Prevalence Of Panic Disorder Research Articles

Disruption of estrogen regulation of orexin neurons: a novel mechanism in the pathophysiology of respiratory manifestations of panic disorder in females

Panic disorder (PD) is an anxiety disorder that affects ~5% of the population. A significant group of PD patients are characterised by excessive behavioral and physiological responses to CO2 inhalation. The prevalence of PD is 2 to 3 times more frequent in women yet, the origins of this sexual dimorphism are unknown; the fact that excessive responsiveness to CO2 inhalation peaks during the pre‐menstrual phase suggest a role of ovarian hormones. Early life stress is a significant risk factor for PD and there is growing evidence indicating that stress‐related increase in the function of orexin‐producing neurons (ORX) is key to PD. Based on data suggesting that 17b‐estradiol (E2) inhibits ORX, we tested the hypothesis that insufficient E2‐regulation of ORX neurons contributes to stress‐related respiratory manifestations of PD in females. Experiments were performed on adult female rats previously subjected to neonatal maternal separation (NMS; 3h/day postnatal days 3 to 12) or raised under standard conditions. In this model, NMS females show an excessive hyperventilatory response to CO2 by comparison with controls; this effect is greatest during the proestrus phase. Inactivation of ORX1 receptors by SB 33486 (15 mg/kg; ip) prevents this effect. Whole cell recordings (voltage clamp) were performed on GFP‐labeled ORX neurons by AAV microinjection. Excitatory post‐synaptic currents (EPSCs) converging onto ORX neurons were recorded under basal conditions and following E2 bath application (100nM; 10 min). Monitoring of the estrus cycle showed that in control females, EPSC frequency was inversely proportional to circulating E2 levels associated with each phase. This relationship was not observed in NMS females; EPSC frequency of NMS females was greater than controls during the proestrus phase. E2 application reduced EPSC frequency (but not amplitude); however, this effect was not affected by stress or the estrus cycle phase. We conclude that NMS disrupts E2‐mediated inhibition of ORX neurons. This is a novel mechanism in the pathophysiology of PD.Support or Funding InformationSupported by an operating grant from the Canadian Institutes of Health Research

The prevalence of panic disorder among English Class students at Medical Faculty, Universitas Udayana, Bali, Indonesia in 2018

Background: Panic disorder is diagnosed in people who experience spontaneous, seemingly out-of-the-blue panic attacks and are very preoccupied with the fear of a recurring attack. Panic disorder usually begins in adulthood (after age 20) and can interfere a lot with daily life, causing people to miss work, go to many doctor visits, and avoid situations where they fear they might experience a panic attack. This study aims to determine the prevalence of panic disorder among English Class students at Medical Faculty, Universitas Udayana, Bali, Indonesia in 2018Methods: An observational cross-sectional study was conducted among 89 medical students from English Class at the Faculty of Medicine, Universitas Udayana in 2018 using total sampling techniques. A self-administered questionnaire was carried out to determine the prevalence of panic disorder by several valid and reliable questions. Data were analysed using SPSS version 20 for Windows and presented in frequency and percentage.Results: Â Most of the respondents were 20 years old (57.3%). There are only 12.0% of English class Semester 7 students are free from panic disorder, 51.0% suffers from mild panic disorder, and 37.0% suffers from moderate panic disorder. Around 64% of female respondents have panic disorder while 34% in male respondents. Female respondents are tended to get more panic attacks than male respondents in a ratio of 2:1.Conclusion: Female medical students tend to have a higher risk of panic disorder compared with males. The majority age of students suffering from panic attacks is from 20 to 23 years old.

Posttraumatic stress, panic disorder, violence, and recidivism among local jail detainees.

