Panic Disorder Severity Scale Scores Research Articles

Effects of antidepressant on FKBP51 mRNA expression and neuroendocrine hormones in patients with panic disorder

ObjectiveThe purpose of this study was to investigate the effects of escitalopram on the peripheral expression of hypothalamic-pituitary-adrenal (HPA) axis-related genes (FKBP51, HSP90, NR3C1 and POMC) and HPA-axis hormones in patients with panic disorder (PD).MethodsSeventy-seven patients with PD were treated with escitalopram for 12 weeks. All participants were assessed for the severity of panic symptoms using the Panic Disorder Severity Scale (PDSS). The expression of HPA-axis genes was measured using real-time quantitative fluorescent PCR, and ACTH and cortisol levels were measured using chemiluminescence at baseline and after 12 weeks of treatment.ResultsAt baseline, patients with PD had elevated levels of ACTH and cortisol, and FKBP51 expression in comparison to healthy controls (all p < 0.01). Correlation analysis revealed that FKBP51 expression levels were significantly positively related to cortisol levels and the severity of PD (all p < 0.01). Furthermore, baseline ACTH and cortisol levels, and FKBP51 expression levels were significantly reduced after 12 weeks of treatment, and the change in the PDSS score from baseline to post-treatment was significantly and positively related to the change in cortisol (p < 0.01).ConclusionsThe results suggest that PD may be associated with elevated levels of ACTH and cortisol, and FKBP51 expression, and that all three biomarkers are substantially decreased in patients who have received escitalopram treatment.

Impact of Intolerance of Uncertainty on Brain Structural Changes in Panic Disorder.

This study investigated the impact of intolerance of uncertainty (IU) on structural changes in the brain and symptom severity in patients with panic disorder. This study included 90 participants diagnosed with panic disorder. The IU Scale, Panic Disorder Severity Scale (PDSS), Beck Depression Inventory-II (BDI-II), Penn State Worry Questionnaire (PSWQ), Self-Forgiveness Scale (SFS), and Short Form 36 Health Survey (SF) were used. A voxel-wise correlation analysis was conducted to investigate the structural differences in the gray matter. As IU increased, the cortical thickness of the right lingual gyrus decreased significantly, while the gray matter volume of the right pars triangularis increased. The cortical thickness of the right lingual gyrus showed a significant negative correlation with the BDI-II score and a positive correlation with the SFS. Additionally, the gray matter volume of the right pars triangularis was positively correlated with the PDSS, PSWQ, and BDI-II scores and negatively correlated with the mental health domain of the SF. According to our findings, elevated IU in participants with panic disorder was associated with cortical thinning in the lingual gyrus and increased gray matter volume in the pars triangularis. These structural alterations may also have an impact on perceived quality of life, as well as high levels of depression and anxiety.

The psychological and physiological effects of integrated cognitive-behavioral and biofeedback therapy on panic disorder: A randomized controlled trial

Cognitive-behavioral therapy (CBT) and biofeedback therapy are commonly regarded as effective treatment modalities for panic disorder. The aim of this study was to establish a Taiwanese version of an integrated cognitive-behavioral and biofeedback therapy (ICB) and examine its effects on panic disorder using psychological and physiological indicators. Thirty patients with panic disorder were enrolled in this study. They were randomly assigned to either the ICB group (n=15) or the treatment as usual (TAU) group (n=15). The intervention consisted of six sessions, conducted once a week. Psychological indicators were measured at baseline (prior to intervention), week 3, and week 6, while physiological indicators were measured at baseline and week 6. The psychological indicators included five scales, with the Panic Disorder Severity Scale (PDSS) being the primary measure. The physiological indicators included respiratory sinus arrhythmia (RSA) and skin conductance, which respectively represent parasympathetic and sympathetic activity. Considering all participants, PDSS scores significantly decreased over time, but the difference between the ICB and TAU groups did not reach statistical significance. Among the physiological indicators, resting-state RSA and RSA under relaxation showed significant between-group differences over time, with the ICB group demonstrating a more pronounced improvement in RSA. In the context of existing pharmacological treatments, the benefits of ICB for panic disorder may not be observable through psychological indicators. However, it can lead to enhancement of parasympathetic activity as evidenced by the physiological indicators.

The relationship of separation anxiety with the age of onset of panic disorder.

