Number Of Other Symptoms Research Articles

Associations between ethnicity and persistent physical and mental health symptoms experienced as part of ongoing symptomatic COVID-19.

Ethnicity can influence susceptibility to SARS-CoV-2 infection, hospitalisation and death. Its association with ongoing symptomatic COVID-19 is unclear. We assessed if, among a population followed up after discharge from hospital with COVID-19, adults from Asian, black, mixed and other backgrounds are at increased risk of physical and mental health symptoms. Adults discharged after hospitalisation with COVID-19 between 03/03/2020 and 27/11/2021 were routinely offered follow-up six to 12 weeks post-discharge and reviewed for ongoing symptomatic COVID-19, as defined by persisting physical symptoms (respiratory symptoms, fatigue, impaired sleep and number of other symptoms), mental health symptoms and inability to return to work if employed. Descriptive statistics and multiple regression analyses were used to compare differences in characteristics, follow-up outcomes and blood tests between ethnic groups. To account for possible selection bias, analyses were adjusted for propensity scores. 986 adults completed follow-up: 202 (20.5%) Asian, 105 (10.6%) black, 18 (1.8%) mixed, 468 (47.5%) white and 111 (11.3%) from other backgrounds. Differences between groups included white adults being older than those from Asian/'other' backgrounds and black adults being more likely from deprived areas than those from Asian/white/'other' backgrounds. After adjusting for these differences, at follow-up, black adults had fewer respiratory (adjusted odds ratio 0.49 (0.25-0.96)) and other symptoms (adjusted count ratio 0.68 (0.34-0.99)) compared to white adults. There were otherwise no significant differences between ethnic groups in terms of physical health, mental health or ability to return to work if employed. These findings were not altered after adjustment for propensity scores. In our population, despite having more co-morbidities associated with worse outcomes, adults from Asian, black, mixed and other ethnic backgrounds are not more likely to develop ongoing symptomatic COVID-19. However, it is important that healthcare services remain vigilant in ensuring the provision of timely patient-centred care.

Glaucoma Patient with Suspected Flammer Syndrome: Diagnostic Procedures and Therapeutic Implications

If glaucoma damage develops despite normal intraocular pressure or if the damage progresses despite well-controlled intraocular pressure, we usually find other risk factors. One important group are the vascular factors. We should focus not only on the classical risk factors of atherosclerosis, such as arterial hypertension or dyslipidaemia, but also on dysregulation of blood flow, especially on primary vascular dysregulation (PVD). Low blood pressure, either current or in adolescence, low body mass index or frequently cold hands and feet may provide important hints. Very often PVD is coupled with a number of other symptoms and signs, and we then speak of a Flammer Syndrome (FS). If there is any indication of FS, we take a targeted patient history, undertake 24 h blood pressure monitoring, measure retinal venous pressure, and perform a dynamic retinal vessel analysis or nail fold capillary microscopy. This is especially recommended if the patient is relatively young or the damage is progressing rapidly. If the suspicion is confirmed, we then try to reduce the drops in blood pressure, lower the retinal venous pressure, improve the regulation of blood flow and reduce the oxidative stress in the mitochondria.

Optimal Deep Transfer Learning-Based Human-Centric Biomedical Diagnosis for Acute Lymphoblastic Leukemia Detection.

Human-centric biomedical diagnosis (HCBD) becomes a hot research topic in the healthcare sector, which assists physicians in the disease diagnosis and decision-making process. Leukemia is a pathology that affects younger people and adults, instigating early death and a number of other symptoms. Computer-aided detection models are found to be useful for reducing the probability of recommending unsuitable treatments and helping physicians in the disease detection process. Besides, the rapid development of deep learning (DL) models assists in the detection and classification of medical-imaging-related problems. Since the training of DL models necessitates massive datasets, transfer learning models can be employed for image feature extraction. In this view, this study develops an optimal deep transfer learning-based human-centric biomedical diagnosis model for acute lymphoblastic detection (ODLHBD-ALLD). The presented ODLHBD-ALLD model mainly intends to detect and classify acute lymphoblastic leukemia using blood smear images. To accomplish this, the ODLHBD-ALLD model involves the Gabor filtering (GF) technique as a noise removal step. In addition, it makes use of a modified fuzzy c-means (MFCM) based segmentation approach for segmenting the images. Besides, the competitive swarm optimization (CSO) algorithm with the EfficientNetB0 model is utilized as a feature extractor. Lastly, the attention-based long-short term memory (ABiLSTM) model is employed for the proper identification of class labels. For investigating the enhanced performance of the ODLHBD-ALLD approach, a wide range of simulations were executed on open access dataset. The comparative analysis reported the betterment of the ODLHBD-ALLD model over the other existing approaches.

