1
|
Gros DF, Pavlacic JM, Wray JM, Szafranski DD. Investigating Relations Between the Symptoms of Panic, Agoraphobia, and Suicidal Ideation: The Significance of Comorbid Depressive Symptoms in Veterans with Panic Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023; 45:1154-1162. [PMID: 38585157 PMCID: PMC10996580 DOI: 10.1007/s10862-023-10082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 04/09/2024]
Abstract
Although panic disorder has been frequently associated with increased suicidal ideation and behaviors, there are multiple explanations for this association in the literature. For example, some research has demonstrated panic disorder symptoms to mediate agoraphobia and suicidal ideation, while other researchers have hypothesized that comorbid depression symptoms contribute to suicidal ideation across anxiety disorders. Of note, none of these studies were completed in veterans, a population at higher risk for suicide relative to civilian samples. The present study investigated relations between the symptoms of panic, agoraphobia, depression, and suicidal ideation in 58 veterans diagnosed with panic disorder via correlations, hierarchical regression, and exploratory path analyses. Multiple models were investigated based on prior research. The final path model demonstrated that symptoms of panic disorder predicted agoraphobia symptoms, with agoraphobia predicting symptoms of depression. Symptoms of depression, then, predicted suicidal ideation. Discussion of the findings related to comorbid depressive symptoms highlight considerations for the assessment and treatment practices for panic disorder, with a particular focus on veterans receiving care within Veterans Affairs Healthcare System.
Collapse
Affiliation(s)
- Daniel F. Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, 109 Bee Street, 29401 Charleston, SC, USA
- Department of Psychology & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey M. Pavlacic
- Mental Health Service, Ralph H. Johnson VA Healthcare System, 109 Bee Street, 29401 Charleston, SC, USA
- Department of Psychology & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer M. Wray
- Mental Health Service, Ralph H. Johnson VA Healthcare System, 109 Bee Street, 29401 Charleston, SC, USA
- Department of Psychology & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
2
|
Karpov B, Lipsanen JO, Ritola V, Rosenström T, Saarni S, Pihlaja S, Stenberg JH, Laizane P, Joffe G. The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study. J Med Internet Res 2023; 25:e45362. [PMID: 37590055 PMCID: PMC10472172 DOI: 10.2196/45362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. OBJECTIVE We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. METHODS We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. RESULTS The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=-0.02; 95% CI -0.108 to -0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=-0.06; 95% CI -0.109 to -0.017; P=.007), Penn State Worry Questionnaire (F4270.8=-0.52; 95% CI -0.620 to -0.437; P<.001), and Social Phobia Inventory (F862.1=-0.39; 95% CI -0.596 to -0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. CONCLUSIONS OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice.
Collapse
Affiliation(s)
- Boris Karpov
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | | | - Ville Ritola
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Suoma Saarni
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Satu Pihlaja
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Grigori Joffe
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
3
|
Kopańska M, Dejnowicz-Velitchkov A, Bartman P, Szczygielski J. MiniQEEG and Neurofeedback in Diagnosis and Treatment of COVID-19-Related Panic Attacks: A Case Report. Brain Sci 2022; 12:1541. [PMID: 36421865 PMCID: PMC9688264 DOI: 10.3390/brainsci12111541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Both the global COVID-19 pandemic situation, as well as the current political situation in Eastern Europe may exacerbate anxiety and contribute to stress-related disorders such as panic disorder. Electroencephalography (EEG)-based neurofeedback provides both assessment of the subject's brainwave activity as well as the possibility of its therapeutic correction. It is possible that it can be implemented as an auxiliary treatment in panic disorders of different origin. The aim of this feasibility study was to demonstrate (both short- and long-term) effectiveness of neurofeedback therapy in a patient with previously diagnosed panic attacks, related to fear of COVID-19 infection. METHODS We report the case study of a 47-year-old man affected by panic attacks, related to his profound, constant fear of COVID-19 infection and its sequelae. For the initial diagnostic workup, several clinical and research tools were used: 1. Baseline psychological exam; 2. Anxiety-targeted interview performed by miniQEEG therapist; 3. Analysis of previous clinical test results (EEG record/lab blood test); and 4. The miniQEEG exam (central strip recording Cz-C3-C4), The patient was subjected to regular EEG Neurofeedback sessions for two consecutive months. After completing the treatment, follow-up tests, as listed above were repeated immediately after completing the whole treatment program, as well as 1 and 2 years later. MiniQEEG results were compared with healthy control (age-matched male subject not affected with panic attacks) and evaluated over the time that the subject was involved in the study. RESULTS Initially, the patient was suffering from severe panic attacks accompanied by vegetative symptoms and from destructive and negative thoughts. After 8 consecutive weeks of treatment encompassing sixteen QEEG neurofeedback training sessions (each lasting 30 min), a subjective improvement of his complaints was reported. More importantly, QEEG records of the patient also improved, approximating the pattern of QEEG recorded in the healthy control. CONCLUSION In this single case-based feasibility analysis, we demonstrate that systematic application of QEEG-Neurofeedback may result in manifest and durable therapeutic effect. Of note, use of this treatment may be a valuable option for patients with panic attack/panic disorder, especially if related to the psychological burden of the COVID-19/war era. Future studies on a larger patient population, especially with a longitudinal/prospective design, are warranted.