This study aimed to investigate whether separation anxiety (SA) constitutes a dimension related to age at onset of panic disorder (PD), in homogeneous subgroups of outpatients with PD, based on their age of onset and symptom severity. A sample of 232 outpatients with PD was assessed with the Panic Disorder Severity Scale (PDSS) and the Sheehan Disability Scale (SDS) for functional impairments. Separation anxiety was evaluated using structured interviews and questionnaires. We applied a K-Means Cluster Analysis based on the standardized "PD age of onset" and "the PDSS total score" to identify distinct but homogeneous groups. We identified three groups of patients: group 1 ("PD early onset/severe", N = 97, 42%, onset 23.2 ± 6.7 years), group 2 ("PD early onset/not severe", N = 76, 33%, onset 23.4 ± 6.0 years) and group 3 ("PD adult onset/not severe", N = 59, 25%, onset 42.8 ± 7.0 years). Patients with early onset/severe PD had significantly higher scores on all SA measures than PD late-onset/not severe. Regression analyses showed that SA scores, but not PDSS scores, were predictive of impairment in SDS work/school, social life, and family functioning domains. Our data indicate a significant relationship between SA and PD with an earlier age of onset and an impact on individual functioning. This may have important implications for implementing preventive interventions targeting early risk factors for the subsequent onset of PD.

Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study.

Prior clinical trials have shown consistent clinical benefit for Capnometry Guided Respiratory Intervention (CGRI), a prescription digital therapeutic for the treatment of panic disorder (PD) and post-traumatic stress disorder (PTSD). The purpose of this study is to report real-world outcomes in a series of patients treated with the intervention in clinical practice. This paper reports pre- and post-treatment self-reported symptom reduction, measures of respiratory rate and end-tidal carbon dioxide levels, drop-out and adherence rates drawn from an automatic data repository in a large real-world series of patients receiving CGRI for panic disorder and PTSD. Patients used the intervention in their homes, supported by telehealth coaching. Patients meeting symptom criteria for panic disorder (n = 1,395) or posttraumatic stress disorder (n = 174) were treated following assessment by a healthcare professional. Capnometry Guided Respiratory Intervention is a 28-day home-based treatment that provides breath-to-breath feedback of respiratory rate and exhaled carbon dioxide levels, aimed at normalizing respiratory style and increasing patients' mastery for coping with symptoms of stress, anxiety, and panic. Health coaches provide initial training with weekly follow up during the treatment episode. Remote data upload and monitoring facilitates individualized coaching and aggregate outcomes analysis. Self-reported Panic Disorder Severity Scale (PDSS) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores were obtained at pre-treatment and post-treatment. Panic disorder (PD) patients showed a mean pre-to-post-treatment reduction in total PDSS scores of 50.2% (P < 0.001, d = 1.31). Treatment response rates for PD (defined as a 40% or greater reduction in PDSS total scores) were observed in 65.3% of the PD patients. PTSD patients showed a pre-to-post-treatment reduction in total PCL-5 scores of 41.1% (P < 0.001, d = 1.16). The treatment response rate for PTSD (defined as a ≥10-point reduction in PCL-5 scores) was 72.4%. In an additional analysis of response at the individual level, 55.7% of panic disorder patients and 53.5% of PTSD patients were classified as treatment responders using the Reliable Change Index. Patients with both normal and below-normal baseline exhaled CO2 levels experienced comparable benefit. Across the 28-day treatment period, mean adherence rates of 74.8% (PD) and 74.9% (PTSD) were recorded during the 28-day treatment. Dropout rates were 10% (PD) and 11% (PTSD) respectively. The results from this cohort of 1,569 patients treated with the CGRI intervention demonstrate significant rates of symptom reduction and adherence consistent with prior published clinical trials. The brief duration of treatment, high adherence rates, and clinical benefit suggests that CGRI provides an important addition to treatment options for panic disorder and PTSD.