Restless Legs Syndrome and Severe Preeclampsia: A Case-Control Study.

This study sought to determine whether there is an association between restless legs syndrome (RLS) and severe preeclampsia using a case-control study design. A total of 147 patients with severe preeclampsia and 147 patients with normal pregnancies were evaluated for symptoms of RLS. In the first phase, before or immediately after delivery, participants were given a questionnaire on common complaints experienced during pregnancy. Mixed with these complaints were the symptoms that comprised the diagnostic criteria for RLS. If a participant indicated she met the diagnositic criteria, she was informed about RLS. In the second phase, a severity evaluation was performed in this population using the International Restless Legs Syndrome Study Group Rating Scale. Among the participants, independent of the presence of preeclampsia, 13.61% met the criteria for a diagnosis of RLS. There was no statistical difference between groups (severe preeclampsia: 12.93% vs. controls: 14.29%; odds ratio [OR] 0.89; 95% CI 0.46-1.74, P = 0.37). After analysis, 65% of patients with RLS had a score on the International Restless Legs Syndrome Study Group Rating Scale compatible with "very severe" or "severe" RLS. There was again no statistical difference between groups for the combination of "severe" and "very severe" scoring criteria (severe preeclampsia: 68.42% vs. controls: 61.90%; OR 1.33; 95% CI 0.36-4.93, P = 0.66) and "very severe" alone (severe preeclampsia: 21.05% vs. controls: 4.76%; OR 5.33; 95% CI 0.54-52.73, P = 0.11). The prevalence of RLS among pregnant women in our study was in accordance with the medical literature and avoided the probable bias caused by the high number of other symptoms experienced during pregnancy. There were no significant differences between normotensive participants and those with severe preeclampsia. In general, symptom severity was high, with a tendency toward greater severity in patients with severe preeclampsia, but this difference did not reach statistical significance.

Infectious agents as a risk factor for Alzheimer’s disease

Cognitive disorders are one of the relevant problems of modern clinical medicine. This is due to both their high frequency of occurrence and significant negative impact, which has a violation of higher cortical functions on the quality of life of patients due to the deterioration of their social communication, as well as reducing the effectiveness of professional and household functions. The main cause of cognitive disorders is Alzheimer’s disease. At the same time, according to statistical studies, a significant increase in the incidence of the number of persons in the human population as a whole suffering from this pathology is predicted. At the heart of Alzheimer’s disease is a complex of pathobiochemical changes leading to synaptic dysfunction, accompanied by the development of atrophic changes in certain areas of the brain, against which a specific clinical picture is formed. The earliest and most important manifestation of Alzheimer’s disease is memory impairment for current events, which are subsequently joined by a number of other symptoms. The literature describes certain risk factors that contribute to the development of the disease, among which a certain place is occupied by infectious pathology. However, this aspect remains largely outside the traditional study of the pathogenesis of Alzheimer’s disease. In the review the analysis of the results of modern studies confirm the possible involvement of infections in the development of dementia of Alzheimer’s type.

Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort

Background ContextEvidence is lacking on the prognosis and prognostic factors of back-related leg pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PurposeThe present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related leg pain and sciatica. Study DesignThis is a prospective cohort study. Patient SampleThe present study included adults visiting their family doctor with back-related leg pain in the United Kingdom. Outcome MeasuresInformation about pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire). MethodsParticipants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (leg pain duration, pain intensity, neuropathic pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest. ResultsA total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer leg pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19–0.90), higher identity score (OR 0.70; CI 0.53–0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13–0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup. ConclusionsThe present study provides new evidence on the prognosis and prognostic factors of back-related leg pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options.

