Asthma and panic disorder

Claustrophobia and Adherence to CPAP Treatment

This study evaluated the effect of claustrophobia, an abnormal dread or fear of closed spaces, on adherence to continuous positive airway pressure (CPAP) therapy. The design was a secondary analysis of data from a prospective study of participants (N = 153) that completed 3 months of CPAP therapy from seven sleep disorders centers in the United States and Canada. A 15-item subscale adapted from the Fear and Avoidance Scale measured claustrophobic tendencies pre-CPAP treatment and again after 3 months. An overt monitor attached to the CPAP machines recorded mask-on CPAP adherence. There was a statistically significant difference in claustrophobia scores by adherence group (< 2 hours, 2 to < 5 hours, ≥ 5 hours) and time period (pre-CPAP and after 3 months CPAP). Poor CPAP adherence (< 2 hours per night)was more than two times higher in participants with a claustrophobia score ≥ 25. Identification of persons with increased claustrophobia tendencies and targeted interventions may increase adherence.

Psychiatric comorbidities in Asian adolescent asthma patients and the contributions of neuroticism and perceived stress

PURPOSE

Psychiatric comorbidity is reported to be common among adolescents with asthma, but little is known about its underlying psychological factors.

OBJECTIVE

This study explored the profile of anxiety and depressive comorbidities among adolescents with well-controlled and poorly controlled asthma and the contribution of neuroticism and perceived stress.

METHODS

The Revised Child Anxiety and Depression Scale, Neuroticism subscale of Big Five Inventory, Perceived Stress Scale, and Asthma Control Test were administered to 198 adolescents (aged 12-19 years) with well-controlled (n = 137) and poorly controlled asthma (n = 61) as well as 171 healthy neighborhood controls.

RESULTS

Adolescents with poorly controlled asthma, compared with well-controlled asthma patients and healthy controls, had higher scores of depression (p = .006), panic attacks (p = .002), total anxiety (p = .038), and total internalizing symptoms (p = .017), after adjusting for gender, age, ethnicity, smoking status, and family housing type. Adolescents with asthma had higher neuroticism (p = .025), perceived stress (p = .022), and body mass index (p = .006) and lower self-rated health (p < .001) than healthy controls. No significant differences in psychiatric comorbidity scores were observed after accounting for differences in underlying psychological and physical factors. Among asthma patients, increased asthma control was associated with decreased scores of psychiatric comorbidity (p < .01), but the association was not significant after allowing for decreased neuroticism and perceived stress.

CONCLUSIONS

The diagnosis of asthma and poor asthma control in adolescents is associated with excess psychiatric comorbidity, which is likely due to increased neuroticism and perceived stress.

Interaction of asthmatics and their spouses: A preliminary study of individual differences

Some asthmatics show evidence of airways reactivity triggered by strong emotions. Six case studies of married patients with severe asthma are reported. The videotaped interactions of the asthmatic and his/her spouse were coded for affect and behavior. Repeated measures of pulmonary function and affective state were recorded before and after two interaction tasks. Over the course of the experimental period, two patients' pulmonary function improved and four patients' deteriorated. In general, decreased pulmonary function was associated with more self-rated hostility and depression. The results are discussed in terms of their implications for the intra- and interpersonal factors that are important in asthma management.

Role of chiropractic and sacro-occipital technique in asthma treatment

Asthma is a multifactorial dysfunction of the respiratory system. Nutritional, environmental, genetic, and emotional factors all play animportant part in the etiology of this condition. One form of chiropractic, Sacro Occipital Technique (SOT), offers some conservative alternatives to the treatment of asthma. SOT expands the chiropractic armamentarium of techniques available, allowing methods putatively affecting the viscera, vertebra, post and preganglionic reflexes, as well as cranial and sacral influences on the primary respiratory mechanism. Though more research is needed to evaluate the efficacy of chiropractic care of asthma, the conservative nature of chiropractic care with its minimal side effects, warrants patient and a health practitioner's consideration prior to embarking on any course of treatment that might have serious side effects.

The role of panic-fear in comorbid asthma and panic disorder

We examined mediational models of panic-fear, panic disorder (PD), and asthma outcomes among adult asthma patients. PD was assessed by the Anxiety Disorders Interview Schedule. Twenty-one asthma-PD patients and 27 asthma-only patients completed spirometry and questionnaires. Asthma-PD patients reported greater illness-specific and generalized panic-fear than asthma-only patients, despite no differences in asthma severity or physical symptoms during asthma attacks. Illness-specific panic-fear mediated the relationship between PD and poorer health-related quality of life, including emotional disturbance due to asthma. Illness-specific panic-fear was associated with more primary care office visits for asthma. Asthma-PD patients reported greater irritability during asthma attacks than asthma-only patients. Generalized panic-fear was directly associated with restriction of activities due to asthma and use of rescue medication for asthma. Neither measure of panic-fear was associated with asthma severity. Panic-fear experienced during asthma attacks may be an important area to target for improving health-related quality of life among asthma-PD patients.