Efficacy and safety of hangekobokuto (Banxia‐houpo‐tang) in treating panic disorder: A pilot study

AbstractAimThe prevalence of panic disorder in patients with comorbidities is higher than in the general population. Selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, the common pharmacotherapy, can cause adverse effects in the patients. To research other options, we report a retrospective pilot study on hangekobokuto in treating panic disorder.MethodsWe reviewed the data of consecutive cases with panic disorder treated with hangekobokuto from April 1, 2017 to March 31, 2021 at Kindai University Nara Hospital. The changes in the symptoms, assessed by the Panic Disorder Severity Scale (PDSS), and adverse events were investigated.ResultsThe total number of patients was 35 (8 males and 27 females). The median and the interquartile range (IQR) of age (years old) were 50 and 42.5–70. The mean and standard deviation (SD) of PDSS score were initially 14.51/28 (±4.76). They changed to 10.91/28 (±6.11) after one month, then 9.40/28 (±6.99) after three months (p &lt; 0.05). After one month 19 patients (54.3%) and after three months 23 patients (65.7%) saw an improvement with a decrease of PDSS score equal to or more than three points from the baseline. The middle‐aged group seemed to have shown the highest response to hangekobokuto. As adverse effects, one patient reported nausea and another diarrhea.ConclusionThe efficacy and safety of hangekobokuto for panic disorder are suggested in our study, but more research will be necessary.

Prediction of prognosis in patients with panic disorder using pre-treatment brain white matter features

BackgroundThe early identification of patients with panic disorder (PD) with a poor prognosis is important for improving treatment outcomes; however, it is challenging due to a lack of objective biomarkers. We investigated the reliability of characterizing structural white matter (WM) connectivity and its ability to predict PD prognosis after pharmacotherapy. MethodsA total of 138 patients (59 men) with PD and 153 healthy controls (HCs; 73 men) participated in this study. PD symptom severity was measured using the Panic Disorder Severity Scale (PDSS) at baseline and follow-up periods of 8 weeks, 6 months, and 1 year. The least absolute shrinkage and selection operator (Lasso) was utilized to identify prognosis-related WM regions on diffusion imaging features. ResultsLasso identified seven prognosis-related WM regions: the bilateral posterior corona radiata, bilateral posterior limb of the internal capsule, the left retrolenticular part of the internal capsule, the left sagittal stratum, and the right fornix/stria terminalis. Some of these regions showed lower mean fractional anisotropy (FA) values in patients with PD than in HCs. The predicted PDSS scores using FA from these regions consistently correlated with the actual prognosis in all periods. LimitationsThis study had limited ability to evaluate individual longitudinal changes in detail owing to the data acquisition time and brain atlas resolution. ConclusionsOur findings suggest the possibility of using structural WM connectivity as a biomarker for the clinical characterization of PD. Our findings will expand our understanding of the neurobiology of PD and improve biomarker-based prognosis prediction in clinical practice.

Retinal Changes in Panic Disorder Patients

AimOptical coherence tomography (OCT) is a novel method that allows high resolution cross-sectional imaging of biological tissues. It was suggested that changes in the cranial structure or functions would be reflected in the retina. OCT has been an important method in the diagnosis and follow-up of diseases via morphometric or quantitative retinal measurements. Panic disorder (PD) is an anxiety disorder, where free radicals, inflammatory processes and neurotransmitter transmission disorders play a role in the etiology. The present study aimed to demonstrate neurodegeneration in PD by the comparison of PD patient and control OCT data. Material and MethodThe study group included 21 PD patients who met the study criteria. The control group included 21 healthy individuals without any known psychiatric or organic disease, including eye disease, and gender-matched to the patient group. All participants underwent detailed psychiatric and eye examinations. Central macular thickness (CMT), macular volume (MV), mean and retinal nerve fiber layer thickness (RNFL), ganglion cell layer thickness (GCLT), and central choroidal thickness (CCT) were measured in both eyes of all participants with OCT. A sociodemographic data form, Clinical Global Impression Scale (CGIS), and Panic Disorder Severity Scale (PDSS) were administered to the participants. ResultsIn the study, it was determined that the CMT values of the PD patients were lower when compared to the controls in the OCT examination. There was a statistically significant difference between the CMT of the PD patient group and the control group; the CMT was lower in the patient group. There were no significant differences between the groups based on GCLT, RNFL superior, RNFL inferior, RNFL nasal, RNFL temporal, and CCT. There was no significant correlation between CGIS, PDSS scores and OCT measurements. ConclusionThis is the first study in the literature where patients with a PD diagnosis were analyzed based on the OCT method. OCT, which is a simple, noninvasive and relatively inexpensive method that the patient could easily adapt to during imaging, could be employed as a supplementary method in the diagnosis and follow-up of PD patients.