Children with depression and family

Depression is a psychiatric disease with a predominant symptom, emotional disturbance, physical annoyances and difficulties in interpersonal relationships. It can occur at any age, even in children. About 3 % of all children may experience depression. Depression as a disease affects the whole body and has an impact on how the child feels, thinks and behaves. These symptoms are accompanied by a number of other symptoms that affect appetite, sleep, levels of activity and concentration, children's self-confidence, and the image they have formed for themselves. Children with depression are usually sad and generally experience the disease in a similar way to older people.

Гемангиома яичников: обзор литературы и описание клинического случая

Hemangiomas of the ovaries are rare benign tumors that develop as a result of congenital malformation of blood vessels. Most often they are small in size and are a random finding during the operation or at autopsy. In rare cases, they can reach large sizes and cause discomfort in the lower abdomen, an increase in the level of cancer markers, and a number of other symptoms. In the literature, no more than 60 patients are described, with a confirmed diagnosis of ovarian hemangioma. We give a description of the case of detection of bilateral asymptomatic hemangiomas of the ovaries in a patient 59 years after performing pantheisterectomy.

The curious case of a woman with two BRCA1 mutations in trans

Since the identification of BRCA1 twenty years ago there has not been a single unequivocal case of anyone (even in populations where there is a high frequency of founder mutations) harboring two BRCA1 mutations in trans, suggesting that this is embryonically lethal. These findings have been substantiated by animal models where no viable offspring BRCA null mice have been generated by crossing heterozygote carriers. It is known that Brca1 mice can be partially rescued by Tp53 mutations, but they do not survive well. Recently one patient has been reported with a nonsense mutation on one BRCA1 allele and a missense on the other. The patient in this study suffered from malignancy, intellectual disability and a number of other symptoms. The missense variant has not been extensively verified and as such cannot be verified as pathogenic at this time. Here we report a woman, diagnosed with breast cancer during her fourth decade of life, who has been shown to harbour one nonsense mutation and a splice site mutation. Both changes results in the loss of wild-type BRCA1. The question raised by this finding is: How come this woman is alive and outside of her initial presentation is currently healthy? An in depth molecular analysis was performed which revealed the complexity of BRCA1 expression and how this could only be achieved by close examination of other family members. The outcome of the study represents the most likely explanation for this extraordinary case.

Non headache phenotypes in pediatric age.

Although headache represents the main symptom of migraine, it is a very complex disease and can be manifested by a number of other symptoms. This is particularly evident in pediatric age where clinical conditions different from headache can involve children who are already suffering or will suffer from migrainous headache. In the International Classification of Headache Disorders 3rd edition (ICHD-III), these conditions, occurring as repeated attacks with complete remission between episodes, are defined as “Episodic syndromes which may be associated with migraine”. They include “Cyclical vomiting syndrome” (1.6.1.1), “Abdominal migraine” (1.6.1.2), “Benign paroxysmal vertigo” (1.6.2) and “Benign paroxysmal torticollis” (1.6.3). Though not included in the ICHD-III, other clinical entities, such as motion sickness and limb pain, have been associated with migraine. In order to underline the strict relationship between all these non headache symptoms and migraine, they are also known as “migraine equivalents”. We investigated the migraine equivalents prevalence in a large population of children referred to our pediatric headache centre[1]. A total of 1,134 of children/adolescents (73.2% with migraine and 26.8% with tension-type headache) were included. We found that migraine equivalents could equally involve children with either migraine or tension-type headache and that high frequency of headache attacks correlated with migraine equivalents presence. It was concluded that migraine equivalents should not be considered merely as headache precursors, but they are part of the migrainous syndrome. In a more recent study, we showed that anxiety and somatization levels were higher in migraine children with migraine equivalents, as compared to those without migraine equivalents[2]. Our findings, together with those issued from the literature, suggest that in children and adolescents migraine equivalents should be considered as symptoms of the migrainous disease, thus their inclusion among the diagnostic criteria for pediatric migraine/tension-type headache would be hopeful.

Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain.The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.

English

Dysmenorrhea is the painful menstruation mostly accompanied by the number of other symptoms which are disturbing to herself. The purpose of the study was to determine the prevalence of dysmenorrhea in first year medical students and its impact on their academic and personal activities. STUDY DESIGN: Cross sectional study MATERIALS AND METHODOLOGY: Subjects are asked to complete the given questionnaire handed out by researcher. The predesigned and pretested questionnaire included questions regarding sociodemographic information, menstrual pattern, severity with grading, associated symptoms and impact of dysmenorrhea. RESULTS: The prevalence of dysmenorrhea was 87%. The most common symptoms were mood changes, backache and stomach cramps. Only 2.7% had severe dysmenorrhea. The most common management strategy practiced was the rest (93.7%). Only 17.4% had consulted doctors for their complaints. CONCLUSION AND RECOMMENDATION: Dysmenorrhea is the significant public health problem in women’s life. It has great impact on personal and social life. Adolescent girls should be motivated to consult the doctor for their disturbing menstrual problems.

Translational approaches to treatment-induced symptoms in cancer patients

Cancer therapy makes patients sick. The therapies that are available to clinicians allow them to successfully control nausea, emesis and pain. However, this is not the case for a number of other symptoms that include fatigue, distractibility, poor memory, and diminished interest in previously pleasurable activities. These symptoms cluster during the course of cancer therapy and impair patient quality of life, limit therapy options and do not always resolve at the cessation of treatment. It is possible to describe the intensity and temporal features of symptoms and assess their relationship with the inflammatory response that is associated with cancer and cancer therapy. At the preclinical level, sophisticated animal models still need to be deployed to study the causal role of inflammation in specific components of cancer-related symptoms. Various approaches can be optimally combined in a translational symptom research pathway to provide a framework for assessing in a systematic manner the neurobehavioral toxicity of existing and newly developed cancer therapies. Ultimately, this knowledge will allow derivation of mechanism-based interventions to prevent or alleviate cancer-related symptoms.

Can behavioral treatments be enhanced by integrative neuromuscular training in the treatment of juvenile fibromyalgia?

Can behavioral treatments be enhanced by integrative neuromuscular training in the treatment of juvenile fibromyalgia?

A Randomized, Placebo-Controlled Phase 3 Trial (Study SB-767905/012) of Alvimopan for Opioid-Induced Bowel Dysfunction in Patients With Non-Cancer Pain

Gastrointestinal (GI) side effects are common with opioid medication, and constipation affects ∼40% of patients. Such symptoms considerably impair patients' quality of life. Alvimopan is an orally administered, systemically available, peripherally acting mu-opioid receptor (PAM-OR) antagonist approved in the US for short-term, in-hospital management of postoperative ileus in patients undergoing bowel resection. This double-blind, placebo-controlled trial was conducted as part of a recently discontinued clinical program, in which alvimopan was being developed for opioid-induced constipation (OIC). Patients (N = 518) receiving opioids for non-cancer pain were randomized to receive alvimopan .5 mg once daily, alvimopan .5 mg twice daily, or placebo for 12 weeks. The primary efficacy endpoint was the proportion of patients experiencing ≥ 3 spontaneous bowel movements (SBMs; bowel movements with no laxative use in the previous 24 hours) per week over the treatment period and an average increase from baseline of ≥ 1 SBM per week. A significantly greater proportion of patients in the alvimopan .5 mg twice-daily group met the primary endpoint compared with placebo (72% versus 48%, P < .001). Treatment with alvimopan twice daily improved a number of other symptoms compared with placebo and reduced the requirement for rescue laxative use. The opioid-induced bowel dysfunction Symptoms Improvement Scale (SIS) responder rate was 40.4% in the alvimopan .5 mg twice daily group, versus 18.6% with placebo (P < .001). In general, alvimopan .5 mg once daily produced qualitatively similar but numerically smaller responses than twice-daily treatment. Active treatment did not increase the requirement for opioid medication or increase average pain intensity scores. Over the 12-week treatment period, alvimopan appeared to be well tolerated. These results demonstrate the potential for a PAM-OR antagonist to improve the symptoms of OIC without antagonizing opioid analgesia.

