Illness attitudes and coping process in subjects with panic attacks

Salivary alpha-amylase and cortisol responsiveness to stress in first episode, drug-naïve patients with panic disorder

Reported findings on reactivity to stress of the sympathetic-adreno-medullar (SAM) and hypothalamic-pituitary-adrenal (HPA) systems in panic disorder (PD) are very variable. This inconsistency may be explained by differences in treatment exposure, illness duration and emotion regulation strategies. The present study examined the reactivity to mental stress of the SAM and HPA axes in a sample of first episode, drug naïve patients with PD which avoids confounds of medications exposure and illness chronicity. Activation of the SAM axis was evaluated by dosage of salivary alpha-amylase (sAA) and heart rate. Activation of the HPA axis was tested by dosage of salivary cortisol. Psychological assessments were done by the Self-Rating Depression Scale, the Self-Rating Anxiety Scale, the State-Trait Anxiety Inventory, the Cope Orientation to Problems Experienced (COPE) Inventory and the 16 Personality Factor Questionnaire (16PF). Patients showed reduced sAA stress reactivity, higher baseline cortisol levels and a more rapid decrease in stress cortisol levels as compared with controls. A significant correlation was found between active coping strategies and cortisol levels (response to stress). The findings suggest that blunted SAM stress reactivity and a rapid decrease in stress cortisol levels reflect traits that may enhance vulnerability to psychopathology in patients with PD.

Health Beliefs and Behaviour of Cervix Cancer Patients

When people fall prey to a chronic disease they develop their own formulations about the disease. Patients often hold a variety of beliefs about causes, consequences, control and outcomes of the disease. This study examines illness beliefs and health seeking behaviour of educated, uneducated, rural and urban women suffering from the cancer of cervix. A control group (of non–patients) was also studied. The findings revealed that individual and psychosocial causes were more strongly represented in the belief system of patients than environmental or supernatural causes. The perceived consequence of illness was negatively correlated with the degree of social support available to patients. Patients characterised by a high level of social support strongly believed that their disease was in control of either “self ” or “doctor”. They resorted more to “approach–coping” strategy, experienced lesser pain and severity of illness, and expressed greater hope for a disease free life than patients characterised by low social support.

Role of Coping Strategies and Social Support in Perceived Illness Consequences and Controllability among Diabetic Women

Interest in the processes by which people cope with stress has grown dramatically over the past decade. In the present study the role of coping strategies and social support in perceived illness consequences and illness controllability beliefs among diabetic women (n = 100) were studied. It was found that approach coping strategies reduced the severity of perceived illness consequences, whereas avoidance coping strategies increased the severity of perceived illness consequences. The approach strategies of coping were positively correlated to self and doctors’ control. The patients characterised by high level of social support felt less severe consequences of illness. These findings are discussed in the context of the current analyses of lay theories and also folk models of illness find due representation.

Coping strategies in a sample of anxiety patients: factorial analysis and associations with psychopathology

BACKGROUND

The relationship between coping styles and mental disorders has received considerable attention and instruments have been developed to assess coping strategies. The measurement by means of category systems has been criticized and a functional hierarchy of action types linked to the adaptive processes is preferred. We aimed to determine which factors may exist within the Brief-COPE (Brief Coping Orientation to Problems Experienced--COPE--Inventory) in an Italian sample of patients with anxiety disorders; and if these factors correlate with the severity of psychopathology or with other characteristics.

METHODS

A total sample of 148 patients was recruited. The Brief-COPE inventory, the Symptom Check List 90-Revised, the Penn State Worry Questionnaire, the Zung Anxiety Status Inventory and the Zung Self-Rating Anxiety Scale were administered.

RESULTS

Factor analysis of the Brief-COPE yielded nine factors accounting for 65.48% of the variance. Patients scored higher on Searching Support, followed by Acceptance, Changing Perspective, and Problem Solving. Associations between measures of psychopathology and factors of coping strategies, mostly Searching support and Avoidance, were found.

CONCLUSIONS

Data of the present study support a nine-factor structure of the Brief-COPE that includes five broad dimensions of coping. Psychopathology was mostly related to Searching support and Avoidance factors, showing that these strategies may reflect ineffective ways of coping; Problem solving and Changing perspective could be a valid approach to moderate anxiety/depression symptoms and psychopathology in general.

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.

Personality is of central concern to understand health: towards a theoretical model for health psychology

This paper sets out the case that personality traits are central to health psychology. To achieve this, three aims need to be addressed. First, it is necessary to show that personality influences a broad range of health outcomes and mechanisms. Second, the simple descriptive account of Aim 1 is not sufficient, and a theoretical specification needs to be developed to explain the personality-health link and allow for future hypothesis generation. Third, once Aims 1 and 2 are met, it is necessary to demonstrate the clinical utility of personality. In this review I make the case that all three Aims are met. I develop a theoretical framework to understand the links between personality and health drawing on current theorising in the biology, evolution, and neuroscience of personality. I identify traits (i.e., alexithymia, Type D, hypochondriasis, and empathy) that are of particular concern to health psychology and set these within evolutionary cost-benefit analysis. The literature is reviewed within a three-level hierarchical model (individual, group, and organisational) and it is argued that health psychology needs to move from its traditional focus on the individual level to engage group and organisational levels.

