Panic And Agoraphobia Scale Research Articles

Quality of life assessment by WHOQOL-BREF in panic disorder patients during treatment

BACKGROUND: Panic disorder (PD) patients show more physical and psychological impairment, than the general population. OBJECTIVES: Our aims are to compare quality of life between PD patients during treatment and healthy subjects and to associate social, demographic and clinical factors with quality of life scores. METHODS: It is a cross-sectional study with 20 PD patients and 20 healthy controls. Anxiety levels assessment: Beck Anxiety Inventory, Hamilton Anxiety Rating Scale, STAIT - Form Y. Panic severity; Panic Agoraphobia Scale; social and environmental problems and global assessment functioning (Axis IV and V, DSM-IV-TR) and quality of life by WHOQOL-BREF. RESULTS: PD patients were 65% female. Mean age = 37.55 ± 9.06. Quality of life domain scores: physical = 57.86 ± 17.56; psychological = 56.04 ± 18.31; social = 56.25 ± 25.92; and environmental = 47.03 ± 16.92; smokers = 20%; BAI = 23.40 ± 15; STAI-S= 43.50 ± 8.79; STAI-T = 50.10 ± 9.19; PAS = 13.60 ± 9.40. DISCUSSION: No significant differences were observed between groups about gender, age, schooling, religion, marital status nor individual income, but family income was significantly higher among controls. All domains of quality of life are significantly impaired among PD patients, compared to healthy controls. Panic disorder compromises well being. Psychosocial problems and high levels of anxiety can also negatively impact quality of life of PD patients.

P-Wave Dispersion in Panic Disorder

P-wave dispersion (PWD) is defined as the difference between the maximum and the minimum P-wave (Pmax and Pmin, respectively) duration. Significant variation in cardiac atrial PWD has been correlated with changes in systemic autonomic tone such as during periods of anxiety. It is also known that the degree of PWD seen on 12-lead electrocardiogram (ECG) may be a predictor of susceptibility of the atrial myocardium to future atrial fibrillation (AF). Therefore, we firstly aimed to show an association between PWD and panic disorder, a state of high sympathetic tone. PWD was measured in 40 outpatients with panic disorder and in 40 physically and mentally healthy age- and gender-matched controls. In addition, the Panic Agoraphobia Scale (PAS) and the Hamilton Depression Rating Scale (HDRS) were scored concomitantly. Both Pmax and Pmin were significantly higher than those of healthy controls. PWD was significantly greater in the panic disorder group than in the controls. As expected, the mean score on PAS was significantly higher for the panic disorder group than for the controls and correlated significantly with PWD. Heart rate (measured as RR intervals in milliseconds on electrocardiogram) did not differ significantly between the groups. The findings of the present study suggest that the disorder may be associated with an increase in PWD. This association may result from prolonged anxiety and increase in sympathetic modulation, which are main characteristics of panic disorder.

High Plasma Concentrations of Paroxetine Impede Clinical Response in Patients With Panic Disorder

Selective serotonin reuptake inhibitors are thought to interact with serotonergic neurons and be effective for treatment of panic disorder. In the present study, the authors investigated an association between plasma concentrations of paroxetine in patients with panic disorder and clinical response to initial treatment with paroxetine. Subjects were 21 unrelated Japanese patients who fulfilled DSM-IV-TR criteria for a diagnosis of panic disorder (6 males, 15 females, mean age 35.9 +/- 11.3 years). Subjects were administered 10 mg/day of paroxetine for 2 weeks as initial treatment. Improvement of the symptoms of the disorder was assessed with the Panic and Agoraphobia Scale (PAS). In the range of plasma levels >20 ng/mL, none of the subjects showed the reduction ratio in PAS score >0.2. The subjects whose plasma concentrations of paroxetine were less than 20 ng/mL had a significantly higher mean reduction ratio in PAS score than the subjects whose plasma concentrations of paroxetine were >20 ng/mL. Multiple regression analysis showed that the plasma concentration of paroxetine was the only significant factor and accounted for 28.0% of the variability in the reduction ratio of PAS score of the subjects. The final model of correlation was: reduction ratio in PAS score = 0.423 - 0.009 x (plasma concentrations of paroxetine) (R = 0.529, P = 0.014, coefficient of determination (R2) = 0.280). Assuming that the reduction ratio in PAS score was 0.2 in the equation above, plasma concentration of paroxetine is calculated to be about 25 ng/mL, which is suggested to be the upper end of the therapeutic window for the initial phase of the treatment with paroxetine for panic disorder.