Sleep Loss and Partner Violence Victimization

Intimate partner violence victimization has been associated with serious health problems among women, including many disorders that involve sleep disturbances. However, there has been only limited examination of sleep duration among women with victimization experiences. A total of 756 women with a domestic violence order (DVO) against a male intimate partner were interviewed about their health, mental health, substance use, and partner violence victimization. Face-to-face interviews were conducted from February 2001 to November 2003 for data collection in three rural and one urban county representing different jurisdictional settings. Because the current analyses focused on understanding intimate partner victimization in the past year and associations with sleep disturbance, 147 participants were excluded for reporting a relationship with the DVO partner for less than 6 months in the past year. The final sample for this article was 609. The women reported an average of a little above 5.5 hours of sleep per night. For women in the current study, significant predictors of sleep disturbance included race, number of children, number of other symptoms of depression in the past 2 weeks excluding sleep criteria, number of other symptoms of PTSD in the past 2 weeks excluding sleep criteria, number of chronic physical health problems, and severity of physical violence by the DVO partner in the past year. Addressing short sleep duration among partner victims in health care settings might enhance safety planning and prevent the development of health/mental health problems that can arise from victimization.

The Role of Non-Pharmacologic Approaches in the Management of Fibromyalgia

The optimal management of fibromyalgia (FM) is comprised of both pharmacologic and nonpharmacologic approaches. This multidimensional approach is preferred given that FM is not only a pain condition, but involves a number of other symptoms as is reflected in the new clinical criteria being developed by Wolfe and colleagues. Proper management of FM should be informed through multidimensional assessment of the clinically relevant domains described previously in this supplement. Pharmacologic and nonpharmacologic approaches work together to provide the broadest possible coverage of these domains, minimize the impact of each domain on functioning and well-being, and facilitate long-term adaptations to one's lifestyle.The use of nonpharmacologic strategies in the management of FM has varying levels of evidence. The strongest evidence currently exists for aerobic exercise, cognitive-behavioral therapy (CBT), and for patient education or self-management. Moderate evidence exists for strength training, acupuncture, hypnotherapy, and biofeedback modalities. Weaker evidence exists for manual massage therapy. Currently, there is no evidence of long-term benefit for tender point injections or flexibility exercise modalities, although these options may be beneficial in the short term. This article will focus on the three areas that have the strongest evidence base: patient education, exercise, and CBT.Educational programs are typically offered in the context of primary care or in specialty practices. In their simplest form, these programs try to dispel myths about FM and provide patients with the most up-to-date knowledge about the condition.

Mindfulness-based Cognitive Therapy for Generalized Anxiety Disorder: A Preliminary Evaluation

Mindfulness training has been proposed as a potentially important new approach for the treatment of generalized anxiety disorder (GAD). However, to date only a few studies have investigated mindfulness training for GAD. The aim of this study was to further investigate symptom change and recovery in pathological worry after mindfulness-based cognitive therapy (MBCT) using an uncontrolled pre-post design. Twenty-three adults with a primary diagnosis of GAD participated in the study. The MBCT program involved 9 weekly 2-hour group sessions, a post-treatment assessment session, and 6-week and 3-month follow-up sessions. Intent-to-treat analysis revealed significant improvements in pathological worry, stress, quality of life, and a number of other symptoms at post-treatment, which were maintained at follow-up. Attrition was also low, and MBCT was perceived as a credible and acceptable intervention. However, when applying standardized recovery criteria to pathological worry scores, the rate of recovery at post-treatment was very small, although improved at follow-up. Overall, the findings suggest MBCT is definitely worthy of further investigation as a treatment option for GAD, but falls well short of outcomes achieved by past research. Possible reasons for the poor rate of recovery, implications, and limitations are briefly outlined.