Most research on posttraumatic stress disorder (PTSD) and offending has been conducted with special populations (e.g. veterans and female inmates) and generally overlooks the additive effect of panic disorder (PD) in offending patterns. The purpose of this paper is to assess the prevalence of PTSD and PD among jail inmates, while simultaneously examining the relationships between these disorders, offending types and frequency. A random sample of adults recently booked into a local county jail participated in the Comprehensive Addictions and Psychological Evaluation-5 (CAAPE-5), a structured psychological assessment. The study sample was comprised of 200 male and 83 female inmates. Indications of PTSD were observed among 44.0 percent of male inmates and 57.8 percent of female inmates. Most male inmates (78.4 percent) with positive PTSD indications also met criteria for PD, with a similar proportion (78.1 percent) of female inmates also meeting criteria for both. The combination of PTSD and PD was not associated with offending frequency, but inmates presenting indications of both PTSD and PD were more likely to be charged with a violent offense relative to those with only PTSD. Inmates with PTSD who also have panic attacks may have a more severe condition with possible implications for other risks. Observations of these conditions among adults recently booked into local jails should coincide with each other. Few studies have examined mental health conditions among local jail detainees, despite the ever-present need to address them. The current study considers this important population and investigates the prevalence of co-occurring conditions.

Consequences of Microglial Depletion on the Hypercapnic Ventilatory Response of Female Rats

Panic disorder (PD) is a neurological disorder associated with an abnormally high hypercapnic ventilatory response. In humans and rodents, early life stress is a significant risk factor for PD. Based on recent data indicating that CO2/H+ sensing by microglia is an important mechanism in the translation of hypercapnic stimulation into physiological responses, we tested the hypothesis that depletion of microglia by pharmacological treatment can decrease the hypercapnic ventilatory response. We also proposed that this effect is greater in stressed rats than controls. The prevalence of PD being ~2 times greater in women than men, experiments were performed on female rats. Following birth, rats were either raised under control conditions or subjected to neonatal maternal separation (NMS; 3h/day, postnatal days 3 to 12). At 8 weeks, females were fed a palatable treat containing either vehicle (DMSO) or PLX3397 (40mg/kg). Treatment was performed daily for 10 consecutive days. 1 day after completion of the treatment, rats were placed in a plethysmography chamber to measure ventilatory activity at rest (room air) followed by hypercapnic exposure (FiCO2 = 0.05; 10 min). Iba‐1 immunohistochemistry was used to quantify microglial density; measurements performed in hypothalamic structures containing orexin neurons showed that PLX3397 treatment educed microglial density by 31%; this effect did not differ between the structures quantified. Furthermore, our preliminary results suggest that oestrus cycle influences the impact of microglial depletion on the CO2 response. During the estrus phase, PLX3397 attenuated the hypercapnic ventilatory response of controls but augmented the response of NMS females. These data suggest that microglia contribute to the abnormal effects that ovarian hormones exert on the neural networks regulating CO2/H+ chemoreflex respiratory regulation in NMS rats. These data provide the basis for the exploration of new treatment for respiratory manifestations of PD.Support or Funding InformationSupported by the Canadian Institutes of Health Research (RK & FB).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The prevalence of panic disorder and its related factor in hospitalized patients with chest pain and normal angiography.

BACKGROUND:Chest pain is one of the common causes for referrals to cardiologists, 50% of which have no-cardiac origin. The occurrence of chest pains is among the most important factors responsible for psychological disorders. This study aimed to determine the prevalence of panic disorder and its related factor in hospitalized patients with chest pain and normal angiography.MATERIALS AND METHODS:In a cross-sectional study, 144 patients who referred to Emam Ali Cardiac Hospital of Kermanshah because of chest pain in 2013 and had a normal angiography during admission were selected using census sampling method. The statistical indicators of Chi-square and logistic regression were applied.RESULTS:From 144 patients with atypical chest pain, 95 were male (66%) and 49 were female (34%). Overall, 41 patients met the criteria for panic diagnosis and thus, the prevalence of panic attacks among patients with atypical chest pain was calculated as 28.5%. The results of multiple logistic regression analysis showed that female gender, early age, and the being single were among the predictive factors for the existence of panic disorder in patients with atypical chest pain and normal angiography (P < 0.001).CONCLUSIONS:Given the high prevalence of panic disorder in patients hospitalized for chest pain with normal angiography, it is recommended to consider the importance of paying attention to this disorder and identifying patients and referring them to professional psychiatrists.