Collapse
Affiliation(s)
- Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | | | - Paulina Bartman
- Students Science Club “Reh-Tech”, Institute of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Jacek Szczygielski
- Department of Neurosurgery, Institute of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
- Department of Neurosurgery, Faculty of Medicine, Saarland University, 66123 Saarbrücken, Germany
| |
Collapse
|
4
|
Aksu S, Soyata AZ, Mursalova Z, Eskicioğlu G, Tükel R. Transcranial direct current stimulation does not improve clinical and neurophysiological outcomes in panic disorder: A randomized sham-controlled trial. Psychiatry Clin Neurosci 2022; 76:384-392. [PMID: 35587504 DOI: 10.1111/pcn.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIM Emerging evidence suggests that transcranial direct current stimulation (tDCS) has anxiolytic effects and may enhance emotional processing of threat and reduce threat-related attentional bias. Panic disorder (PD) is considered to be a fear network disorder along with prefrontal activity alterations. We aim to assess the effect of tDCS on clinical and physiological parameters in PD for the first time. METHODS In this triple-blind randomized sham-controlled pilot study, 30 individuals with PD were allocated into active and sham groups to receive 10 sessions of tDCS targeting the dorsolateral prefrontal cortex bilaterally at 2 mA for 20-min duration over 2 weeks. The clinical severity, threat-related attentional bias, interoceptive accuracy, and emotional recognition were assessed before, immediately after, and 1 month after tDCS. RESULTS Active tDCS, in comparison to sham, did not elicit more favorable clinical and neuropsychological/physiological outcomes in PD. CONCLUSION The present study provides the first clinical and neurobehavioral results of prefrontal tDCS in PD and indicates that prefrontal tDCS was not superior to sham in PD.
Collapse
Affiliation(s)
- Serkan Aksu
- Department of Physiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.,Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Zhala Mursalova
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gaye Eskicioğlu
- Department of Psychology, Istanbul University, Istanbul, Turkey
| | - Raşit Tükel
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
5
|
Johnson JCS, Byrne GJ, Pelecanos AM. The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults. BMC Psychiatry 2022; 22:270. [PMID: 35428242 PMCID: PMC9012038 DOI: 10.1186/s12888-022-03834-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Our aim was to describe a broad number of subthreshold psychiatric symptoms (SPS) in a nationally representative population and evaluate associations with substance use. SPS describe groups of symptoms with significant pathology, but that do not quite meet full psychiatric diagnostic criteria. They have been associated with significant impairment and cost. METHODS The National Epidemiologic Survey on Alcohol and Related Conditions-III was a multistage, weighted, cross-sectional survey completed in the United States in 2013 comprising 36,309 noninstitutionalized adults. We report lifetime prevalence rates of 14 SPS related to mood, anxiety, trauma, eating, and personality disorders. We then evaluate associations with lifetime alcohol use disorders (AUD) and all substance use disorders (SUD) using logistic regression and adjusted odds ratios. SPS and psychiatric diagnoses were mutually exclusive (could not co-occur). RESULTS Lifetime prevalence of having at least one of 14 SPS was 57% compared with 37% for the related psychiatric disorders. This was similar for males and females, in contrast to psychiatric disorders in which prevalence was 42% in females and 31% in males. Otherwise, overall SPS and disorders had similar prevalence patterns across sociodemographic characteristics. Subthreshold personality symptoms had the highest prevalence rates (schizotypal 21.3%, antisocial 18.3%, and borderline 17.6%), followed by posttraumatic stress (13.1%). Subthreshold bipolar and depression had lifetime prevalence rates of 2.7 and 8.5%, respectively. Prevalence rates of subthreshold anxiety symptoms ranged from 2.2% (agoraphobia) to 9.8% (specific phobia). Subthreshold eating disorder related symptoms had the lowest prevalence rates (anorexia 1.5% and bulimia 1.7%). Half (seven) of the SPS had significantly increased odds of lifetime AUD. This number increased to 12 for all SUD. Subthreshold antisocial personality symptoms had the highest odds of AUD (2.2; 95% CI 2.00-2.37) and SUD (3.5; 95% CI 3.22-3.81). CONCLUSIONS We found high lifetime SPS prevalence rates and significant associations with AUD and SUD. To our knowledge, this is the first published study evaluating a broad number of SPS. This indicates possible opportunities for early intervention and prevention but requires additional research and development of infrastructure and guidelines to better understand and manage patients who experience SPS.
