Panic attacks and panic disorder in Japanese non-patient population: epidemiology and psychosocial correlates

Association of Job Stressors With Panic Attack and Panic Disorder in a Working Population in Japan: A Cross-Sectional Study

OBJECTIVE

This study aimed to investigate associations of job stressors with panic attack (PA) and panic disorder (PD) among Japanese workers.

METHODS

A cross-sectional online questionnaire survey was conducted of 2060 workers. Job strain, effort/reward imbalance, and workplace social support were measured by the job content questionnaire and effort/reward imbalance questionnaire. These variables were classified into tertiles. PA/PD were measured by self-report based on the mini international neuropsychiatric interview (MINI). Multiple logistic regression was conducted, adjusting for demographic, lifestyle, and health-related covariates.

RESULTS

Data from 1965 participants were analyzed. Adjusted odds ratio (OR) of PA/PD was significantly greater for the group with high effort/reward imbalance compared with the group with low effort/reward imbalance (ORs, 2.64 and 2.94, respectively, both P < 0.05).

CONCLUSION

This study found effort/reward imbalance was associated with having PA/PD among Japanese workers.

Health-seeking behavior, alternative medicine, and quality of life in Taiwanese panic disorder patients

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.

Agoraphobia: a review of the diagnostic classificatory position and criteria

The status of agoraphobia (AG) as an independent diagnostic category is reviewed and preliminary options and recommendations for the fifth edition of The Diagnostic and Statistical Manual (DSM-V) are presented. The review concentrates on epidemiology, psychopathology, neurobiology, vulnerability and risk factors, clinical course and outcome, and correlates and consequences of AG since 1990. Differences and similarities across conventions and criteria of DSM and ICD-10 are considered. Three core questions are addressed. First, what is the evidence for AG as a diagnosis independent of panic disorder? Second, should AG be conceptualized as a subordinate form of panic disorder (PD) as currently stipulated in DSM-IV-TR? Third, is there evidence for modifying or changing the current diagnostic criteria? We come to the conclusion that AG should be conceptualized as an independent disorder with more specific criteria rather than a subordinate, residual form of PD as currently stipulated in DSM-IV-TR. Among other issues, this conclusion was based on psychometric evaluations of the construct, epidemiological investigations which show that AG can exist independently of panic disorder, and the impact of agoraphobic avoidance upon clinical course and outcome. However, evidence from basic and clinic validation studies remains incomplete and partly contradictory. The apparent advantages of a more straightforward, simpler classification without implicit hierarchies and insufficiently supported differential diagnostic considerations, plus the option for improved further research, led to favoring the separate diagnostic criteria for AG as a diagnosis independent of panic disorder.

A placebo-controlled, randomized withdrawal study of sertraline for panic disorder in Japan

The objective of this double-blind, placebo-controlled randomized withdrawal study was to evaluate the efficacy and safety of sertraline for 8 weeks in treating Japanese patients with DSM-IV panic disorder. Patients (n=394) were initially treated with 8 weeks of open-label sertraline followed by 8 weeks of double-blind treatment with either sertraline (50-100 mg/day) or placebo. Responders during the open-label phase were eligible to be entered into the double-blind phase. Two hundred and forty patients were entered to the double-blind phase and randomly assigned to receive sertraline (n=119) or placebo (n=121). On the primary efficacy measure (relapse), there was no significant difference between the two treatment groups (sertraline 10.1%; placebo 13.2%). However, the frequency of panic attacks was significantly (P=0.012) lower for sertraline compared to placebo. The proportion of sertraline-treated patients who met response criteria (Clinical Global Impression-Improvement Scale score of 1 or 2) at the end of double-blind phase treatment was also significantly (P=0.003) higher for sertraline (89.9%) compared to placebo (74.4%). Panic Disorder Severity Scale total score was significantly (P=0.012) lower in the sertraline group compared to the placebo group. Adverse events during acute treatment were consistent with the known adverse event profile of sertraline, and the incidence of adverse events during the double-blind phase treatment was not different between sertraline and placebo.