Epidemiology of panic attacks, panic disorder and the moderating role of age: Results from a population-based study

BackgroundThe aim of this study was to investigate the prevalence of panic attacks (PA) and panic disorder (PD) over the lifespan, determine the main correlates and analyze the potential moderating role of age. MethodWe analyzed cross-sectional data from a nationally-representative sample of 4,569 non-institutionalized adults. Three panic groups were created according to results in the CIDI interview: non-panic, PA (without PD) and PD. Panic groups were used as outcomes in adjusted multinomial regression models where several correlates were investigated. Interactions between each covariate and age were explored. ResultsThe highest prevalence rates of PA (9.5%) and PD (3.3%) were found in people aged 30–39 and 40–49, respectively. Respondents aged 80 + presented the lowest rates. In the adjusted multinomial model, younger ages, having depression, and poorer levels of quality of life were significant correlates for both PA and PD, whereas being female and having 2 or more chronic conditions were only significant for PA (not for PD) and being a frequent drinker (last 12-months) only for PD. Age significantly interacted with frequent alcohol consumption in the last 12-months for PD. The predicted probability of having PD decreased with age for life-abstainer or occasional drinkers, whereas the probability increased with older ages for frequent drinkers. LimitationsLow prevalence of PA and PD resulted in large confidence intervals whereas self-reports could be affected by recall bias. ConclusionsOverall, our results suggest that the probability of having PA and PD decreases as people age and that the significant risk factors are independent of age. However, older adults with a frequent drink pattern seem to be at higher risk of PD. Future longitudinal studies are needed to determine the trajectories of PD and alcohol consumption over the lifespan.

Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study.

Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence.Method: We searched PubMed to access relevant articles published until September 2015, using the keywords “Bipolar disorder” or “Affective Psychosis” or “manic depressive” separately with “generalized anxiety,” “panic disorder,” “social phobia,” “obsessive compulsive,” and “anxiety.” Variables for associated features and prevalence of anxiety disorders were carefully extracted.Results: Lifetime any anxiety disorder comorbidity in BD was 40.5%; panic disorder (PD) 18.1%, generalized anxiety disorder (GAD) 13.3%, social anxiety disorder (SAD) 13.5% and obsessive compulsive disorder (OCD) 9.7%. Current any anxiety disorder comorbidity in BD is 38.2%; GAD is 15.2%, PD 13.3%, SAD 11.7%, and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38% and 34%, PD was 15% and 15%, GAD was 14% and 16.6%, SAD was 8% and 13%, OCD was 8% and 10%, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31% and 37%, PD was 9% and 13%, GAD was 8% and 12%, SAD was 7% and 11%, and OCD was 8% and 7%, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD–SAD comorbidity. History of psychotic features significantly affected current PD and GAD.Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.

Accuracy of the of the PROMIS-57 questionnaire to identify significant depressive and anxiety symptoms among patients on hemodialysis

The prevalence of panic disorder (PD) reportedly is up to fivefold higher in people with tinnitus than it is in the general population. The brain networks in the two conditions overlap but the pathophysiological link remains unclear. In this study the electrophysiological brain activity is investigated in adults with non-pulsatile tinnitus with and without concurrent PD.Resting-state EEGs of 16 participants with non-pulsatile tinnitus and PD were compared with those of 16 peers with non-pulsatile tinnitus without PD and as many healthy controls. The sLORETA technique was used to identify group-specific electrophysiological frequencies in the brain and to approximate the brain regions where differences occurred. The influence of distress was investigated and functional connectivity charted using the Region-of-Interest (ROI) approach (amygdala, anterior cingulate cortex (ACC), insula, precuneus).The comorbid group showed significantly diminished theta activity (p < 0.05) in the precuneus (BA7) compared to the tinnitus group without PD as well as in another region of the precuneus (BA31) as compared to the controls. Higher levels of distress influenced results in the tinnitus group without PD, while in those with PD a diminished connectivity was observed between the dorsal ACC and the other three ROIs as contrasted to the controls.Adults with non-pulsatile tinnitus and concurrent PD show differential brain activity patterns to tinnitus only sufferers and healthy controls. Higher levels of distress may modulate brain activity in the absence of PD. Screening for distress is recommended in both clinical and research settings.