Virtual reality exposure therapy in panic disorder: a pilot study

AimsTo ascertain if virtual reality exposure therapy (VRET) is an effective add-on tool in the treatment of Panic Disorder (PD).BackgroundThe exposure to virtual stimuli has been studied as a useful treatment for PD. However, the studies with PD are still scarce and use dissimilar protocols, with effectiveness varying according to the protocol applied.MethodEight PD patients received VRET as an add-on treatment to pharmacotherapy. The treatment protocol consisted of eight sessions. The first session is for the patient to understand the treatment and to answer the questionnaires. The second and third sessions were to prepare the patients for exposures with breathing training using diaphragmatic breathing and others breathing techniques to manage anxiety. From the fourth to eighth sessions, the patients followed a hierarchy of tasks during virtual reality exposure. Clinicians rated the Clinical Global Impression Scale (CGI) and the Panic Disorder Severity Scale (PDSS). The patients rated the Diagnostic Symptom Questionnaire (DSQ); the Mobility Inventory (MI), the Anxiety Sensibility Index (ASI-R), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the WHOQOL-BREF before and after the protocol. After all exposures, the Igroup Presence Questionnaire (IPQ) was applied to measure the sense of presence experienced in the virtual environment. The virtual environment simulated the subway of Rio de Janeiro.ResultThere were no statistically significant improvements in the CGI-S, PDSS, BAI, MI or WHOQOL. There was a significant improvement in the BDI scores (P = 0.033). There was a trend towards improvement of anxiety measured by the ASI-R (P = 0.084) and of panic symptoms measured by the DSQ (P = 0.081) scores. There was also a significant improvement of sense of presence (IPQ – general presence) through the exposure sessions.ConclusionOur study demonstrated that VRET as an add-on to pharmacological therapy could benefit PD patients. Despite the lack of significant differences in the means, the dispersion of PDSS and BAI scores were smaller after treatment compared to before treatment, suggesting that patients with more severe anxiety, panic and agoraphobia symptoms benefited more of the VRET protocol so, at the end of the treatment, differences were found in important measures of panic. Randomized controlled clinical trials are warranted to confirm the efficacy of VRET.This study was funded by the Brazilian National Council for Scientific Development (Cnpq). The authors report no conflicts of interest.

Early Trauma Is Associated with Poor Pharmacological Treatment Response in Patients with Panic Disorder

Objective Pharmacotherapy is established as an effective method for reducing symptoms of panic disorder (PD). However, about 20–40% of PD patients are treatment-resistant. Predictors of pharmacotherapy outcomes for PD patients are needed. Methods This study included 152 PD patients to measure the clinical severities of PD symptoms and used the Early Trauma Inventory (ETI) to measure early trauma. Treatment response was defined as a 40% reduction in the total Panic Disorder Severity Scale score from baseline. We measured the treatment responses at 8 weeks and 6 months. Binary logistic regression was used to predict treatment response after controlling for confounding variables. Results Early sexual trauma alone was associated with poor treatment response at 8 weeks. However, at 6 months, the total ETI score was associated with an unfavorable treatment response. Conclusion Therefore, our study suggests that clinicians need to be aware of a history of early trauma to optimize treatment outcomes for PD patients.

The Effects of the Five-Session Cognitive Behavior Group Therapy for Panic Disorders: Ultra-Brief Treatment

Structuring short-term and group-based Cognitive Behavioral Therapy (CBT) will make an important contribution to cost-effectiveness. The aim of this study is to evaluate the effectiveness of our five-session CBGT protocol in reducing panic disorder symptoms and beliefs underlying this disorder in the perspective of cognitive theory. A protocol of five sessions was applied with forty-six patients who were diagnosed with panic disorder and volunteered for the study. A sociodemographic data form, the Panic Disorder Severity Scale (PDSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Body Sensations Questionnaire (BSQ), Agoraphobic Cognition Scale (ACS), and Health Anxiety Scale (HAS) were administered to the patients by the study team. The scales were reapplied before the group process started, after the 2nd session, after the 5th session, and at the 6th month after the end of the therapy process. A significant change was observed between baseline and 6th-month controls in all measurements. In addition, there was no difference in PDSS, BDI, BSQ, and HAS scores between the end of therapy and 6th-month values. Our study will make a valuable contribution to the literature as it is the first CBGT study in our country and a short protocol such as five sessions is used.

