Heightened embarrassability discriminates between panic disorder patients with and without agoraphobia

Longitudinal course of panic disorder with and without agoraphobia using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Few naturalistic, longitudinal studies of panic disorder with and without agoraphobia (PD/PDA) exist, limiting our knowledge of the temporal rates of incidence, relapse, and chronicity, or the factors that predict category transition. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1 (n=43,093) and wave 2 (n=34,653) were utilized to determine transitional rates, and predictors of category transitions, over a 3-year period. Analyses revealed very high 3-year remission rates for PD and PDA (75% and 67%, respectively), although relapse also was relatively frequent (PD=12%; PDA=21%). Logistic regression revealed previous history of panic attacks, generalized anxiety disorder/major depression (GAD/MDD), nicotine dependence, female sex, younger age, and major financial crises to be reliable predictors of incidence and relapse. The direction and magnitude of association of many predictor variables were similar for PD and PDA, with notable exceptions for social anxiety and romantic relationship factors. Clinicians should be aware of the relapsing-remitting nature of PD and PDA and, thus, take caution to not reduce or eliminate effective treatments prematurely. Similarly, the current study suggests clinicians pay particular attention to concurrent factors relevant to relapse in PD/PDA that may also be clinically addressed (e.g., co-morbid MDD/GAD and nicotine dependence).

Fear of negative evaluation is associated with delusional ideation in non-clinical population and patients with schizophrenia

PURPOSE

A number of recent studies suggest that delusions may be explained as a continuum from normal beliefs. Fear of negative evaluation from others (FNE) is one of potential factors that might describe this psychological process of delusions.

METHODS

In order to examine whether FNE is associated with delusional ideation in both non-clinical population and patients with schizophrenia, two sets of data [from a non-clinical student sample (n = 282) and from patients with schizophrenia (n = 117)] were collected to examine whether Brief Fear of Negative Evaluation Scale (BFNE) score and the 21-item Peters Delusions Inventory (PDI-21) score were associated with each other. Linear regression analyses were carried out to assess if the BFNE score still remained associated with the PDI-21 scores once the confounding effects of depression were controlled.

RESULTS

BFNE scores were significantly related to PDI-21 scores in both non-clinical [Pearson product-moment correlation coefficient (r) = 0.37, 95% confidence Interval (CI) = 0.25-0.48] and patient (r = 0.33, 95% CI = 0.14-0.49) samples. These associations were still significant when confounding effects of depression were controlled. Standardised coefficients for the BFNE scores in the linear regression model were 0.21 in the student sample and 0.19 in the clinical sample.

CONCLUSIONS

FNE was associated with delusional ideation both in non-clinical population and in patients with schizophrenia. FNE might be a potential target for both pharmacological and psychological interventions for patients with delusions.

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.

Autobiographical memories prompted by automatic thoughts in panic disorder and social phobia

This study examined the retrieval of autobiographical memories when prompted by automatic thoughts that were representative of maladaptive schema content specific to 2 anxiety disorders. Participants with panic disorder (n = 20), those with social phobia (n = 22) and non-anxious participants (n = 20) indicated the first specific memory that came to mind when cued with panic-related, social phobia-related and control automatic thoughts. Panic participants retrieved memories cued with panic disorder-related automatic thoughts more quickly than social phobic and non-anxious participants, and social phobic participants retrieved memories cued with social phobia-related automatic thoughts more quickly than non-anxious participants. Relative to non-anxious participants, participants in both patient groups retrieved more anxious/worried memories when cued with automatic thoughts related to their diagnosis and more fearful memories when cued with either type of diagnosis-related automatic thought. Results indicate that panic and social phobic participants were characterized by general threat-relevant autobiographical memory biases.