Effect of Dissociative Experiences on Drug Treatment of Panic Disorder

Dissociative experiences are widespread among patients with panic disorder and have a negative impact on cognitive-behavioural therapy. In this study we aimed to investigate whether or not dissociative experiences affect response to drug treatment for panic disorder. Thirty-five patients, 20 women and 15 men, with a mean age of 35.4 years and a diagnosis of panic disorder, were enrolled in the study. Paroxetine 20 mg/day was administered over 6 weeks. Patients were assessed on the Dissociative Experience Scale (DES) and Panic and Agoraphobia Scale (PAS) at the commencement of therapy, and on the PAS again after therapy. The average DES score was determined as 30.3. Agoraphobia was identified in 34.3% of patients. DES scores were higher in patients with agoraphobia than in those without agoraphobia. Agoraphobia scores were higher in patients with high DES scores. When patients were divided into those with low DES scores (< or =30) and those with high DES scores (>30), a decrease in PAS scores with treatment was observed in both groups, but the decrease was greater in those with low DES scores (18.8 +/- 6.8 vs 5.7 +/- 5.7 in the high-DES score group; Z = 4.486, p = 0.00000053). Similarly, while a decrease in PAS scores with treatment was observed both in patients with agoraphobia (p < 0.05) and in those without agoraphobia, PAS scores decreased more in non-agoraphobic patients (16.7 +/- 7.5 vs 4.8 +/- 6.6 in patients with agoraphobia; Z = 3.799, p = 0.000047). In addition, the decrease in PAS scores was significantly correlated with baseline DES score (beta = 0.706, T = 5.727, p = 0.0000022). This study shows that dissociative experiences reduce the response to drug therapy in patients with panic disorder.

Panic disorder subtypes: further clinical differences

Panic disorder (PD) is a heterogeneous phenomenon with respect to symptom profile. Most studies agree that a group of patients with prominent respiratory symptoms emerged as a distinct PD subtype. In this study we compared a range of clinical features associated with PD and agoraphobia in patients with respiratory (RS) and nonrespiratory (NRS) subtypes of PD. The participants were 124 patients with PD (79 women and 45 men), with or without agoraphobia, diagnosed by DSM-IV criteria. Following the observer-rated Panic Disorder Severity Scale assessment, subjects completed self-report measures, including the Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale; the Beck Anxiety Inventory; and the Panic-Agoraphobic Spectrum Scale (PAS-SR). Multivariate analysis of variance (MANOVA) showed significant group differences [Pillai's trace = 0.95, F (5, 118)(=)2.48, P = .036]. Patients in RS group had higher mean total scores on the ASI (F = 5.00, df = 1, P = .027) and PAS-SR (F = 11.23, df = 1, P = .001) than patients in NRS group. Also, patients with RS attained higher scores than patients with NRS on four domains of PAS-SR (panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking). A descriptive discriminant analysis of the data correctly identified 69.4% of the patient group in general and 86.1% of RS group (Wilks's lambda = 0.87, df = 8, P = .048). The significant discriminating factors of the RS and NRS groups were domains of panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking. Our findings suggest that anxiety sensitivity and panic-agoraphobic spectrum symptoms might be particularly relevant to understanding subtypes of PD.

