The daily distribution of panic attacks

Intrapatient agreement on phenomenology of panic attacks

Panic disorder is common in primary care settings and such a physician is often a patient's initial contact with the health care system. Previous work concerning the homogeneity of panic phenomenology across patients is contradictory. The purpose of this pilot study was to assess the intrapatient homogeneity of panic attacks and to examine associations between measures of homogeneity and physicians' confidence in the diagnosis. Ten patients meeting DSM-III-R criteria for panic disorder completed a diary documenting the symptomatic phenomenology of five consecutive panic attacks. In addition, the physician rated his diagnostic confidence for each patient. Patterns of symptoms and their sequences during panic showed good agreement within patients as did patterns of abatement and of presence of a precipitating event. The physician's diagnostic confidence was inversely related to agreement on symptom severity and variance of duration of an attack. This study suggests intrapatient homogeneity on most measures.

Course and outcome in panic disorder: a review of recent follow-up studies

This paper reviews the methodologic considerations that are important in evaluating and interpreting panic disorder outcome studies and the results of the most well-designed of these studies. Sixteen studies that used modern diagnostic criteria and interviewed at least 25 patients on at least two occasions over a minimum follow-up period of one year are reviewed. Results show that, despite the availability of effective anti-panic treatments, panic disorder remains a chronic illness. While most patients improve, few are "cured." The presence of agoraphobia, major depression and personality disorder seems to predict poorer outcome. The importance of measuring multiple clinical dimensions of panic is emphasized, along with the need to reach a consensus about the definition of "outcome" and the particular instruments to use to measure it.

Characteristics of panic attack subtypes: assessment of spontaneous panic, situational panic, sleep panic, and limited symptom attacks

We report the analyses of daily journal descriptions of 790 self-defined panic attacks from 59 patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The DSM-III-R specified symptoms occurred with frequencies ranging from choking (17% of attacks) to palpitations (63% of attacks). The mean weekly panic attack severity correlated significantly with the number of symptoms per attack, but not their weekly frequency. Within a given person, situational and spontaneous panic attacks did not significantly differ over a number of characteristics, including severity, duration, frequency per week, diurnal distribution, and the number of symptoms per attack. Limited symptom attacks were less severe, but were otherwise similar to panic attacks. Also, panic attacks during sleep were less frequent than panic attacks in the awake state, but did not significantly differ on other descriptive characteristics. These data support the validity of the symptoms specified for panic attacks by DSM-III-R. They also suggest that within an individual, panic attacks of various subtypes may be descriptively similar, despite the differing contexts in which they arise. In addition, these data question the diagnostic significance of the limited symptom attack-panic attack distinction.