Biological Perspectives

Annie dreaded what would happen next--she had been down this road many times before. There she was--minding her own business, just wanting to watch a movie like any normal person--when she noticed her breathing was off. Immediately she began to monitor her breathing and soon seemed as if she just could not get enough air. She remembered a recent visit to the ER when the nurse patiently showed her that the oxygen saturation levels were good. She remembered, but didn't help. It wasn't that she believed this time was different--that this time she was going to suffocate. No, that might be a textbook explanation but wasn't her explanation. She just couldn't breathe, and knowing that it was all in her head just didn't seem to help. Soon she would be spiraling into symptoms that, like Old Testament prophet, would beget more apprehension, which would beget more symptoms--palpitations, dizziness, a fear of fainting, trembling, feeling that things around her were unreal, fear of going crazy--which would beget more dread. Worst of all, she feared looking foolish. What if she fainted right there in the movie theater? What if she lost control and started gulping big chunks of air down? What if she...? What would they think of her? ********** Annie's experience may be a little different from others' who suffer from panic disorder, but not too different. For some, panic may occur in specific situations or in certain types of environments while for others these come of the blue. The final common pathway, however, is not unique--it is pure human misery. It is not uncommon to find talented men and women who live truncated lives because of panic attacks, the fear of having a panic attack, and the fear of the fear of having a panic attack. Overview of Panic Disorders Panic disorder is one of the most studied anxiety disorders. While about 25% of Americans suffer from anxiety, only a small subgroup will ever be diagnosed with panic disorder (Dugue & Neugroschl, 2002). Clark (1986) described panic as an intense feeling of apprehension or impending doom which is of sudden onset and which is associated with a wide range of distressing physical (p. 461). These physical sensations include all those exhibited by Annie as well as a number of other symptoms (Table 1). According to established criteria, at least four of these symptoms must occur abruptly and peak within 10 minutes (American Psychiatric Association [APA], 2000). Lifetime prevalence rates for panic disorder are thought to be between 1% and 3.5%, with significantly higher prevalence rates found in general medical settings (e.g., patients with chest pain, asthma, headaches, epilepsy) (APA, 2000; Plewa, 2002). Prevalence is higher for women (2:1). Panic disorder results in considerable morbidity (e.g., 10%-20% attempt suicide, 7%-28% have history of substance abuse) and increased mortality (Malizia et al., 1998; Plewa). A considerable variance occurs among individuals related to frequency of attacks and course of illness. Many, but not all, patients report a lifelong history of anxiety before the actual diagnosis of panic disorder is made. A bimodal distribution of onset can be predicted with first panic occurring during late adolescence or during the mid 30s. The majority of patients report their first panic attack happening out of the blue, but subsequent are often attached to situational or environmental stimuli. Elderly individuals are less likely than younger people to suffer from panic attacks, with a number of competing hypotheses generated from this observation. Individuals with a family history of panic are more likely to suffer from panic themselves than is the general population, suggesting a genetic contribution. Finally, a history of childhood separation anxiety correlates to adult panic disorder. Models for Panic Disorders Historically, both psychologic and biologic models for panic disorders have been advanced in the literature. …

Respiratory symptoms and panic in the National Comorbidity Survey: a test of Klein's suffocation false alarm theory

According to suffocation false alarm theory (Arch. Gen. Psychiatry 50 (1993) 31), respiratory symptoms are the symptoms that best distinguish the panic attacks of individuals with panic disorder (PD) from those of individuals without PD. Using National Comorbidity Survey data from those 609 respondents who had lifetime histories of panic attacks or PD, we tested this prediction. Neither respiratory symptom ( smothering; dyspnea) strongly differentiated between respondents with PD and those with only panic attacks. Respiratory symptom endorsement was unrelated to PD when the number of other symptoms endorsed was controlled; furthermore, respiratory symptoms had slight effect sizes and were not included in a multivariate context. In contrast, fear of dying had the largest effect size, an association with PD that persisted after control for other symptom endorsement, and a continuing importance in multivariate analyses. Strikingly, panic attack respondents who reported having had only one panic attack were as likely as PD respondents to report respiratory symptoms during panic. These findings, although based on retrospective self-report and thus subject to recall bias, are inconsistent with the hypothesis that respiratory symptoms during panic have diagnostic significance.