Collapse
Affiliation(s)
- Jeremy C. S. Johnson
- grid.1003.20000 0000 9320 7537The University of Queensland, Mental Health Centre, K Floor, Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Department of Psychiatry, Royal Brisbane & Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
| | - Gerard J. Byrne
- grid.1003.20000 0000 9320 7537The University of Queensland, Mental Health Centre, K Floor, Royal Brisbane & Women’s Hospital, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Department of Psychiatry, Older Persons’ Mental Health Service, Royal Brisbane & Women’s Hospital, Butterfield St, Herston, QLD 4029 Australia
| | - Anita M. Pelecanos
- grid.1049.c0000 0001 2294 1395Statistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD 4006 Australia
| |
Collapse
|
6
|
Abstract
ABSTRACT There are several predictors of suicidality in patients with panic disorder (PD). Being a woman, younger age, low education level, unmarried status, and symptom severity have been suggested. This study aimed to examine whether early trauma is associated with suicidal ideation in patients with PD. Our study included 267 patients with PD and 105 controls. Data on sociodemographic variables and data from the Early Trauma Inventory Self Report-Short Form, Beck Depression Inventory, Panic Disorder Severity Scale, Anxiety Sensitivity Inventory-Revised, Coping Scales, and Scale for Suicide Ideation were collected, and correlation and regression analyses were performed. This study suggests that clinicians should consider early trauma when assessing suicidal ideation in patients with PD. Clinicians could consider alternative treatments, such as trauma-focused cognitive-behavioral therapy, eye movement desensitization, reprocessing approaches, and classical pharmacological and psychological treatments for patients with PD who have a history of early trauma and are expected to be at high risk for suicide.
Collapse
Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul
| | | |
Collapse
|
7
|
Barrio-Martínez S, Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruíz-Rodríguez P, Medrano LA, Ventura L, González-Blanch C. Factors differentiating panic disorder with and without comorbid symptoms of depression. Psychol Psychother 2021; 94:523-540. [PMID: 33993636 DOI: 10.1111/papt.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/17/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p < .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β = .346; p < .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. PRACTITIONER POINTS: Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.
Collapse
Affiliation(s)
| | | | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Human and Social Sciences, University of Zaragoza, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba/Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | - Ludovica Ventura
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain.,Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
| |
Collapse
|
8
|
Kim HJ, Kim JE, Lee SH. Functional Impairment in Patients with Panic Disorder. Psychiatry Investig 2021; 18:434-442. [PMID: 33979948 PMCID: PMC8169331 DOI: 10.30773/pi.2020.0425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/20/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Anxiety and depression and sociodemographic factors such as age, gender, education level, income, and marital status among people with panic disorder (PD) are associated with functional impairment in the areas of work, social, and family. Although both PD-specific scales such as the Panic Disorder Severity Scale (PDSS) and Anxiety Sensitivity Inventory-Revised (ASI-R) and early trauma have been investigated, their relationship with functional impairment in PD patients has not been clarified. METHODS This study included 267 PD patients. The PDSS, Beck Depression Inventory (BDI), ASI-R, and Early Trauma Inventory were used. Pearson's correlation and multiple linear regression analyses were performed. The Sheehan Disability Scale (SDS) was administered to assess the functional impairment level in PD patients. RESULTS Our findings showed that high levels of PDSS, BDI, and ASI-R were significantly correlated with the functional impairment among PD patients. Multiple regression analyses showed that PDSS, BDI, and ASI-R can predict the functional impairment levels, and PDSS and ASI-R were significantly associated with lost and underproductive days in PD patients. CONCLUSION Panic-specific symptoms, depression, and AS are associated with functional impairment level in PD patients. Elevated symptom severity can play a role by affecting productivity and daily responsibilities in PD patients.
Collapse
Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
9
|
Stech EP, Chen AZ, Sharrock MJ, Grierson AB, Upton EL, Mahoney AEJ, Grisham JR, Newby JM. Internet-delivered exposure therapy versus internet-delivered cognitive behavioral therapy for panic disorder: A pilot randomized controlled trial. J Anxiety Disord 2021; 79:102382. [PMID: 33774558 DOI: 10.1016/j.janxdis.2021.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
AIM To compare the efficacy and acceptability of internet-delivered exposure therapy for panic disorder, to multi-component internet-delivered cognitive behavioral therapy (iCBT) that included controlled breathing, cognitive restructuring and exposure. METHODS Participants with panic disorder, with or without agoraphobia, were randomized to internet-delivered exposure therapy (n = 35) or iCBT (n = 34). Both programs were clinician guided, with six lessons delivered over eight weeks. Outcomes included panic disorder and agoraphobia symptom severity, as well as depression symptom severity, functional impairment and days out of role. RESULTS Participants in both conditions displayed a large reduction in panic disorder symptom severity (ds >1.30) from pre- to post-treatment. Participants in both conditions displayed medium to large reduction in agoraphobia and depression symptom severity, functional impairment and days out of role. Effects were maintained at three- and six-month follow-up. There was no significant difference between the interventions in clinical outcomes, adherence or treatment satisfaction. CONCLUSIONS Internet-delivered exposure therapy appeared to be as acceptable and efficacious as more established iCBT, despite including less strategies. However, a fully powered replication is now needed to compare the two approaches.
