Lively controversies related to panic disorder are under active investigation by research groups around the world. However, publications from different laboratories are difficult to compare since there has been little consistency in measures or even in types of assessment used to characterize and follow up patients. Participants in the recently convened National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder noted this problem and recommended establishment of procedures to ensure comparability of studies. We organized a conference of clinical investigators whose objective was to develop a standard assessment package. Participants represented biological and psychosocial panic disorder treatment research sites in the United States and Canada. The 2-day conference resulted in agreement on a battery of assessments considered essential for panic disorder studies. The purposes of our report are to disseminate the conference conclusions and to encourage adoption of the proposed standards by clinical researchers, journal editors, Public Health Service peer review committees, and the Food and Drug Administration. We also identify some problematic issues that require further work.
"The BAI has demonstrated good psychometric qualities (Beck & Steer, 1984; Steer, Ranieri, Beck, & Clark, 1993). Furthermore, it has been recommended as a measure of anxiety in psychotherapy research (Crits-Cristoph & Conelly, 1997) and as a measure of anxiety in panic disorder (Shear & Maser, 1994). Cronbach's a for the BAI in the study was .91. "
[Show abstract][Hide abstract] ABSTRACT: The efficacy of cognitive behavioural therapy (CBT) for panic disorder with or without agoraphobia (PD) is well-established; however, little is known about the underlying change processes of clinical improvement during therapy. According to cognitive theories, CBT for PD primarily works by changing catastrophic misinterpretations of bodily symptoms and panic attacks. However, panic self-efficacy, i.e. the perceived ability to cope with panic attacks, has also been suggested as an important change mechanism in CBT for PD. The aim of the study was to investigate if change in catastrophic misinterpretations and panic self-efficacy mediated change in the level of anxiety during the course of thirteen sessions of group CBT for PD. Forty-five participants completed weekly self-report measures of the possible cognitive mediators and the level of anxiety throughout therapy. The results indicated that within-person change in panic self-efficacy in one session, but not in catastrophic misinterpretations, predicted within-person level of anxiety symptoms the following week. However, in a reversed analysis, prior change in level of anxiety symptoms also predicted change in panic self-efficacy the following session. These results support panic self-efficacy as a mediator of change in CBT for PD, although a reciprocal causal relationship between panic self-efficacy and level of anxiety seems to be implied.
Behaviour Research and Therapy 06/2013; 51(9):579-587. DOI:10.1016/j.brat.2013.06.002 · 3.85 Impact Factor
"Currently, selective serotonin-reuptake inhibitors (SSRIs) are indicated as the first-line treatment for PD. SSRIs are relatively safe and have few side effects.10) Escitalopram is the most recently developed SSRI and is used widely for the treatment of patients with PD. "
[Show abstract][Hide abstract] ABSTRACT: Panic disorder is characterized by recurrent panic attacks, persistent concerns about additional attacks, and worry about the implications of the attack or significant changes in behavior related to the attacks. We examined the efficacy of 24-week naturalistic, open-label escitalopram treatment in terms of the response and remission rates and functional disability in 119 adult Korean patients with panic disorder from 6 clinical centers in South Korea.
Clinical severity and functional impairment were assessed at baseline and at 4, 12, and 24 weeks after the treatment using the Panic Disorder Severity Scale and Sheehan Disability Scale. Ninety-six patients (80.7%) showed a treatment response, and 87 patients (73.1%) had attained remission after 24 weeks of escitalopram treatment.
Continuous improvement in the Panic Disorder Severity Scale and Sheehan Disability Scale scores was found over the 24 weeks of treatment.
These findings suggest that escitalopram treatment is very effective for panic disorder in terms of both response and remission rates and that long-term pharmacotherapy with escitalopram continuously improved panic symptoms and functional disability in Korean patients with panic disorder.
Clinical Psychopharmacology and Neuroscience 04/2012; 10(1):44-8. DOI:10.9758/cpn.2012.10.1.44
"Even assuming that there were subjects at baseline with mental symptoms, but not yet treated with antidepressant, or with prescriptions before 1997, while it is possible that these subjects have decreased their exposure to psychological stressors in a differential way compared to non-cases because of their symptoms, this would have led to an underestimation of the risk of depressive symptoms. Anxiety is complex construct, for which there is agreement that a valid diagnostic assessment should be based on semistructured clinical interviews, such as the Anxiety Disorders Interview Schedule or the Structured Clinical Interview for DSM-IV (Shear and Maser 1994; Summerfeldt and Antony 2002). Use of these tools is, however, very time-consuming, since almost 2 h are needed to administer this kind of interviews, so that they are not commonly used in epidemiological research. "
[Show abstract][Hide abstract] ABSTRACT: The main aim of this study was to examine prospectively the relationship between antidepressant prescriptions (ADP), as a proxy of depressive symptoms, and work-related stress, measured according to the demand-control model.
A cohort of 2,046 union workers who participated in a survey on working conditions and health in 1999-2000 was followed up to 2005, through the Regional Drug Prescription Register, for an ADP. The relative risks associated with demand, control and job strain were estimated using Poisson regression, adjusting for age, sex and other workplace factors (shift work, overtime, loud noise and psychological violence).
In final multivariable models, high demand significantly increased the risk of depressive symptoms among blue collars (RR = 1.82), whereas among white collars, it was significantly protective (RR = 0.38). No significant relationship was found for job control or strain in either occupational class.
The direct association observed elsewhere among blue collars between depressive symptoms and demand was confirmed, but not for job control or job strain. It cannot be ruled out that the association with demand was at least in part determined by reverse causation, due to exposure over-reporting among subjects with subclinical depressive symptoms at baseline. The protective effect of demand among white collars is not consistent with the literature and may be attributable to the particular characteristics of this sample, which included mainly workers employed in public administrative positions.
International Archives of Occupational and Environmental Health 10/2010; 84(4):413-24. DOI:10.1007/s00420-010-0586-3 · 2.20 Impact Factor
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