Short-term antidepressant treatment of comorbid dental anxiety in patients with panic disorder

Objectives. The aims of this study were to determine the frequency of dental anxiety (DA) and dental phobia (DP) in panic disorder, and to follow the changes in DA levels during antidepressant treatment of panic disorder. Methods. Fifty-three controls and 102 panic disorder patients were assessed using the Structured Clinical Interview (SCID), the Panic-Agoraphobia Scale (PAS), and the Corah Dental Anxiety Scale (DAS). Oral health status was defined by the number of decayed, missing, and filled teeth (DMFT) index. The patients were classified into three groups: (1) those without dental anxiety (WDA), (2) those with dental anxiety (DA), and (3) those with dental phobia (DP). All patients were treated with antidepressants for 3 months and the response rates were assessed. Results. At baseline, DAS was significantly higher in both the DA and the DP groups than in the control group. Ten (9.8%) of the panic disorder patients fulfilled the diagnostic criteria for DP; 31 (30.4%) had severe DA. In the control group, none of the patients was diagnosed as DP, whereas 7 (13.5%) had severe DA. Panic disorder and DA both responded to the antidepressant treatment, but DAS scores remained significantly higher in the DP group than in the DA group and the control group at the end of the third month. Conclusions. Our data suggest that both DA and DP are more frequent in panic disorder than in healthy controls. Antidepressant treatment may have been helpful in decreasing DA levels in the DA group but not in the DP group.

Audiovestibular functioning in patients with panic disorder

Objective The objective of this study was to investigate audiovestibular function in patients with panic disorder and healthy subjects by using vestibular and audiologic tests. Methods Thirty-four panic disorder patients and 20 healthy control subjects were assessed by using clinical otoneurological examination, pure tone audiometry, tympanometry, and electronystagmography (ENG). All patients were evaluated with the Panic and Agoraphobia Scale (PAS), the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the State-Trait Anxiety Inventory (STAI). Results On vestibular testing, abnormal responses were more prevalent in panic disorder patients compared to healthy controls. The presence of agoraphobia in panic disorder patients did not make a significant difference on vestibular test results. The only variable that may be a predictor of vestibular abnormalities in panic disorder patients was found to be dizziness between attacks. Conclusion The results show that dizziness between panic attacks may warrant audiovestibular testing among other medical investigations.

Predictors of work disabilities in patients with panic disorder with agoraphobia

Objective. – The aim of this study was to ascertain predictors of work insufficiency in patients with panic disorder (PD) with agoraphobia (AG). Method. – Linear regression was used to identify predictors of work insufficiency in a sample of 72 consecutive outpatients with PD with AG. Intensity of work insufficiency was ascertained from modified National Institute of Mental Health Panic Questionnaire (NIMH PQ). That represented dependent variable. Independent variables were demographic data, duration of illness, presence of comorbid current major depression episode, presence of any personality disorder and scores on the Panic and Agoraphobia Scale (PAS) subscales: panic attacks, AG (avoidance behavior), anticipatory anxiety and worries about health. Results. – Patients reported severe work insufficiency. The best predict variable for the work insufficiency in patients with PD with AG was high score on the PAS dimension of AG. Conclusion. – Patients generally reported severe effects of PD with AG on work efficacy and the results suggested that the impaired work efficacy was the most associated with avoidance behavior. These results recommend that the treatment of PD with AG patients should be related to decreasing avoidance behavior in order to establish adequate work performance in patients.

Altered diurnal variation of nitric oxide production in patients with panic disorder.

The aim of this prospective study was to investigate the diurnal change in serum nitric oxide (NO) levels in active and remission phases of patients with panic disorder. This study included 15 patients fulfilling the criteria for panic disorder of Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition and 15 healthy controls matched for age and sex. All patients were receiving a selective serotonin reuptake inhibitor at therapeutic doses. The serum nitrite and nitrate levels of subjects were determined at 10:00 a.m. after overnight fasting and at 3:00 p.m. 2 hours after lunch. NO levels of all patients measured in the morning were significantly higher than those of controls. The patients were also divided into active and remission groups according to clinical status and Panic Agoraphobia Scale's cut-off point. There were no statistically significant differences in serum nitrite and nitrate levels of the active group between the 10:00 a.m. and 3:00 p.m. measurements. In contrast, statistically significant differences were found in the serum levels of nitrite (p<0.05) and nitrate (p<0.05) in the remission group. Notably, the afternoon nitrite and nitrate levels of the remission group were higher than those of the morning levels as seen in control subjects. Thus, diurnal variation of NO production is altered in patients with panic disorder but is resumed in the remission phase. The present study suggests that serum NO levels are a good marker for evaluation of panic disorder.