Collapse
Affiliation(s)
- Eileen P Stech
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia.
| | - Aileen Z Chen
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Maria J Sharrock
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Ashlee B Grierson
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Emily L Upton
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia
| | - Alison E J Mahoney
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia; Black Dog Institute, University of New South Wales Sydney, NSW 2052, Australia
| |
Collapse
|
10
|
Kim HJ, Kim JE, Lee SH. Early Trauma Is Associated with Poor Pharmacological Treatment Response in Patients with Panic Disorder. Psychiatry Investig 2021; 18:249-256. [PMID: 33735547 PMCID: PMC8016688 DOI: 10.30773/pi.2020.0380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
11
|
Bou Khalil R, Sleilaty G, El-Khoury J, Nemr E. Teaching the use of framing and decontextualization to address context-based bias in psychiatry. Asian J Psychiatr 2020; 54:102276. [PMID: 32653853 DOI: 10.1016/j.ajp.2020.102276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
The framing effect in medical decision making is a type of cognitive bias that can lead a medical trainee at undergraduate and graduate level to reach a diagnosis or take action based on emotional states induced by the frame in which the information has been approached. This literature review on the framing effect in medical decision making will be done in the context of a case presentation in which the framing of scientific information may lead to conflicting decisions in psychiatry. As a matter of fact, debiasing techniques which help medical students/residents become aware of the fact that they might be easily influenced by the frame used in scientific data, have started to be implemented in medical teaching programs. It is important to incorporate exercises that improve debiasing skills in the curriculum at all levels of medical education. An example of such exercises is decontextualization which consists of improving problem-solving in a non-medical context in order to consolidate the use of the same schema of critical thinking in a medical context afterwards.
Collapse
Affiliation(s)
- Rami Bou Khalil
- Saint Joseph University, Department of Psychiatry, Beirut, Lebanon.
| | - Ghassan Sleilaty
- Saint Joseph University, Department of Cardiothoracic Surgery, Beirut, Lebanon; Saint Joseph University, Head of Clinical Research Center, Beirut, Lebanon
| | - Joseph El-Khoury
- American University of Beirut, Department of Psychiatry, Beirut, Lebanon
| | - Elie Nemr
- Saint Joseph University, Department of Urology, Beirut, Lebanon
| |
Collapse
|
12
|
Wootton BM, Macgregor A. Accelerated outpatient individual cognitive‐behaviour therapy for panic disorder: A case study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Bethany M. Wootton
- Department of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia,
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Amy Macgregor
- Department of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia,
| |
Collapse
|
13
|
Horenstein A, Heimberg RG. Anxiety disorders and healthcare utilization: A systematic review. Clin Psychol Rev 2020; 81:101894. [DOI: 10.1016/j.cpr.2020.101894] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022]
|
14
|
Caldirola D, Alciati A, Daccò S, Micieli W, Perna G. Relapse prevention in panic disorder with pharmacotherapy: where are we now? Expert Opin Pharmacother 2020; 21:1699-1711. [PMID: 32543949 DOI: 10.1080/14656566.2020.1779220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: A substantial number of patients with PD experience relapse after the discontinuation of effective pharmacotherapy, leading to detrimental effects on the individuals and considerable societal costs. This suggests the need to optimize pharmacotherapy to minimize relapse risk. Area covered: The present systematic review examines randomized, double-blind, placebo-controlled relapse prevention studies published over the last 20 years involving recommended medications. The authors aim to provide an overview of this topic and evaluate whether recent advances were achieved. Only seven studies were included, providing limited results. One-year maintenance pharmacotherapy with constant doses had protective effects against relapse in patients who had previously exhibited satisfactory responses to the same medication at the same doses. The duration of maintenance treatment did not influence relapse risk. No data were available concerning the use of lower doses or the predictors of relapse. Expert opinion: Relapse prevention in PD has received limited attention. Recent progress and conclusive indications are lacking. Rethinking pharmacological research in PD may be productive. Collecting a wide range of clinical and individual features/biomarkers in large-scale, multicenter long-term naturalistic studies, and implementing recent technological innovations (e.g., electronic medical records/'big data' platforms, wearable devices, and machine learning techniques) may help identify reliable predictive models.
Collapse
Affiliation(s)
- Daniela Caldirola
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele (Milan), Italy
| | - Alessandra Alciati
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Humanitas Clinical and Research Center, IRCCS , Rozzano (Milan), Italy
| | - Silvia Daccò
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele (Milan), Italy
| | - Wilma Micieli
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias , Albese Con Cassano (Como), Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele (Milan), Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University , Miami, FL, USA
| |
Collapse
|
15
|
Reliability, validity and cut-off score of the Chinese version of the panic disorder severity scale self-report form in patients with panic disorder. BMC Psychiatry 2020; 20:170. [PMID: 32295552 PMCID: PMC7160984 DOI: 10.1186/s12888-020-02560-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Panic disorder (PD) is often undiagnosed, misdiagnosed, or untreated in non-psychiatric clinical settings. Therefore, a cost-effective, accurate and easy-to-administer instrument for PD assessment is still needed. For that reason, the self-report version of the Panic Disorder Severity Scale (PDSS-SR) has been developed and suggested to be a reliable and useful tool in clinical and research settings. The current study aims to evaluate the reliability and validity of the Chinese version of the PDSS-SR and determine the cut-off score of the PDSS-SR. METHODS A total of 133 patients with PD in Shanghai were assessed by the PDSS-SR, PDSS and Hamilton Anxiety Rating Scale (HAMA). Moreover, 117 patients with non-PD anxiety and 51 healthy subjects also completed the PDSS-SR to construct a receiver operating characteristic (ROC) curve with the scores of PD patients. RESULTS The internal consistency (Cronbach's α) of the PDSS-SR was 0.72-0.80, and the interrater correlation coefficient was 0.78. The results of principal component analysis and varimax rotation indicated that the PDSS-SR had a two-factor structure, with all seven items having salient loadings. The cut-off score was 4, which was associated with high sensitivity (96.03%) and specificity (61.31%). CONCLUSIONS The findings demonstrate that these items and the total score of the PDSS-SR have acceptable reliability and validity in patients with PD and that the PDSS-SR can be used by general doctors for clinical screening in China.
