the ASD group once again achieved the highest scores after the PD individuals, although this time the difference was not statistically significant compared to the other diagnostic groups.DiscussionThese findings highlight the central role of the autism spectrum in SAD and OCD diagnoses. They provide support for the hypotheses of a neurodevelopmental basis for social anxiety and OCD, contributing to the growing body of evidence supporting a dimensional and interconnected view of mental health conditions.

This study aims to evaluate the cross-cultural validity and utility of the Chinese version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) as a screening and assessment tool for eating disorders (EDs) among Chinese females. Participants included 652 female patients diagnosed with EDs and 311 healthy female controls, with data collected from five separate research projects conducted between 2018 and 2024. Receiver operating characteristic (ROC) curve analysis determined diagnostic accuracy and optimal cut-off scores. Correlation analyses, Wilcoxon signed-rank tests, and regression analyses were used to evaluate the relationship between changes in EDE-Q 6.0 scores and other clinical measures following treatment in 55 patients with anorexia nervosa (AN) and 74 patients with bulimia nervosa (BN). The Chinese version of the EDE-Q 6.0 demonstrated strong diagnostic accuracy in distinguishing EDs from the healthy population, with an optimal cut-off global score of 2.54 (area under ROC curve = 88.5%, sensitivity = 77.5%, specificity = 91.8%), significantly higher than in previous reports. Changes in EDE-Q 6.0 scores significantly correlated with clinical measures such as BMI, binge-eating frequency, Beck Depression Inventory, Beck Anxiety Inventory, and Eating Disorder Inventory subscales in both patients with AN and patients with BN (p < 0.05). Wilcoxon tests and stepwise regression confirmed its validity in reflecting clinical changes, capturing symptom variability related to BMI and depression in AN (p < 0.01) and binge-eating frequency and body dissatisfaction in BN (p < 0.01). The Chinese version of the EDE-Q 6.0 is a valid and effective screening and assessment tool for EDs in Chinese females. The updated cut-off score, now closer to international standards, reflects progress in the cultural adaptation of the tool and a potential shift in acceptance to report psychological problems among Chinese patients.

Test accuracy studies often use small datasets to simultaneously select an optimal cutoff score that maximizes test accuracy and generate accuracy estimates. To evaluate the degree to which using data-driven methods to simultaneously select an optimal Patient Health Questionnaire-9 (PHQ-9) cutoff score and estimate accuracy yields (1) optimal cutoff scores that differ from the population-level optimal cutoff score and (2) biased accuracy estimates. This study used cross-sectional data from an existing individual participant data meta-analysis (IPDMA) database on PHQ-9 screening accuracy to represent a hypothetical population. Studies in the IPDMA database compared participant PHQ-9 scores with a major depression classification. From the IPDMA population, 1000 studies of 100, 200, 500, and 1000 participants each were resampled. For the full IPDMA population and each simulated study, an optimal cutoff score was selected by maximizing the Youden index. Accuracy estimates for optimal cutoff scores in simulated studies were compared with accuracy in the full population. The IPDMA database included 100 primary studies with 44 503 participants (4541 [10%] cases of major depression). The population-level optimal cutoff score was 8 or higher. Optimal cutoff scores in simulated studies ranged from 2 or higher to 21 or higher in samples of 100 participants and 5 or higher to 11 or higher in samples of 1000 participants. The percentage of simulated studies that identified the true optimal cutoff score of 8 or higher was 17% for samples of 100 participants and 33% for samples of 1000 participants. Compared with estimates for a cutoff score of 8 or higher in the population, sensitivity was overestimated by 6.4 (95% CI, 5.7-7.1) percentage points in samples of 100 participants, 4.9 (95% CI, 4.3-5.5) percentage points in samples of 200 participants, 2.2 (95% CI, 1.8-2.6) percentage points in samples of 500 participants, and 1.8 (95% CI, 1.5-2.1) percentage points in samples of 1000 participants. Specificity was within 1 percentage point across sample sizes. This study of cross-sectional data found that optimal cutoff scores and accuracy estimates differed substantially from population values when data-driven methods were used to simultaneously identify an optimal cutoff score and estimate accuracy. Users of diagnostic accuracy evidence should evaluate studies of accuracy with caution and ensure that cutoff score recommendations are based on adequately powered research or well-conducted meta-analyses.

Past episodes of depressive or anxiety disorders and subthreshold symptoms have both been reported to predict the occurrence of depressive or anxiety disorders. It is unclear to what extent the two factors interact or predict these disorders independently. To examine the extent to which history, subthreshold symptoms and their combination predict the occurrence of depressive (major depressive disorder, dysthymia) or anxiety disorders (social phobia, panic disorder, agoraphobia, generalised anxiety disorder) over a 2-year period. This was a prospective cohort study with 1167 participants: the Netherlands Study of Depression and Anxiety. Anxiety and depressive disorders were determined with the Composite International Diagnostic Interview, subthreshold symptoms were determined with the Inventory of Depressive Symptomatology-Self Report and the Beck Anxiety Inventory. Occurrence of depressive disorder was best predicted by a combination of a history of depression and subthreshold symptoms, followed by either one alone. Occurrence of anxiety disorder was best predicted by both a combination of a history of anxiety disorder and subthreshold symptoms and a combination of a history of depression and subthreshold symptoms, followed by any subthreshold symptoms or a history of any disorder alone. A history and subthreshold symptoms independently predicted the subsequent occurrence of depressive or anxiety disorder. Together these two characteristics provide reasonable discriminative value. Whereas anxiety predicted the occurrence of an anxiety disorder only, depression predicted the occurrence of both depressive and anxiety disorders.

Magical Ideation was examined in 71 individuals across four groups matched, where possible, for gender and age. These groups were: (1) Obsessive Compulsive Disorder (OCD) patients with cleaning compulsions (n = 11); (2) OCD patients with checking compulsions (n = 20); (3) panic disorder patients with minimal obsessive compulsive symptoms (n = 19); (4) a “normal” control group with minimal obsessive compulsive symptoms (n = 21). The Magical Ideation Scale (MI, Eckblad and Chapman, 1983), the Obsessive Compulsive Inventory- Short Version (OCI-SV; Foa et al., 2002) and the Maudsley Obsessional-Compulsive Inventory (MOCI, Hodgson and Rachman, 1977) were administered to all participants. A one-way Anova was conducted with four planned contrasts. As expected, the OCD groups obtained magical ideation scores higher than the normal subjects. This suggests that OCD patients engage in more magical thinking tendencies than non-anxious controls. Similarly, OCD participants obtained a mean magical ideation score significantly higher than the panic disorder group, suggesting that obsessional compulsive patients are more likely to exhibit magical thinking than individuals with panic disorder. Of note, panic disorder and control group means on MI did not differ significantly. Finally, individuals with obsessive cleaning compulsions displayed higher levels of magical thinking compared to individuals with obsessive checking compulsions, despite no difference in severity of their obsessive compulsive symptoms. This observation was counter to previous findings (Einstein and Menzies, 2004a; Einstein and Menzies, 2004b).