Phenomenology and epidemiology of panic disorder

University of Oklahoma College of Medicine, Tulsa, OK, USA.
Annals of Clinical Psychiatry (Impact Factor: 2.36). 05/2009; 21(2):95-102.
Source: PubMed


BACKGROUND: Panic disorder is a common and severe psychiatric disorder. The estimated current prevalence rate for panic disorder is 1% to 2% of the adult population. Panic disorder is commonly accompanied by major depression, substance use disorders, and other anxiety disorders. Female gender, low socioeconomic status, and anxious childhood temperament are common risk factors for panic disorder. Panic disorder can produce marked distress and impairment and is associated with significant suicide risk. Panic disorder appears to increase risk for all-cause mortality because it may increase risk for cardiovascular disease.

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    • "Most of the studies were conducted in research centers with a selected clientele, such that comorbid disorders, very severe conditions, and concomitant medication were mostly excluded or characterized a non-representative proportion of subjects. Epidemiological studies have shown that comorbidity with other mental disorders is very common in panic disorder [Yates, 2009]. With a diagnosis of panic disorder, there is an 83.1% risk (lifetime prevalence) that an additional comorbid mental disorder will be diagnosed according to DSM-IV [Kessler et al., 2006]. "
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    ABSTRACT: ZusammenfassungHintergrund: Eine beeindruckende Vielzahl an Therapiestudien belegt inzwischen die Effektivität kognitiver Verhaltenstherapie in der Behandlung von Panikstörungen. Die Behandlungsprogramme setzen sich meist aus psychoedukativen, kognitiven und behavioralen (Exposition) Therapieelementen zusammen. Der Anteil von Expositionsübungen innerhalb der untersuchten Programme variiert stark. Bisher ist unklar, welchen Nutzen Expositionsphasen in einer effizienten Behandlung bringen und wie zeitintensiv diese sein sollen. In dieser Untersuchung wird der Therapieerfolg eines kognitiv-verhaltenstherapeutischen Gruppenprogramms überprüft, insbesondere, ob eine Erhöhung des Anteils an Expositionsübungen zusätzliche Therapieeffekte bringt. Methode: Verglichen wurden 2 Patientengruppen mit Panikstörungen. Beide Gruppen nahmen an einem stationären Gruppentherapieprogramm zur Angstbehandlung teil, das ein Expositionstraining beinhaltete. Für die 1. Behandlungsgruppe (n = 81) erfolgte ein Expositionstraining von einem Tag therapeutenbegleiteter Exposition, für die 2. Gruppe (n = 88) wurde die Expositionszeit verlängert und es erfolgten 2 Tage Exposition. Der Verlauf symptomspezifischer Variablen (Vermeidungsverhalten, ängstliche Bewertungen), depressiver Symptome und psychosozialer Beeinträchtigung wurde vor der Therapie, zu Therapiebeginn und -ende sowie in einer Katamnese (1 Jahr) erhoben. Ergebnisse: In beiden Gruppen zeigten sich signifikante Symptomreduktionen bei Abschluss der Therapie für die störungsspezifischen Selbsteinschätzungsverfahren (Zeiteffekt MANOVA mit Messwiederholung; p < 0,001). Beide Behandlungsgruppen sprachen in gleichem Ausmaß auf die Therapie an, in der Gruppe mit der verlängerten Exposition waren die erzielten Erfolge zum Katamnesezeitpunkt (1 Jahr) jedoch größer (signifikante Interaktionen Zeit × Behandlungsgruppe; p < 0,001). Schlussfolgerung: Die Ergebnisse unterstützen die bisherige Praxis der Kombination kognitiver und verhaltenstherapeutischer Interventionsstrategien, wobei sie die Wirksamkeit der verhaltensorientierten Therapieelemente unterstreichen. Sie sprechen dafür, dass sich der erhöhte Expositionsaufwand lohnt und sich der Therapieerfolg bei Panikstörung durch eine Verlängerung der Expositionszeit verbessern lässt.Copyright © 2012 S. Karger AG, Basel
    Verhaltenstherapie 01/2012; 22:95-105. DOI:10.1159/000339136 · 0.48 Impact Factor
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    • "Anxiety disorders are prevalent diagnoses and are associated with substantial life impairments (Roy-Byrne & Cowley, 1994 ; Bruce et al. 2005 ; Grant et al. 2005 ; Boden et al. 2007 ; Weisberg, 2009 ; Yates, 2009). Prospective studies on the course of anxiety disorders suggest a chronic burden, with low rates of recovery that appear to be worsened by certain co-morbid psychiatric conditions (Bowen et al. 2000 ; Yonkers et al. 2003 ; Bruce et al. 2005). "
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    ABSTRACT: This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs. Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia. Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia. Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.
    Psychological Medicine 05/2011; 41(5):1019-28. DOI:10.1017/S0033291710001777 · 5.94 Impact Factor
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    ABSTRACT: Depression is associated with an inter-hemispheric imbalance; a hyperactive right-hemisphere (RH) and a relatively hypoactive left-hemisphere (LH). Nevertheless, the underlying mechanisms which can explain why depression is associated with a RH dominance remain elusive. This article points out the potential links between functional cerebral asymmetries and specific symptoms and features of depression. There is evidence that the RH is selectively involved in processing negative emotions, pessimistic thoughts and unconstructive thinking styles--all which comprise the cognitive phenomenology of depression and in turn contribute to the elevated anxiety, stress and pain associated with the illness. Additionally, the RH mediates vigilance and arousal which may explain the sleep disturbances often reported in depression. The RH had also been linked with self-reflection, accounting for the tendency of depressed individuals to withdraw from their external environments and focus attention inward. Physiologically, RH activation is associated with hyprecortisolemia, which contributes to the deterioration of the immune system functioning and puts depressed patients at a greater risk of developing other illnesses, accounting for depression's high comorbidity with other diseases. Conversely, the LH is specifically involved in processing pleasurable experiences, and its relative attenuation is in line with the symptoms of anhedonia that characterize depression. The LH is also relatively more involved in decision-making processes, accounting for the indecisiveness that is often accompanied with depression.
    Neuroscience Research 10/2010; 68(2):77-87. DOI:10.1016/j.neures.2010.06.013 · 1.94 Impact Factor
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