Non-cardiac chest pain: a 2018 update.

Non-cardiac chest pain (NCCP) is defined as recurring, angina-like, chest pain of non-cardiac origin. Studies have estimated that gastroesophageal reflux disease (GERD) is the most common contributing factor for NCCP. In patients with non-GERD related NCCP, esophageal motility disorders, and functional chest pain of presumed esophageal origin are the main underlying mechanisms for symptoms. Epidemiologic studies show a high prevalence of panic disorder, anxiety and major depression in NCCP patients. The diagnostic esophageal workup starts only after that cardiac and pulmonary diseases have been ruled out. NCCP patients with typical reflux symptoms are more likely to have GERD-related NCCP than those without typical reflux symptoms. High-dose proton pump inhibitor trial (PPI test) can be used to confirm the diagnosis of GERD-related NCCP. Negative upper endoscopy is quite common. For patients unresponsive to antireflux treatment and with negative endoscopy, impedance-pH monitoring should be done. Treatment of patients with non-GERD-related NCCP has focused on esophageal (hypercontractile or spastic) motility disorders and esophageal visceral hypersensitivity. In the first case, several trials using calcium channel blockers, nitrates, anticholinergics, or botulinum toxin injection and recent trials with endoscopic myotomy have been conducted. In case of visceral hypersensitivity, studies found that the amelioration, when compared to placebo, was significant with venlafaxine, sertraline, and imipramine. In this context, also cognitive behavioral therapy has been proposed.

Differential electrophysiological correlates of panic disorder in non-pulsatile tinnitus

AimsThe prevalence of panic disorder (PD) reportedly is up to fivefold higher in people with tinnitus than it is in the general population. The brain networks in the two conditions overlap but the pathophysiological link remains unclear. In this study the electrophysiological brain activity is investigated in adults with non-pulsatile tinnitus with and without concurrent PD. MethodsResting-state EEGs of 16 participants with non-pulsatile tinnitus and PD were compared with those of 16 peers with non-pulsatile tinnitus without PD and as many healthy controls. The sLORETA technique was used to identify group-specific electrophysiological frequencies in the brain and to approximate the brain regions where differences occurred. The influence of distress was investigated and functional connectivity charted using the Region-of-Interest (ROI) approach (amygdala, anterior cingulate cortex (ACC), insula, precuneus). ResultsThe comorbid group showed significantly diminished theta activity (p < 0.05) in the precuneus (BA7) compared to the tinnitus group without PD as well as in another region of the precuneus (BA31) as compared to the controls. Higher levels of distress influenced results in the tinnitus group without PD, while in those with PD a diminished connectivity was observed between the dorsal ACC and the other three ROIs as contrasted to the controls. ConclusionsAdults with non-pulsatile tinnitus and concurrent PD show differential brain activity patterns to tinnitus only sufferers and healthy controls. Higher levels of distress may modulate brain activity in the absence of PD. Screening for distress is recommended in both clinical and research settings.

Haptoglobin Phenotype Among Arab Patients With Mental Disorders.