Collapse
|
16
|
Intensive one-week internet-delivered cognitive behavioral therapy for panic disorder and agoraphobia: A pilot study. Internet Interv 2020; 20:100315. [PMID: 32257825 PMCID: PMC7103776 DOI: 10.1016/j.invent.2020.100315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 12/25/2022] Open
Abstract
This is the first pilot study to explore the feasibility, acceptability and preliminary efficacy of intensive cognitive behavioral therapy (CBT) for panic disorder and/or agoraphobia delivered via the internet. Ten participants who met DSM-5 criteria for panic disorder and/or agoraphobia (6 males; mean age = 43.40, SD = 15.25) completed The Intensive Panic Program: a six-lesson exposure-based CBT program, delivered online over seven days. Clinician support was provided via phone and email. All 10 participants completed the program (100% adherence) and high levels of satisfaction were reported. We found large and significant reductions in panic symptom severity at post-treatment (d = 1.40), which were maintained at two-month follow-up. We also found large reductions in agoraphobic avoidance (d = 0.92) and functional impairment (d = 1.04) at follow-up, and days out of role were halved. On average, 132 min (SD = 42, range: 47-183) of clinician time was spent per participant during the treatment week. The results provide promising preliminary evidence for the feasibility and acceptability of internet-delivered intensive CBT for panic disorder and/or agoraphobia. A larger, randomized control trial is now needed to evaluate the efficacy of this program compared to a control group and to explore long-term outcomes. Clinical trial registration number ACTRN12618001501235.
Collapse
|
17
|
Freire RC, Ferreira-Garcia R, Cabo MC, Martins RM, Nardi AE. Panic attack provocation in panic disorder patients with a computer simulation. J Affect Disord 2020; 264:498-505. [PMID: 31786029 DOI: 10.1016/j.jad.2019.11.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/30/2019] [Accepted: 11/12/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Computer simulations (CS) and virtual reality exposure are promising techniques for research and treatment of panic disorder with agoraphobia (PDA). The objective of this study was to ascertain whether a given CS was a stimulus capable of producing panic attacks (PAs), anxiety and psychophysiological changes in patients with PDA. METHODS Thirty PDA patients and 30 healthy subjects were recruited for this study. Subjects were exposed to a 3-min CS of a situation relevant to agoraphobic patients. Anxiety, panic symptoms, PAs, heart rate, skin conductance and respiration were recorded before, during and after the CS exposure. RESULTS The CS effectively induced anxiety, hyperventilation and electrodermal responses in PDA patients but not in healthy subjects. Forty percent of PDA patients had a PA while none of the control subjects had a PA. A subgroup of patients who were less sensitive to the CS than the other subgroup of PDA patients and did not present full-blown PAs still had more panic symptoms, higher anxiety levels and more respiratory irregularities than the controls. LIMITATIONS Low immersion and low sense of presence, lack of interaction with the environment. CONCLUSIONS Exposure to the CS produced effects similar to in vivo exposure, respiratory and caffeine challenges. Subsequent studies should: make direct comparisons between CS and other challenges for PDA; investigate if CS can be a tool for predicting effects of medication; determine the potential of CS as a desensitization technique for situational PAs.
Collapse
Affiliation(s)
- Rafael Christophe Freire
- Department of Psychiatry, Queen's University, Kingston, Canada; Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Rafael Ferreira-Garcia
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Costa Cabo
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renan Machado Martins
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
18
|
Haller J, Krecsak L, Zámbori J. Double-blind placebo controlled trial of the anxiolytic effects of a standardized Echinacea extract. Phytother Res 2019; 34:660-668. [PMID: 31876052 DOI: 10.1002/ptr.6558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/30/2019] [Accepted: 11/08/2019] [Indexed: 01/12/2023]
Abstract
Earlier studies suggested that specific Echinacea preparations might decrease anxiety. To further study the issue, we performed a double blind, placebo controlled trial with a standardized Echinacea angustifolia root extract. Participants were volunteers scoring above 45 points on the state or on the trait subscale of the State Trait Anxiety Inventory (STAI). They were treated with 40 mg Echinacea or with placebo tablets twice daily for 7 days followed by a 3 week-long washout period. Participants were also administered the Beck Depression Inventory (BDI) and the Perceived Stress Scale (PSS). In the Echinacea group, state anxiety scores decreased by approximately 11 points by the end of the treatment period, whereas the decrease was around 3-points in the placebo group (p< 0.01). The effect maintained over the washout period. The difference from placebo was significant from the 7th day of treatment throughout. Changes were less robust with trait anxiety scores, but the preparation performed better than placebo in patients with high baseline anxiety. Neither BDI nor PSS scores were affected by the treatments. Adverse effects were rare and mild, and all were observed in the placebo group. These findings suggest that particular Echinacea preparations have significant beneficial effects on anxiety in humans.