Psychiatry to dermatology; panic disorder

ObjectiveAnxiety is commonly observed together with skin diseases and can aggravate them, while skin diseases can increase anxiety. The relationship of skin diseases observed in panic disorder with quantitative electroencephalography (QEEG) findings has not been investigated yet. The aim of this study is to compare the absolute alpha and delta power of panic disorder patients with and without skin disease. Methods246 panic disorder patients, 19 of whom had skin disease and 227 of whom did not have skin disease, were included in the study. Panic disorder severity scale (PDSS) scores of patients were recorded, and QEEG recording was performed. Absolute alpha and delta power and PDSS scores were compared between the two groups. ResultsIt was found that the absolute delta power in the left hemisphere was lower and PDSS scores were higher in the patients with skin diseases compared to the control group. In the patients with skin disease, decreased delta power in the left hemisphere may cause impairment in the processing of positive emotions and may cause trait anxiety. ConclusionTrait anxiety may increase susceptibility to skin diseases by disrupting cutaneous homeostasis resulting from the prolonged sympathetic nervous system activation.

Relationship between impulsivity, comorbid anxiety and neurocognitive functions in bipolar disorder

Objective The aim of the study is to examine the relationship between anxiety and impulsivity and to reveal the correlation of these variables with clinical and sociodemographic features. It is also aimed to investigate the relationship between impulsivity and anxiety with neurocognitive functions in bipolar disorder. Methods The sample of the study comprises of 71 patients with bipolar disorder type I without any comorbidity (BD), 37 patients with anxiety disorder comorbidity with bipolar disorder type I (BDAD), 52 patients with anxiety disorder (AD) and 50 healthy controls (HC). Participants completed Barratt Impulsivity Scale-11, State-Trait Anxiety Inventory 1–2, Panic Disorder Severity Scale (PDSS), brief version of Fear of Negative Evaluation Scale (FNES), Anxiety Sensitivity Index-3 (ASI-3), Trail-Making Test A–B, Digit Span Test, Stroop Test. Results PDSS scores, trait anxiety level, hypomanic and mixed episode numbers explain 26% of attention impulsivity. Gender and ASI-3 social dimensions explain 16% of motor impulsivity. Trait anxiety explains non-planning and total impulsivity at 26 and 24%, respectively. When neurocognitive impairment’s effect was controlled, it was found AD and BDAD groups had higher impulsivity levels than the BD and HC groups. Conclusion Anxiety disorder comorbidity increases impulsivity in bipolar disorder. KEYPOINTS In the presence of anxiety disorder spectrum comorbidity, bipolar disorder patients will have increased impulsivity and the clinical course may be more severe. Trait anxiety levels and anxiety sensitivity may be predictive factors for impulsivity. In the presence of anxiety disorder spectrum comorbidity, it should be taken into consideration that these patients may be more impulsive and should be treated with more care in terms of evaluation of the disorder.

Features of the pathogenesis, diagnosis, and treatment of panic attacks in young people

Objective : to investigate the features of the pathogenesis, diagnosis, and treatment of panic attacks (PAs) in young people. Patients and methods . A total of 39 outpatients (27 females and 12 males) aged 19 to 38 years with PAs were examined. The Panic Disorder Severity Scale (PDSS) was used to measure the severity of clinical manifestations of PAs; the Covey Anxiety Scale was employed to identify an anxiety state. In order to exclude depressed patients from being examined, the Montgomery— А sberg rating scale was applied to assess the severity of depression. All the patients were divided into two groups: 1) 22 patients with PAs who received standard therapy and the alpha-adrenoblocker proroxan (Vegetrox) as a 15-mg tablet thrice daily for 8 weeks; 2) 17 patients who were prescribed only standard therapy. The patients were examined twice before and 4 weeks after the end of an 8-week vegetrox therapy cycle. Results and discussion . In the patients of both groups with PAs, the total score ranged from 3 to 11, with the median PDSS score of 7. According to the Covey anxiety scale, an anxiety state developed in 33 patients; only the symptoms of anxiety were detected in 6. There was a direct significant correlation between the PDSS and Covey anxiety scale values; Spearman's rank correlation coefficient was 0.681 (p&lt;0.01). The PA severity indexes proved to be significantly lower after incorporating Vegetrox into the standard therapy. Comparing the anxiety scale values in the patients of Groups 1 and 2 after the treatment cycle revealed a significant decrease in the level of anxiety in the patients receiving standard therapy and Vegetrox. This effect of the latter may be explained by the fact that it blocks postsynaptic α 1 -adrenoceptors and presynaptic α 2 -adrenoceptors and decreases the stimulation intensity of the hypothalamic structures that are closely connected with the limbicoreticular system. Conclusion . The severity of PAs in young people depends on the level of anxiety. Vegetrox has a significant positive effect on the values of PDSS and the Covey anxiety scale in PAs.