Antioxidant Enzyme and Malondialdehyde Levels in Patients with Panic Disorder

There is evidence of an etiopathogenetic role of free radicals (FRs) in some neuropsychiatric disorders. The aim of the present study was to determine whether the activity levels of some antioxidant enzymes [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT)] and malondialdehyde (MDA), a product of lipid peroxidation, were associated with panic disorder (PD). Twenty patients diagnosed with PD and 20 healthy controls were enrolled in this study. A clinical evaluation and measurements of GSH-Px SOD, CAT and MDA were performed. Additionally, all patients were assessed by the Panic Agoraphobia Scale (PAS). The mean GSH-Px, SOD and MDA levels of the patient group were significantly higher than those of the controls. There was a significant positive correlation between PAS scores and GSH-Px, SOD and MDA levels and between the duration of illness and SOD, CAT and MDA levels in the patient group. In conclusion, our results suggest that FRs may be involved in PD.

The role of catastrophic misinterpretation of bodily sensations and panic self-efficacy in predicting panic severity

This study investigated the role of both negative and positive cognitions in predicting panic severity in an international sample of patients diagnosed with panic disorder (with and without agoraphobia). One hundred and fifty-nine patients were administered the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), the Self-efficacy to Control Panic Attacks Questionnaire, and the Panic and Agoraphobia Scale (PAS) prior to receiving treatment. Regression analyses indicated that both catastrophic misinterpretation of bodily sensations and panic self-efficacy independently predicted panic severity. The influence of panic self-efficacy upon panic severity remained significant even after controlling for the presence or absence of agoraphobia. There was no evidence to suggest a moderating relationship between the two cognitive factors. Results are discussed in terms of the need to consider both negative and positive cognitions in cognitive accounts of panic disorder.

Panic disorder patients at the time of air strikes.

We assessed the impact of real danger on several aspects of the panic disorder (PD) patients' psychopathology and level of disability. At the time of the NATO air strikes on Belgrade, 84 PD patients who were in partial or complete remission were administered the Panic and Agoraphobia Scale (PAS). All had been treated previously, and the majority (58.3%) were taking antipanic medications. The PAS, which was used as part of the regular follow-up assessment battery for PD patients, measures the overall severity of PD and the severity of key aspects and components of PD. Compared to the PAS assessments made before the onset of air strikes, the PAS assessments made at the time of air strikes showed significant differences in terms of decreased overall severity of PD, fewer health concerns, decrease in the level of disability, and greater intensity and frequency of anticipatory anxiety. Differences on the measures of panic attacks and agoraphobic avoidance were negligible. These results suggest that there is no relationship between panic attacks and real danger and lend support to the notion that panic attacks and fear induced by real danger are different phenomena. Contrary to the expectations of many PD patients, the presence of real danger does not seem to be associated with deterioration in their functioning, and PD patients can be reassured that they are not likely to cope worse under conditions of danger.

Endurance Training in Panic Patients: Spiroergometric and Clinical Effects

Endurance capacity was determined by bicycle spiroergometry in patients with panic disorder before (n = 38) and after (n = 10) a 10 week running program and compared to untrained healthy control subjects carrying out the same training (n = 11) and patients receiving clomipramine drug therapy (n = 7) or placebo (n = 7). Before the running program maximal oxygen uptake (VO2peak) and the workload corresponding to a lactate concentration of 4 mmol/l (PLAC4) were significantly reduced in panic patients compared to controls. Patients in the running program and healthy controls improved PLaC4 significantly by running. No significant differences in endurance gains were found between these groups, showing that patients and controls improved equally. At study termination (week 10) running was more efficient than placebo in improving panic symptoms (Bandelow PanicAgoraphobia Scale, Hamilton Anxiety Scale, Clinical Global Impression Scale). Clomipramine treatment was better than placebo (all scales) and running (only Clinical Global Impression). Endurance capacity did not correlate with anxiety scores at baseline, nor did improvement in fitness substantially correlate with changes in psychopathology measures during the study. Panic patients were shown to have a decreased endurance capacity which can be raised by training. Endurance training based on spiroergometric results gives rise to clinical improvement.

P.3.004 The application of the panic and agoraphobia scale (PAS) in clinical trials

P.3.004 The application of the panic and agoraphobia scale (PAS) in clinical trials