BackgroundDepression, schizophrenia and panic disorder are common mental disorders in the community and hospitalized patients. These mental disorders negatively affect life quality and even expectancy of life. Haptoglobin (Hp) phenotype (Hp 1-1, 1-2, or 2-2) is associated with risk for cardiovascular diseases, but its association with psychiatric disorders, a growing concern in the modern society, has not been studied thoroughly. The aim of the study was to examine whether Hp phenotype is associated with common mental disorders such as depression, schizophrenia, and panic disorder.MethodsThe study included 92 Arab patients with mental disorders, and among them 44 suffered from schizophrenia (mean age 39 ± 1.5 years), 17 from depression (mean age 44.5 ± 3.1 years), 31 from panic disorder (mean age of 44.9 ± 2.7 years), and 206 healthy Arab control subjects with a mean age of 42.6 ± 0.9 years. Beck’s depression inventory assessment and Hamilton depression scale were administered for depression and panic disorder diagnosis. Schizophrenia was evaluated with positive and negative affect schedule (Panas) test. All mental disorders were evaluated by clinical review. Blood analysis for Hp phenotype was performed. Diagnosis was made using the Diagnostic and Statistical Manual of Mental Disorders axis to correlate depression with Hp phenotype.ResultsIn mentally healthy controls, 10.7% were Hp 1-1, 38.8% Hp 2-1, and 50.5% Hp 2-2. In patients with the studied psychiatric disorders, Hp phenotype was comparable to healthy subjects; 8.7% were Hp 1-1, 50% Hp 2-1, and 41.3% Hp 2-2. When Hp phenotyping was analyzed in the psychiatric subgroups, Hp 2-1 was more common among depressed and schizophrenic patients, as compared with healthy subjects (58.8% and 52.3% vs. 38.8%). In patients who suffer from panic disorder, Hp phenotype distribution was 6.5% Hp 1-1, 41.9% Hp 2-1, and 51.6% Hp 2-2, suggesting a lower prevalence among Hp 1-1 phenotype.ConclusionsArab patients who carry Hp 2-1 phenotype may be at risk to develop depression or schizophrenia more than the general healthy population. In contrast, Hp 1-1 subjects have a lower prevalence of panic disorder.

Neonatal maternal separation opposes the facilitatory effect of castration on the respiratory response to hypercapnia of the adult male rat: Evidence for the involvement of the medial amygdala.

Respiratory manifestations of panic disorder (PD) include a greater respiratory instability and enhanced responsiveness to CO2 compared to normal individuals. Although the prevalence of PD is approximately three times greater in women compared to men, the origins of this sexual dimorphism remain poorly understood. Similar to PD patients, adult female rats previously subjected to neonatal maternal separation (NMS) show an increase in their ventilatory response to CO2 . Because this effect of NMS is not observed in males, we hypothesised that testosterone prevents NMS-induced hyper-responsiveness to CO2 . Pups subjected to NMS were placed in an incubator for 3hd-1 from postnatal days 3-12. Control pups remained undisturbed. At adulthood (8-10weeks of age), rats were then subjected either to sham surgery or castration. Fourteen days later, breathing was measured at rest (room air) and during acute exposure to hypercapnia (5 and 10% CO2 for 10minutes each) using plethysmography. To gain insight into the mechanisms involved, c-fos expression was used as an indicator of neuronal activation. Brains were collected following air or CO2 exposure for quantification of c-fos positive cells by immunohistochemistry in selected regions, including the paraventricular nucleus of the hypothalamus, the dorsomedial hypothalamus and the amygdalar complex. Castration produced a 100% increase of hyperventilatory response to 10% CO2 in control rats. Unexpectedly, castration had no effect on the hyperventilatory response of NMS rats. The intensity of the hypercapnic response was inversely correlated with c-fos expression in the medial amygdala. We conclude that testosterone prevents the hyper-responsiveness to CO2 , whereas NMS attenuates sensitivity to hormone withdrawal. We propose that an inhibitory influence from the medial amygdala contributes to this effect.

E.03.02 - Hoarding disorder: update on neurobiology, diagnosis and treatment

Compared to studies in adults, there have been few studies of hoarding in children and adolescents with obsessive–compulsive disorder (OCD). In the current study, we evaluated OCD clinical features, Axis I disorders, and social reciprocity scores in 641 children and adolescents with OCD, of whom 163 (25%) had hoarding compulsions and 478 did not. We found that, as a group, youth with hoarding had an earlier age at onset and more severe lifetime OCD symptoms, poorer insight, more difficulty making decisions and completing tasks, and more overall impairment. The hoarding group also had a greater lifetime prevalence of panic disorder, specific phobia, Tourette disorder, and tics. As measured with the Social Reciprocity Scale, the hoarding group had more severe deficits in parent-rated domains of social communication, social motivation, and restricted interests and repetitive behavior. In a multivariable model, the overall social reciprocity score, age at onset of OCD symptoms, symmetry obsessions, and indecision were independently related to hoarding in these children and adolescents with OCD. These features should be considered as candidate risk factors for the development of hoarding behavior in pediatric OCD.

Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms

Patients with panic disorder experience symptoms such as palpitations, chest pain, dizziness, and breathlessness. Consequently, they may attend the Emergency Department (ED) to be assessed for possible emergency medical conditions. Recognition of panic disorder within the ED is low. We sought to establish the prevalence of panic disorder in patients presenting for ED investigation of potential acute coronary syndrome. We also sought to characterise the cohort of patients with panic disorder in terms of presenting symptoms, risk factors, medical history and major adverse cardiac events (MACE). This was an observational study of 338 adult patients presenting to the Emergency Department of a tertiary hospital in Australia. Research nurses collected clinical data using a customised case report form. The outcome was panic disorder, assessed using the Mini International Neuropsychiatric Interview. The average age of participants was 50.2 years and 37.9% were female. Thirty-day MACE occurred in 7.7% of the cohort. The clinical diagnosis of panic disorder was made in 5.6% (95% CI: 3.4-8.6%) of patients. Compared to patients without panic disorder, patients with panic disorder were slightly more likely to report that their pain felt heavy (48.9% and 73.7% respectively, p=0.04). All other reported symptoms were similar in the two groups. The prevalence of panic disorder was low in patients presenting to an Australian ED with chest pain. Clinical signs or symptoms that are routinely collected as part of the chest pain workup cannot be used to distinguish patients with and without panic disorder.

The effect of Korean-group cognitive behavioural therapy among patients with panic disorder in clinic settings.

Introduction In panic disorder, sensitivity to bodily sensations increases due to the patient's cognitive vulnerability. Cognitive behavioural therapy (CBT) can help to decrease sensitivity to bodily sensations by correcting these cognitive distortions by controlling negative thoughts and panic attacks. Aims This study verified whether group CBT is more effective than treatment as usual (TAU) in South Korean patients with panic disorder. Methods The study participants consisted of 76 panic disorder patients. Patients in the therapy condition attended sessions once a week for a total of 12 sessions in addition to drug treatment. Results In the therapy condition, there were significant decreases in panic-related bodily sensations and ranking and belief scores for catastrophic misinterpretation of external events. Discussion Group CBT, in comparison to TAU, decreases panic and agoraphobia symptom severity in South Korean patients with panic disorder. Our study provides evidence for the effectiveness of a panic disorder management programme that integrates group CBT and traditional pharmacotherapeutic treatment for patients with panic disorder. Implications for Practice The cognitive behavioural approach is needed to reduce panic and agoraphobia symptoms for hospitalized patients with panic disorder more than activity therapies, medications and supportive counselling by doctors and nurses.

Sex- and Subtype-Related Differences in the Comorbidity of Adult ADHDs

Objective: Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size. Method: A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences. Results: Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. Conclusion: Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences.

Prevalence of comorbid anxiety disorders in schizophrenia.

Background:Diagnostic and treatment hierarchical reductionisms have resulted in an oversight of anxiety syndromes in schizophrenia.Aim:The aim of this study was to find the prevalence of different anxiety disorders in schizophrenia patients.Materials and Methods:The study was conducted on inpatients of a tertiary care psychiatric hospital using a prospective, purposive sampling technique. The study consisted of 93 schizophrenia patients and a similar number of normal controls. The schizophrenia patients and controls were evaluated for psychopathology and the presence of anxiety disorder.Results:The prevalence of anxiety disorder was significantly higher in schizophrenia patients (45.16%) compared to controls (16.12%). Further, the prevalence of panic disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD) was significantly higher in schizophrenia patients. No significant correlation was observed between anxiety disorder scores and psychopathology scores.Conclusions:The prevalence of comorbid anxiety disorders (panic disorder, social anxiety disorder, and OCD) in schizophrenia is significantly higher in the general population. The onset of anxiety disorder commonly precedes the onset of schizophrenia.