Avoidant coping in panic disorder: a yohimbine biological challenge study

Few studies have addressed whether the use of avoidance-oriented coping strategies is related to the development of panic in patients with panic disorder(PD). Self-report, clinician-rated, and physiological data were collected from 42 individuals who participated in a yohimbine biological challenge study, performed under double-blind, placebo-controlled conditions. Participants included 20 healthy controls and 22 currently symptomatic patients who met DSM-IV-TR diagnostic criteria for PD. Consistent with prediction, patients with PD who had higher perceived efficacy of avoidance-oriented strategies in reducing anxiety-related thoughts reported increased severity in panic symptoms during the yohimbine challenge condition as compared to the placebo. Further, patients with PD who had more fear of cognitive dyscontrol, cardiovascular symptoms, and publicly observable anxiety also reported increased severity in panic symptoms during the challenge. Healthy controls who had more fear of cardiovascular symptoms similarly reported increased severity in panic symptoms during the challenge. No effects were found for heart rate response to the challenge agent. These results provide support for the role of avoidance-oriented coping strategies and fear of anxiety-related symptoms as risk and maintenance factors in the development of panic symptoms, particularly within a biological challenge model.

The measurement of abnormal illness behavior: toward a new research agenda for the Illness Behavior Questionnaire

Abnormal illness behavior (AIB) refers to a maladaptive manner of experiencing, evaluating, or acting in response to health and illness that is disproportionate to evident pathology. The construct was originally informed by the sociological notions of the sick role and illness behavior. The present article provides a comprehensive review of the conceptual and empirical development of AIB with a detailed insight into the variety of illness contexts to which it has been applied using the Illness Behavior Questionnaire (IBQ). While the relevance of AIB continues to be demonstrated within the prescribed contexts of the chronic pain and psychiatric literatures, criticisms of AIB and its measurement have arisen when researchers have attempted to move beyond these contexts. In recognition of these criticisms, this article presents a new research agenda to address key limitations that currently impede the broader development and application of AIB. Most importantly, it is proposed that greater consideration needs to be given to the definition of AIB according to type of illness and for general community members without a current illness. The article concludes with comment on the potential practical implications of any future reconceptualization of AIB, including the need to reconsider the manner in which IBQ scores are derived and interpreted, and the need for caution when applying the label "abnormal" in specific illness contexts.

Chest pain and its importance in patients with panic disorder: an updated literature review

CONTEXT

Chest pain is a common symptom in primary care settings, associated with considerable morbidity and health care utilization. Failure to recognize panic disorder as the source of chest pain leads to increased health care costs and inappropriate management.

OBJECTIVE

To identify characteristics of the chest pain associated with the presence of panic disorder, review the consequences and possible mechanisms of chest pain in panic disorder, and discuss the recognition of panic disorder in patients presenting with chest pain.

DATA SOURCES

Potential studies were identified via a computerized search of MEDLINE and PsycINFO databases and review of bibliographies. MeSH headings used included panic disorder with chest pain, panic disorder with coronary disease or cardiovascular disorders or heart disorders, and panic disorder with cholesterol or essential hypertension or tobacco smoking.

STUDY SELECTION

The diagnosis of panic disorder in eligible studies was based on DSM criteria, and studies must have used objective criteria for coronary artery disease and risk factors. Only case control and cohort studies were included.

DATA SYNTHESIS

Although numerous chest pain characteristics (believed to be both associated and not associated with coronary artery disease) have been reportedly linked to panic disorder, only nonanginal chest pain is consistently associated with panic disorder (relative risk = 2.03, 95% CI = 1.41 to 2.92).

CONCLUSION

Chest pain during panic attacks is associated with increased health care utilization, poor quality of life, and phobic avoidance. Because the chest pain during panic attacks may be due to ischemia, the presence of panic attacks may go unrecognized. Ultimately, the diagnosis of panic disorder must be based on DSM criteria. However, once panic disorder is recognized, clinicians must remain open to the possibility of co-occurring coronary artery disease.