Psychological treatment of comorbid asthma and panic disorder: a pilot study

We evaluated two protocols for treating adults with comorbid asthma and panic disorder. The protocols included elements of Barlow's panic control therapy and elements of Barlow's "panic control therapy" and several asthma education programs, as well as modules designed to teach participants how to differentiate asthma and panic symptoms, and how to apply specific home management strategies for each. Fifty percent of subjects dropped out of a 14-session protocol by the eighth session; however, 83% of patients were retained in an eight-session protocol. Clinical results were mostly equivalent: significant decreases of >50% in panic symptoms, clinically significant decreases in asthma symptoms, improvement in asthma quality of life, and maintenance of clinical stability in asthma. Albuterol use decreased significantly in the 14-session protocol and at a borderline level I the 8-session protocol, while pulmonary function was maintained. A controlled evaluation of this procedure is warranted.

Symptom Clusters

The purpose of this article is to analyze the concept of symptom clusters and to discuss its application to cancer nursing to promote communication and enhance scientific knowledge. Rodgers' evolutionary method of concept analysis served as the framework for reviewing literature from psychology/psychiatry, general medicine, and nursing. Attributes of symptom clusters were relationships of symptoms and relationships of clusters, concurrence, underlying dimensions, stability, and common etiology. The major antecedent was the presence of 2 or more symptoms. Consequences were poorer physical health status, interference with activities of daily living, emotional distress, and increased financial burden. A symptom cluster is defined as consisting of 2 or more symptoms that are related to each other and that occur together. Symptom clusters are composed of stable groups of symptoms, are relatively independent of other clusters, and may reveal specific underlying dimensions of symptoms. Relationships among symptoms within a cluster should be stronger than relationships among symptoms across different clusters. Symptoms in a cluster may or may not share the same etiology. Symptom should be broadened to include both subjective (self-reported) symptoms and objective (observed) signs. Implications for researchers include the need to use a clear definition, determine the optimal methods of identifying etiology and nature of symptom clusters in various populations, assess the clinical utility of symptom clusters, and test interventions. Implications for practitioners include the need to comprehensively assess symptoms over the entire cancer trajectory, select interventions that target single and multiple symptoms, and evaluate outcomes that include quality of life and economic variables.

Cognitive-behavioral treatment combined with asthma education for adults with asthma and coexisting panic disorder

This study tested the efficacy of a nurse-administered 8-week group treatment program for adults with asthma suffering from coexisting panic disorder. The program consisted of cognitive behavioral treatment (CBT) for panic disorder combined with asthma education (AE). Forty-eight women with a confirmed diagnosis of asthma and panic disorder were randomly allocated to a treatment condition (n=25) and a wait-list control condition (n=23). Twenty-five participants--15 in the treatment group and 10 in the wait-list control group--completed treatment. Repeated measures ANOVA procedures were used to compare the groups on panic and asthma outcomes at posttreatment and 6-month follow-up. The results demonstrate that the CBT-AE program is capable of producing substantial and durable antipanic and antianxiety treatment effects and led to substantial but nonsustained improvement in morning peak-flow expiratory rate and asthma-related quality of life. Implications of these findings for this clinical population are addressed.

Psychological aspects of asthma

Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures.

Panic disorder and asthma

The presence of asthma is a risk factor for the development of panic disorder. The co-occurrence of panic disorder and asthma is greater than would be expected based on their individual prevalence rates. This may be due in part to the important role of respiratory factors in panic disorder. Panic and anxiety can directly exacerbate asthma symptoms through hyperventilation, and are associated with patients' overuse of as-needed asthma medications, with more frequent hospital admissions and longer hospital stays, and with more frequent steroid treatment, all of which are independent of degree of objective pulmonary impairment. This paper reviews the literature on the relationship between panic and anxiety on the one hand, and the experience and management of asthma on the other.

Postpartum onset of panic disorder

PURPOSE

To describe the experience of panic disorder in mothers during the postpartum period. The onset of panic disorder during the postpartum period has recently been reported. Clinicians are urged to differentiate between the more widely known presentation of postpartum depression and the newly reported postpartum panic disorder.

DESIGN

Phenomenology. The purposive sample consisted of six women with panic disorder during the postpartum period.

METHODS

In 1995, mothers were interviewed regarding their experiences with panic. The verbatim transcripts of these interviews were analyzed using Colaizzi's phenomenological method. In all, 214 statements regarding mothers' experiences of panic were extracted and clustered into six themes.

FINDINGS

Panic during the postpartum period seriously complicated mothers' lives as they struggled to maintain their composure during panic attacks. As a result of recurring panic attacks, negative changes in women's lifestyles ensued stripping them of their self-esteem and leaving them to bear the burden of disappointing not only themselves, but also their families.

CLINICAL IMPLICATIONS

Implications for nursing practice with mothers suffering from postpartum onset of panic disorder can be derived from each one of the six themes. Nurses can help women identify panic triggers to help prevent further panic attacks. Also, nursing interventions can target the guilt mothers experience over repeatedly disappointing themselves and their families.