Testosterone Increase Hypercapnic Ventilatory Response of Adult Male Rats Subjected to Panic Attack Model

Panic attacks occur when the brain wrongly detects a lack of air triggering a false suffocation alarm system. Panic disorder (PD) patients exhibit greater CO2 chemo-sensitivity and an increasedventilatory response to CO2 compared to normal individuals. Interestingly, the prevalence of PD is ~3 times greater in women than men. Neonatal Maternal Separation (NMS) is a form of stress that disrupts respiratory control development in a sex-specific fashion. We showed that NMS augments the ventilatory response to CO2 in females but not males. These results brought us to propose that testosterone prevents NMS-induced enhancement of the ventilatory response to CO2. Pups subjected to NMS were placed in an incubator for 3 h/day from postnatal day 3 to 12. Control pups remained undisturbed. Rats were reared until adulthood, and the ventilatory response to CO2 was measured by whole-body plethysmography (FICO2 = 0.10, for 10 min). We used gonadectomy to evaluate the effects of reducing testosterone on the hypercapnic response. By comparison with sham-operated animals, gonadectomy augmented the hypercapnic ventilatory response of control rats; an opposite (albeit modest) effect was observed in NMS rats. While these results do not support our initial hypothesis, they highlight the importance of testosterone in regulating the CO2-related respiratory drive in normal rats. Further experiments (hormone measurements) will help elucidate the mechanisms underlying the sexual dimorphism of stress-related respiratory disorder such as PD. Supported by: Canadian Institutes of Health Research.

The attributable burden of panic disorder in the impairment of quality of life in a national survey in Italy

The aim was to measure the lifetime prevalence of panic disorder (PD) in an Italian community sample, and to estimate the burden attributable to PD in compromising the quality of life (QoL) of people diagnosed with it. Community survey was conducted on a sample of 4,999 randomly selected adult subjects. Instruments used were semi-structured clinical interview Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians and allowing diagnosis according to Diagnostic and Statistical Manual of Mental Disorder (4th ed.; DSM-IV); Short Form Health Survey (SF-12). The lifetime prevalence of PD was 3.6% (4.4% in females, 2.5% in males; p = .002). People with PD had a lower SF-12 score than the standardized community sample (35.5 ± 6.5 vs. 38.4 ± 5.9; p < .0001) with a mean difference (attributable burden) of 2.9 ± 0.7, that is, lower than PD with agoraphobia (AP; 4.2 ± 2.4). Wilson Disease (WD), Multiple Sclerosis, Major Depressive Disorder and Eating Disorders (ED) show a higher attributable burden in impaired QoL than PD, while the attributable burden of PD with AP is not lower than in ED and WD. The burden attributable to the impairment of QoL following a lifetime diagnosis of PD was found to be not so great compared to the impairment caused by Major Depressive Disorder (MDD) or neurological conditions. The comorbidity of PD with AP worsens QoL significantly.

Schizophrenia and Panic Disorder

Introduction Patients with schizophrenia mightexperience panic attacks and meet the criteria for both schizophrenia and panicdisorder. Classification of mental disorders with hierarchical approach givesschizophrenia the first position before the panic disorder. The panic attacksmight not be well recognized and adequately treated. The aim of this study isto determine the prevalence of panic disorder in schizophrenic patients, torecognise the impact of comorbidity on the clinical picture and the course ofthe disease, and to determine the appropriate/possible treatment. Method The articles were identified by the keywords “schizophrenia” and “panic disorder”, or “agoraphobia”, using the Medline and Web of Science search. Additional sources were obtained by studying the references of summaries ofimportant articles. Results The prevalence of comorbid panic disorder inpatients with schizophrenia ranges from 16% to 63%, but the results are notconsistent. Etiopathogentical hypothesis of schizophrenia and panic disorderand also the concept of panic psychosis are discussed. There is a limitedbiological evidence to support those hypotheses. Data suggest that patientswith schizophrenia and panic disorder exhibit higher rates of depression, suicidal ideation and increased extrapyramidal side effects. Panic comorbiditymay worsen severity of positive and negative symptoms of schizophrenia and theoverall quality of life. Conclusion Panic disorder and schizophreniaoften occurs comorbid. It is found most commonly in patients with paranoidsubtype. Comorbid panic disorder may worsen positive symptoms and lead todepressive symptoms. It negatively affects the quality of life and add up tohigher level of suicidality. The pharmacotherapy with atypical antipsychoticsis preferred, or their combination with clonazepam or alprazolam.