Collapse
Affiliation(s)
- József Haller
- Institute of Experimental Medicine, Budapest, Hungary.,University of Public Service, Budapest, Hungary
| | | | | |
Collapse
|
19
|
Zulfarina MS, Syarifah-Noratiqah SB, Nazrun SA, Sharif R, Naina-Mohamed I. Pharmacological Therapy in Panic Disorder: Current Guidelines and Novel Drugs Discovery for Treatment-resistant Patient. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:145-154. [PMID: 30905115 PMCID: PMC6478076 DOI: 10.9758/cpn.2019.17.2.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/26/2022]
Abstract
Panic disorder (PD) being one of the most intensively investigated anxiety disorders is considered a heterogeneous psychiatric disease which has difficulties with early diagnosis. The disorder is recurrent and usually associated with low remission rates and high rates of relapse which may exacerbated social and quality of life, causes unnecessary cost and increased risk for complication and suicide. Current pharmacotherapy for PD are available but these drugs have slow therapeutic onset, several side effects and most patients do not fully respond to these standard pharmacological treatments. Ongoing investigations indicate the need for new and promising agents for the treatment of PD. This article will cover the importance of immediate and proper treatment, the gap in the current management of PD with special emphasis on pharmacotherapy, and evidence regarding the novel anti-panic drugs including the drugs in developments such as metabotropic glutamate (mGlu 2/3) agonist and levetiracetam. Preliminary results suggest the anti-panic properties and the efficacy of duloxetine, reboxetine, mirtazapine, nefazodone, risperidone and inositol as a monotherapy drug. Apart for their effectiveness, the aforementioned compounds were generally well tolerated compared to the standard available pharmacotherapy drugs, indicating their potential therapeutic usefulness for ambivalent and hypervigilance patient. Further strong clinical trials will provide an ample support to these novel compounds as an alternative monotherapy for PD treatment-resistant patient.
Collapse
Affiliation(s)
- Mohamed S Zulfarina
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Syed-Badrul Syarifah-Noratiqah
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shuid A Nazrun
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Razinah Sharif
- Program of Nutritional Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Isa Naina-Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
20
|
Pignon B, Tezenas du Montcel C, Carton L, Pelissolo A. The Place of Antipsychotics in the Therapy of Anxiety Disorders and Obsessive-Compulsive Disorders. Curr Psychiatry Rep 2017; 19:103. [PMID: 29110139 DOI: 10.1007/s11920-017-0847-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking. RECENT FINDINGS Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants. Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.
Collapse
Affiliation(s)
- Baptiste Pignon
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France. .,INSERM, U955, team 15, 94000, Créteil, France. .,Fondation FondaMental, 94000, Créteil, France. .,Faculté de médecine, UPEC, Université Paris-Est, 94000, Créteil, France. .,Hôpital Albert Chenevier, Groupe Hospitalier Henri-Mondor, CHU de Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), 40 rue de Mesly, 94 000, Créteil, France.