The association between panic disorder and the L/L genotype of catechol-O-methyltransferase

To clarify the role of catechol-O-methyltransferase (COMT) polymorphism in panic disorder (PD), we investigated a large group of Korean PD patients (N = 178) and controls (N = 182) using a case-control study. We also assessed the response to paroxetine treatment and other clinical variables in the PD patients. The increase in the COMT(L) allele was not statistically significant in PD (p = 0.104). However, compared with the sum of the other genotypes, the frequency of the L/L genotype was significantly higher in PD (p = 0.042). The odd ratios (ORs) also indicated a significant effect of the homozygosity for the COMT(L) allele on an increased risk for PD (OR=2.38; 95% CI 1.03-5.51). In addition, patients with L/L genotype had higher trait-anxiety levels (p = 0.030) and poorer treatment response to paroxetine than those with other genotypes (p = 0.002). Our results suggest that the COMT L/L genotype is associated with PD and the genetic variant of the COMT enzyme may be related to the clinical severity and treatment response to paroxetine in PD.

Understanding personality traits from early life experiences

The contribution of early experiences towards the onset of personality disorder has often been stressed. However, the contribution to trait personality has received less attention. To examine the impact of early experiences on the development of personality, two subscale scores of the Eysenck Personality Questionnaire (EPQ): neuroticism (N) and extroversion (E), were used to assess a total of 220 residents of a rural city of Japan (aged > or =18 years). After controlling for age and social desirability response bias, the N score of men could be predicted by the experience of relocation; the E score of men by high parental care and low parental overprotection; and the E score of women by the experience of death of a sibling. Personality traits in a non-patient population may be explained by early experiences.

Quality of life and its correlates in a community population in a Japanese rural area

Correlations of three aspects of quality of life (QOL) (health perception, life satisfaction, and self-confidence) with personality traits and early experiences were examined. Quality of life aspects were examined using 220 inhabitants in a rural community in Japan. Health perception was better among men than among women. Life satisfaction and self-confidence were better in people aged 55 or over than in those under 55. Among the current predictor variables, the Eysenck Personality Questionnaire neuroticism score was correlated with poor life satisfaction in the younger women; the extraversion score with the older women's health perception, the older men's life satisfaction, and the women's self-confidence; and the psychoticism score with the older men's life satisfaction. Among early life predictors, self-confidence was lower among those older men who had reported early parental loss. Childhood paternal overprotection was correlated with poor health perception in younger people and with good health perception in older women. Some negative life events experienced during childhood were correlated with poorer QOL measures in some subgroups, while positive life experiences were correlated with the older women's life satisfaction. These findings suggest that the three aspects of the QOL are discrete in their psychosocial correlates and that interventions on health education and care should take into account individual's psychosocial attributes.

Precedents of perceived social support: personality, early life experiences and gender

The perception of social support may be a trait-like construct stemming from the current personality and early environment as well as a summation of the actual support perceived. A total of 220 community individuals were examined for the effects of Eysenck Personality Questionnaire (EPQ) items and early life experience at home and outside on the number of sources of perceived social support and satisfaction with that support. High extraversion and low neuroticism scores of the EPQ were correlated with the availability of support only in women, while high maternal care and low maternal overprotection in childhood were correlated with the satisfaction with support only in men. Availability of support was also correlated with some types of early life events. The quantity and quality of perception of social support differ in their links to personality and early environment, and may be, to some extent, explainable in terms of them.

Is DSM widely accepted by Japanese clinicians?

The Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), a new standardized diagnostic system with multiaxial diagnosis, operational criteria and renewed definitions of mental disorders, was introduced in 1980 and prompted movements to reform conventions in Japanese psychiatry. This review overviews the initial response of Japanese clinicians to accept DSM-III, and its effects on the development of systematic research of psychiatric diagnosis. These new research activities include those on reliability of psychiatric diagnosis, application of various evaluation tools, discussion on the concept of mental disorders, relation of personality disorders with depressive disorders, and Taijin-kyofusho, or culturally distinctive phobia in Japan. A reference database search to survey the latest trend on psychiatric research indicated that the number of papers published by Japanese workers increased sharply after 1987, and DSM apparently greatly influenced their internationalization. Twenty years after the publication of DSM-III, a questionnaire on the use of DSM-IV was set out in 2000 to survey how widely DSM is utilized in clinical practice in Japan. Two hundred and twelve psychiatrists answered the questionnaire, and the results show that DSM has been accepted positively by the younger generation, while the older generation (over 40s) has still less interest in DSM, and DSM is used mainly for research purposes rather than in daily practice.

Early parental separation experiences among patients with bipolar disorder and major depression: a case-control study

BACKGROUND

Although the association between childhood parental loss and later development of mood disorder has received much research interest in the past, the results obtained and conclusions drawn have been various, and inconsistent with each other. The present study aims to examine this old, yet unresolved, question among the Japanese.

METHODS

Patients with bipolar disorder (n = 73) and unipolar depression (n = 570) and community healthy controls (n = 122) were examined as to their psychopathology and childhood parental loss experiences with semi-structured interviews.

RESULTS

Stratified for sex and age, no statistically significant difference was observed in the incidence of paternal or maternal death or separation before age 16 between bipolar patients and healthy controls. Female patients with unipolar depression under the age of 54 experienced significantly more maternal loss than the corresponding controls. This excess in loss appeared to be largely due to the patients experiencing separation from their mothers.

CONCLUSION

Our findings concerning bipolar disorder have replicated the previous two studies reported in the literature. Those concerning unipolar depression appear to be in line with several recent studies on the subject but, as stated, many discrepant findings can also be found in the literature.

Childhood parental loss and schizophrenia: evidence against pathogenic but for some pathoplastic effects

Childhood parental loss has been associated with a number of psychiatric disorders in adulthood. The present article aims to examine, firstly, the etiologic relationship between early parental loss and later development of schizophrenia and, secondly, the pathoplastic effect of the former on the symptomatology of the latter. We have administered semi-structured interviews inquiring into psychopathology and early separation experiences to a representative sample of first-visit patients to the 31 hospitals and clinics all over Japan (n=1963) and also to a community sample in a small city in Japan (n=218). When 225 patients diagnosed with schizophrenia according to DSM-III-R criteria were compared with 122 healthy control subjects without any lifetime psychiatric disorder, controlled for sex and age, there was no statistically significant difference in the rates of childhood parental loss (death or separation). As regards the pathoplastic effects, it was found that schizophrenic men were less likely to present with negative symptoms if they had experienced separation from the father, and were more likely to show panic attacks if they had experienced separation from the mother. Schizophrenic women were more likely to present with hallucinations if they had suffered any loss of the father. Childhood parental loss is not pathogenic of schizophrenia but appears to exert some pathoplastic influences on its presenting symptoms.

Psychiatric epidemiology in Japan: towards psychological understanding of the etiology of minor psychiatric disorders

Epidemiological studies of psychiatric disorders using structured interviews and operational diagnostic criteria in a community population are rare in Japan. In our community study with mainly middle-aged people (Kofu Study), the lifetime prevalence of Major Depressive Episode was 19%. The prevalence was about twice as high in women as in men. The prevalence of Major Depressive Episode showed a tendency to increase as the subjects became younger. No sex difference in the lifetime prevalence of Major Depressive Episode was observed among an adolescent population (Gotemba Study), due to the equally high prevalence of this disorder among male adolescents. The figures were 24% for men and 23% for women. In a follow-up study of pregnant women (Kawasaki Study), risk factors of depression during pregnancy and after childbirth are different and, in some instances, reversed. Therefore, we speculate that the combination of psychological risk factors of the onset of depression may differ from one situation to another. Specificity of the combination of risk factors may be more important than single risk factors in the etiology of mild-form depression.