Smaller volume of right hippocampal CA2/3 in patients with panic disorder.

The hippocampus is thought to play an important role in conveying contextual information to the amygdala as the neural basis of panic disorder (PD). Previous studies have revealed functional abnormalities in the hippocampus in patients with PD compared with healthy control subjects (HC), but no study has reported volume abnormalities in the hippocampus or evaluated minute structural changes in the hippocampus in such patients. We thus investigated volume abnormalities in the subfields of the hippocampus to better understand the neurobiological basis of PD. The hippocampus was extracted from structural brain magnetic resonance images obtained from 38 patients with PD and 38 HC and then segmented into six subfields. The relative volume of each subfield was compared between the two groups. The severity of symptoms was assessed using the Panic Disorder Severity Scale (PDSS) and social functioning was assessed using the Global Assessment of Functioning (GAF) scale. Our results revealed that patients with PD had a significantly smaller volume of the right cornu ammonis (CA) 2/3 hippocampal subfield compared with HC. No significant associations were found between the volumes of the right CA 2/3 and the PDSS or GAF scores in correlation analyses. In conclusion, CA2/3 is thought to be related to contextual memory function, and our results suggest that this particular hippocampal subfield plays a role in the development of PD symptoms.

Early sexual trauma is related with the tapetum in patients with panic disorder

BackgroundEarly trauma exposure is suggested to confer a greater risk for the development of panic disorder (PD) by altering neurodevelopmental processes. A body of studies have shown that white matter microstructures, particularly in the fronto-limbic and callosal regions, could be affected by a history of early trauma in patients with PD. The tapetum, the extended posterior part of the corpus callosum connecting the bilateral temporal lobes, has not yet been studied regarding its relationship with early trauma, especially sexual one. MethodsSeventy participants with PD, sixty age- and sex-matched healthy controls were enrolled. The Early Trauma Inventory Self Report-Short Form (ETISR-SF), Neuroticism Scale, and Panic Disorder Severity Scale (PDSS) were administered. Voxel-wise statistical analysis of diffusion tensor imaging data was performed within the bilateral tapetum regions using Tract-Based Spatial Statistics (TBSS). ResultsIn participants with PD, higher levels of sexual trauma were significantly associated with the increased fractional anisotropies (FAs) in a cluster of the right tapetum. Exploratory correlation analysis revealed that FAs in this cluster were significantly correlated with higher neuroticism and poorer treatment response after one year of pharmacotherapy. No significant correlation was found between FAs of the right tapetum cluster and the PDSS scores. LimitationsThe possibility of retrospective recall bias for early trauma cannot be completely ruled out. ConclusionsThe findings of this study suggest that the right tapetum may serve as a potential neural marker of early sexual trauma in patients with PD and contribute to personal vulnerability and poorer treatment outcome after pharmacotherapy.

Blended cognitive behavioural therapy for adolescents with panic disorder co-morbid with autism spectrum disorder: a case study