| | - Chloé Tezenas du Montcel
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France
| | - Louise Carton
- Département de Pharmacologie Médicale, Univ.Lille, Inserm U1171, CHU Lille, 59000, Lille, France.,Service d'addictologie, CHU Lille, 59000, Lille, France
| | - Antoine Pelissolo
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France.,INSERM, U955, team 15, 94000, Créteil, France.,Fondation FondaMental, 94000, Créteil, France.,Faculté de médecine, UPEC, Université Paris-Est, 94000, Créteil, France
| |
Collapse
|
21
|
Parnas J, Nordgaard J, Henriksen MG. Panic, Self-Disorder, and EASE Research: Methodological Considerations. Psychopathology 2017; 50:169-170. [PMID: 28395290 DOI: 10.1159/000471505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/16/2017] [Indexed: 11/19/2022]
|
22
|
Anxiofit‐1 and reduction of subthreshold and mild anxiety: evaluation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
23
|
Freire RC, Zugliani MM, Garcia RF, Nardi AE. Treatment–resistant panic disorder: a systematic review. Expert Opin Pharmacother 2015; 17:159-68. [DOI: 10.1517/14656566.2016.1109628] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
24
|
Ebenfeld L, Kleine Stegemann S, Lehr D, Ebert DD, Jazaieri H, van Ballegooijen W, Funk B, Riper H, Berking M. Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. Trials 2014; 15:427. [PMID: 25370504 PMCID: PMC4233107 DOI: 10.1186/1745-6215-15-427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recently, internet-based interventions have been proposed as effective treatments for people with panic disorder (PD). However, little is known about the clinical effects of integrating mobile technology into these interventions. Because users carry their smartphones with them throughout the day, we hypothesize that this technology can be used to significantly support individuals with monitoring and overcoming their PD symptoms. The aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed hybrid intervention that combines internet/PC with smartphone delivery to treat the symptoms of PD. The intervention is based on cognitive behavioral therapy and consists of six modules over a total of six weeks. Methods/Design A two-arm randomized controlled trial (RCT) will be conducted to evaluate the effects of a hybrid online training module for PD. Based on a power calculation (d =0.60; 1-β of 80%; α =0.05), 90 participants with mild to moderate panic symptoms with or without agoraphobia (as assessed by the Panic and Agoraphobia Scale) will be recruited from the general population and randomly assigned to either the intervention group or a six-month waitlist control group. The primary outcome measure will be the severity of panic symptoms. Secondary outcomes will include depression, quality of life, and an observer-based rating of panic severity. Furthermore, data regarding acceptance and the usability of the smartphone app will be assessed. Assessments will take place at baseline as well as eight weeks, three months, and six months after randomization. Moreover, a cost-effectiveness analysis will be performed from a societal perspective. Data will be analyzed on an intention-to-treat basis and per protocol. Discussion To our knowledge, this RCT is one of the first to examine the efficacy of a hybrid online training for adult PD. This study seeks to contribute to the emerging field of hybrid online training. If the intervention is efficacious, then research on this hybrid online training should be extended. The cost-effectiveness analysis will also indicate whether online training is an economical tool for treating PD among adults. Trial registration German Clinical Trial Register:
DRKS00005223 (registered on 15 August 2013).
Collapse
Affiliation(s)
- Lara Ebenfeld
- Division of Health Training Online, Leuphana University Lueneburg, Innovation Incubator, Rotenbleicher Weg 67, 21335 Lueneburg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Predictors of healthcare service utilization for mental health reasons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10559-86. [PMID: 25321874 PMCID: PMC4210995 DOI: 10.3390/ijerph111010559] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 01/04/2023]
Abstract
This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.
Collapse
|
26
|
The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review. BMC Psychiatry 2014; 14:128. [PMID: 24886240 PMCID: PMC4048364 DOI: 10.1186/1471-244x-14-128] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 04/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. METHODS A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations. RESULTS Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality. CONCLUSIONS Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
Collapse
|
27
|
Chen MT, Li CY, Lin HC, Shen WW, Hsieh PC, Chen CC. Health-seeking behavior, alternative medicine, and quality of life in Taiwanese panic disorder patients. Int J Psychiatry Clin Pract 2013; 17:206-15. [PMID: 22809126 DOI: 10.3109/13651501.2012.713111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Panic disorder (PD) is an anxiety disorder characterized by spontaneous and unexpected panic attacks of varying frequency. Clinically manifest PD is widespread among the general population in developed countries worldwide. This study is aimed to identify factors influencing Taiwanese patients' decision to seek psychiatric help and to assess relationships between patients' health-seeking behaviors and quality of life (QOL). METHODS One hundred patients from the outpatient psychiatric clinic of a university hospital in Taiwan were evaluated for PD. RESULTS Delayed diagnosis of panic disorder, high comorbidity with other mental and physical disorders, and high utilization of health care services were identified. Thirty-three percent of PD patients sought alternative therapies, delaying their seeking psychiatric care. CONCLUSIONS More PD patients in Taiwan seek care from family practitioners and alternative and complementary medicine than from psychiatrists. Taiwanese patients with PD who seek psychiatric consultation more than one year after disease onset have lower QOL and lower physical health scores.
Collapse
Affiliation(s)
- Miao-Tzu Chen
- Department of Nursing, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | | | | | | | | | | |
Collapse
|
28
|
van Ballegooijen W, Riper H, Klein B, Ebert DD, Kramer J, Meulenbeek P, Cuijpers P. An Internet-based guided self-help intervention for panic symptoms: randomized controlled trial. J Med Internet Res 2013; 15:e154. [PMID: 23896222 PMCID: PMC3742403 DOI: 10.2196/jmir.2362] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/26/2013] [Accepted: 05/11/2013] [Indexed: 12/01/2022] Open
Abstract
Background Internet-based guided self-help is efficacious for panic disorder, but it is not known whether such treatment is effective for milder panic symptoms as well. Objective To evaluate the effectiveness of Don’t Panic Online, an Internet-based self-help course for mild panic symptoms, which is based on cognitive behavioral principles and includes guidance by email. Methods A pragmatic randomized controlled trial was conducted. Participants (N=126) were recruited from the general population and randomized to either the intervention group or to a waiting-list control group. Inclusion criteria were a Panic Disorder Severity Scale-Self Report (PDSS-SR) score between 5-15 and no suicide risk. Panic symptom severity was the primary outcome measure; secondary outcome measures were anxiety and depressive symptom severity. Measurements were conducted online and took place at baseline and 12 weeks after baseline (T1). At baseline, diagnoses were obtained by telephone interviews. Results Analyses of covariance (intention-to-treat) showed no significant differences in panic symptom reduction between groups. Completers-only analyses revealed a moderate effect size in favor of the intervention group (Cohen’s d=0.73, P=.01). Only 27% of the intervention group finished lesson 4 or more (out of 6). Nonresponse at T1 was high for the total sample (42.1%). Diagnostic interviews showed that many participants suffered from comorbid depression and anxiety disorders. Conclusions The Internet-based guided self-help course appears to be ineffective for individuals with panic symptoms. However, intervention completers did derive clinical benefits from the intervention. Trial Registration Nederlands Trial Register: NTR1639; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1639 (Archived by WebCite at http://www.webcitation.org/6ITZPozs9).