Hopelessness in a community population: factorial structure and psychosocial correlates

The factorial structure of the Beck Hopelessness Scale (BHS; A. T. Beck, A. Weissman, D. Lester, & L. Trexler, 1974) was examined in a nonclinical sample (N = 154) in Japan, and the relationships between dimensions of hopelessness and psychosocial variables were analyzed. A semistructured interview was used, as well as a questionnaire consisting of the BHS, the Eysenck Personality Questionnaire (EPQ; H. J. Eysenck & S. B. Eysenck, 1975), and the Parental Bonding Instrument (PBI; G. Parker, H. Tupling, & L. B. Brown, 1979). A factor analysis with principal components solution after oblimin rotation yielded 2 factors--Doubt About a Hopeful Future (Factor 1) and Belief About a Hopeless Future (Factor 2). Significant, positive correlations were found between Factor 2 and (a) the number of emotional symptoms of depression in a 4-day depressive episode and (b) scores on the Neuroticism subscale of the EPQ. The Factor 1 score was significantly and negatively correlated with the Extraversion subscale of the EPQ and the Paternal Care subscale of the PBI.

Prevalence of chronic fatigue syndrome in a community population in Japan

In order to know the prevalence of chronic fatigue syndrome (CFS) in a community population in Japan, we analyzed data from a population-based interview survey. Two cases out of 137 respondents experienced chronic fatigue during a period of nine months, suffered from 50% or more reduction of daily activity due to fatigue and had no other physical or psychiatric diagnosis. Both of the two cases fulfilled the 1994 Centers for Disease Control (CDC) criteria and the British criteria. The point and nine-month prevalence rates of CFS were both 1.5% (95% confidence intervals, 0.4-5.2%). None fulfilled the 1989 CDC criteria for CFS. The prevalence rate of CFS was higher than those in previous studies in the Western countries, suggesting a need for future research on cross-cultural differences in the definition, prevalence and symptomatology of CFS.

Childhood parental loss and alcohol dependence among Japanese men: a case-control study. Group for Longitudinal Affective Disorders Study (GLADS)

There have been many studies in the literature examining childhood parental loss as a risk factor for adult psychiatric disorders such as depression, schizophrenia or anxiety disorders. However, with regard to alcohol dependence, only a limited number of such studies exists, and these have reported inconsistent findings. The present paper aims to examine the relationship between early parental loss and subsequent development of alcohol dependence among Japanese men. We directly interviewed 75 men with alcohol dependence (according to DSM-III-R), who were visiting 23 psychiatric hospitals and clinics all over Japan, and 52 healthy controls without any lifetime psychiatric diagnosis, drawn from a general population. When stratified for sex and age, there was no statistically significant difference between the patients and the controls in the rates of maternal or paternal death or separation before the age of 16 years. These findings and the review of the literature suggest that the relationship between childhood parental loss and alcohol dependence is not a straightforward one.

Prevalence of mood and anxiety disorders in a working population in Japan

To learn the prevalence of mood and anxiety disorders (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised) in a working population in Japan, we analyzed data from a population-based survey. Among 140 respondents who had a job, 8% experienced any of seven mood and anxiety disorders in the past 6 months and 19% had in their lifetime. The 6-month and lifetime prevalence rates of major depressive episodes were 4% and 14%, respectively. The 6-month and lifetime prevalence rates of phobic disorders were both 4%. The lifetime prevalence rates for other anxiety disorders were 1% or less. The 6-month rate of any disorder, as well as 6-month and lifetime rates of phobic disorders, was higher in white-collar employees than in self-employed workers (P < 0.05). The multiple logistic regression confirmed the tendency after controlling for sex and age, although the result was not significant (P > 0.05).