Abstract Cognitive behavioural therapy (CBT) is an effective treatment for improving anxiety symptoms in patients with autism spectrum disorder (ASD). However, some patients with ASD take extra time for learning, and they can find it hard to change their thinking styles and behaviour due to cognitive deficits. The therapist must be creative when implementing CBT in this context. Here, it may be helpful for the patient with ASD to understand CBT’s concepts by using visual aid material. Blended CBT during which the patient is shown visual aid material with his or her therapist has been suggested as effective for adults without ASD to reduce anxiety. Blended CBT combines face-to-face treatment with internet guided support and resource. Blended CBT may facilitate an understanding of essential knowledge and help people with ASD and anxiety acquire skills based on cognitive behavioural science. However, as far as we know, no previous studies have reported on the use of blended CBT for patients with panic disorder co-morbid with ASD. This study, therefore, consecutively performed 16 blended CBT sessions on a biweekly basis to treat panic disorder (PD) in an adolescent Japanese female co-morbid with ASD. The patient exhibited improvements in PD symptoms and agoraphobia after treatment: the Panic Disorder Severity Scale score decreased from 18 to 2. These results indicate that visual aid-assisted treatment may help patients with impaired imagination and social cognition related to ASD. Furthermore, this study’s therapist notes the need for paced treatments and repeated psychoeducation for patients with impairments in central coherence and cognitive flexibility. Key learning aims (1) Blended CBT may patients with panic disorder (PD) co-morbid with autism spectrum disorder (ASD) to understand concepts based on cognitive behavioural science and symptoms. (2) Blended CBT sessions can each be conducted in approximately 20 min (about one-third of the time needed for typical 45- to 90-min CBT sessions); in other words, it is less burdensome for the patient and therapist. (3) How to adjust blended CBT for those who have low average intelligence quotients (IQ) and/or ASD.

Cognitive behavioral therapy for postpartum panic disorder: a case series

BackgroundClinical anxiety is common during the perinatal period, and anxiety symptoms often persist after childbirth. Ten to 30 % of perinatal women are diagnosed with panic disorder (PD)—far more than the 1.5–3% rate among the general population. Although cognitive behavioral therapy (CBT) has been determined to be an effective treatment for PD, few studies have been conducted on CBT effectiveness in treating postpartum PD and, to the best of the knowledge of the present authors, no research has been conducted on postpartum PD among Japanese women. In this manuscript, we report on our administration of CBT to three postpartum patients with PD, detailing the improvement in their symptoms.Case presentationAll patients in this study were married, in their thirties, and diagnosed using the Mini-International Neuropsychiatric Interview as having PD with agoraphobia. The Panic Disorder Severity Scale (PDSS) was used to evaluate patients’ panic symptoms and their severity. All patients received a total of 16 weekly 50-min sessions of CBT, and all completed the treatment. All patients were exceedingly preoccupied with the perception that a “mother must protect her child,” which reinforced the fear that “the continuation of their perinatal symptoms would prevent them from rearing their children”. After treatment, all participants’ panic symptoms were found to have decreased according to the PDSS, and two no longer met clinical criteria: Chihiro’s score changed from 13 to 3, Beth’s PDSS score at baseline from 22 to 6, and Tammy’s score changed from 7 to 1.ConclusionsCBT provides a therapeutic effect and is a feasible method for treating postpartum PD. It is important that therapists prescribe tasks that patients can perform collaboratively with their children.

Changes in serum BDNF levels after treatment of panic disorder patients

Aim: Panic disorder is a significant psychiatric disorder that more frequently occurs in women, with daily attacks such as fear of death, limiting the patient’s daily life. It is often associated with agoraphobia. The aim of this study was to investigate the relationship between BDNF levels and the clinical features of panic disorder.Material and Methods: The study was carried out between January 2015 and July 2015 with 42 female patients and 38 healthy females who were admitted to Psychiatry Outpatient Clinic. The patients who were diagnosed with panic disorder without agoraphobia included in the study. The Panic Disorder Severity Scale (PDSS) was applied to the patients. Serum BDNF was measured by sandwich ELISA.Results: The mean age of the 38 female patients was 35.1±11.5 years. The mean age of the control group of 38 healthy women was 34.9±9.82 years. Serum BDNF levels measured before treatment were significantly lower than BDNF levels measured after treatment (p 0.001). Serum BDNF levels measured before treatment were significantly lower than BDNF levels of the control group (p0.001). While there was a statistically significant negative correlation between BDNF levels and PDSS scores before treatment.Conclusion: Serum BDNF levels were significantly increased after treatment. The PDSS scores also decreased significantly after treatment. These results inform us about the effectiveness of the treatment. BDNF levels may also be considered as an indicator of the clinical follow-up of the panic disorder without agoraphobia.Keywords: Panic disorder; brain-derived neurotrophic factor; agoraphobia.

Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder.

Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.