Collapse
Affiliation(s)
- Wouter van Ballegooijen
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1,Amsterdam, Netherlands.
| | | | | | | | | | | | | |
Collapse
|
29
|
Sanches SHB, Osório FDL, Udina M, Martín-Santos R, Crippa JAS. Anxiety and joint hypermobility association: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2013; 34 Suppl 1:S53-60. [PMID: 22729449 DOI: 10.1590/s1516-44462012000500005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anxiety disorders are often associated with several non-psychiatric medical conditions. Among the clinical conditions found in association with anxiety stands out the joint hypermobility (JH). OBJECTIVES To carry out a systematic review of the clinical association between anxiety disorders and JH. METHOD A survey was conducted in MEDLINE, PsychINFO, LILACS e SciELO databases up to December 2011. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety. The reference lists of selected articles were systematically hand-searched for other publications relevant to the review. RESULTS Seventeen articles were included in the analysis and classified to better extract data. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Panic disorder/agoraphobia was the anxiety disorder associated with JH in several studies. Etiological explanation of the relationship between anxiety and JH is still controversial. CONCLUSION Future research in large samples from the community and clinical setting and longitudinal studies of the association between anxiety and HA and the underlying biological mechanisms involved in this association are welcome.
Collapse
Affiliation(s)
- Simone H Bianchi Sanches
- Neurosciences and Behavior Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil.
| | | | | | | | | |
Collapse
|
30
|
The Autonomic Nervous System Questionnaire and the Brief Patient Health Questionnaire as screening instruments for panic disorder in Finnish primary care. Eur Psychiatry 2013; 28:442-7. [PMID: 23273422 DOI: 10.1016/j.eurpsy.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE As panic disorder often remains unrecognized in the health care system, some screening methods have been developed to enhance its recognition. The aim of this study was to test and compare the Autonomic Nervous System Questionnaire (ANS) and the Brief Patient Health Questionnaire (BPHQ) in primary care. SUBJECTS AND METHODS A total sample of 211 primary care outpatients was studied. The Structured Clinical Interview for DSM-IV was the criterion standard for the presence of panic disorder. Indices of diagnostic utility for both screening methods were calculated and compared. RESULTS The AUC (area under the ROC curve) was 0.885 for the ANS and 0.877 for the BPHQ. At the optimal cut-off level, the ANS had the sensitivity of 0.88 and specificity of 0.77; the BPHQ had the sensitivity of 0.79 and the specificity of 0.87. There was not any statistically significant difference between the screens. CONCLUSIONS Both screening methods can be recommended both for clinical practice and research use. In busy primary care practice, the BPHQ may be more useful, as it can be used together with the depression module of the BPHQ.
Collapse
|
31
|
Bianchi Sanches SH, Osório FDL, Udina M, Martín-Santos R, Crippa JAS. Anxiety and joint hypermobility association: a systematic review. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70054-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
32
|
Freire RC, Hallak JE, Crippa JA, Nardi AE. New treatment options for panic disorder: clinical trials from 2000 to 2010. Expert Opin Pharmacother 2011; 12:1419-28. [DOI: 10.1517/14656566.2011.562200] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
Current world literature. Curr Opin Psychiatry 2011; 24:78-87. [PMID: 21116133 DOI: 10.1097/yco.0b013e3283423055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
34
|
Peres MFP, Lucchetti G, Mercante JPP, Young WB. New daily persistent headache and panic disorder. Cephalalgia 2010; 31:250-3. [DOI: 10.1177/0333102410383588] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: New daily persistent headache (NDPH) is a primary chronic daily headache that is generally considered to be difficult to treat. Migraine has been linked to comorbid psychiatric conditions, mainly mood and anxiety disorders, but NDPH has never been linked to psychiatric conditions, and never studied extensively for such an association. Case: We report nine cases (six women and three men) of patients diagnosed with NDPH and panic disorder who were treated for both conditions. Six of them (66%) had good or excellent responses. Conclusion: The spectrum of anxiety disorders, particularly panic disorder, should be considered in NDPH patients. Simultaneous treatment of both disorders may lead to good outcomes.
Collapse
Affiliation(s)
- Mario FP Peres
- Albert Einstein Hospital, Brazil
- Federal University of São Paulo, Brazil
| | | | | | | |
Collapse
|