Anxiety sensitivity-physical concerns as a moderator of the emotional consequences of emotion suppression during biological challenge: an experimental test using individual growth curve analysis

Anxiety-related responding to, and recovery from, a 5-min 10% carbon dioxide-enriched air presentation among 80 participants with no history of psychopathology was examined. Half of participants were instructed to suppress challenge-induced emotional responses, whereas their matched counterparts were instructed to observe such responses. Responding from immediately post-challenge through a 10-min recovery period was analyzed as a function of Anxiety Sensitivity-Physical Concerns and experimental condition using individual growth curve modeling. Anxiety Sensitivity-Physical Concerns moderated the effect of suppression only on emotion valence during recovery. In terms of main effects, suppression resulted in increased heart rate during recovery and Anxiety Sensitivity-Physical Concerns was positively associated with post-challenge self-reported anxiety. Results are discussed in terms of the potential role of inhibition-oriented affect regulation processes in the etiology of panic disorder.

The role of anxiety level, coping styles, and cycle phase in menstrual distress

Using three samples, researchers investigated the relation between various anxiety levels, coping strategy use, and menstrual cycle phase to menstrual distress. In Studies 1 and 2, women low in anxiety sensitivity used more acceptance coping strategies and women high in anxiety sensitivity reported using more maladaptive coping strategies. In Study 2, women with medium anxiety sensitivity reported similar coping strategies to women low in anxiety. Menstrual cycle phase did not differentially affect coping strategy use in women varying in anxiety sensitivity levels in Studies 1 and 2. In addition to depressed mood emerging as a significant predictor of premenstrual distress in these two studies for all participants, avoidance coping for women high in anxiety sensitivity and problem-focused coping for women low in anxiety sensitivity were also significant predictors of premenstrual distress. In Study 3, during the premenstrual phase, women with panic disorder, compared to controls, reported using more avoidance coping whereas controls reported used more active coping and seeking social support for emotional and instrumental reasons. Results are discussed within a continuity model from high anxiety sensitivity to anxiety disorder for maladaptive coping and menstrual distress.

Coping strategies of panic and control subjects undergoing lactate infusion during magnetic resonance imaging confinement

The psychological reactions and coping strategies used in response to a behavioral contingency (confinement in a magnetic resonance imaging [MRI] scanner) during a biological challenge (sodium lactate infusion) were systematically studied in 13 subjects with panic disorder (PD) and 11 control subjects using the Claustrophobia Questionnaire (CQ) and the Revised Ways of Coping Checklist (RWCCL). All participants were able to successfully complete the experimental procedure. Findings suggest between-group coping strategy differences in response to general stressors, but relative convergence of coping strategies in response to the experimental procedure, with relatively greater emphasis on problem-focused coping approaches. These observations suggest that PD patients are able to engage in effective coping strategies in response to stressful but highly structured experimental situations. An overall pre-post MR scanning reduction in the fear of restriction but not suffocation was observed for the combined sample, primarily reflecting changes in the control group. Among PD subjects, higher levels of suffocation fears were maintained despite emergence of more problem-focused coping in the experimental situation.

Marital relationship and the treatment of panic disorder with agoraphobia: a critical review

The purpose of this paper is (1) to specify, among studies on the links between marital relationship and cognitive-behavioral treatment of panic disorder with agoraphobia (PDA), the conceptual and methodological limitations that may have produced inconsistent results in this field so far; and (2) to propose avenues of research that will help in remedying current weaknesses and answering important questions in this area. Following definition of PDA and a survey of its socioeconomic consequences, the authors examine results of the various ways research has tried to specify the links between marital relationship and the development, maintenance, and treatment of this disorder: the study of major life events before and after the onset of PDA, interpersonal problems and quality of marital relationship in the presence of PDA, the links between marital relationship and PDA treatment outcome, variability of experimental outcomes according to types of measure used to study these links, the effect of the spouse as co-therapist in PDA treatment, and the impact of a PDA treatment based on marital communication and problem-solving. Research hypotheses and methodological procedures are proposed to improve understanding of PDA and its treatment outcome.

Sobre o transtorno de pânico e a hipocondria: uma revisão

Introdução/Objetivos: A hipocondria é associada a diversos transtornos de ansiedade, sobretudo ao transtorno de pânico (TP). Estima-se que 50% a 70% dos pacientes com TP tenham sintomas hipocondríacos, e que 13% a 17 % dos hipocondríacos tenham TP associado. O presente estudo teve como objetivo revisar a literatura sobre as relações clínicas, fenomenológicas, cognitivas e psicodinâmicas entre o TP e a hipocondria, além de discutir aspectos conceituais e critérios diagnósticos. Métodos: A busca de artigos foi feita pelo sistema Medline entre 1990 e 2001, utilizando-se, como palavras-chave, transtorno de pânico, agorafobia, hipocondria e preocupações hipocondríacas. Resultados: Considera-se que há comorbidade com hipocondria no TP quando as preocupações com saúde não se restringem a sintomas das crises de pânico. Apesar de geralmente consideradas secundárias, vários pacientes com TP apresentam, antes da primeira crise, manifestações hipocondríacas que podem ser consideradas prodrômicas. A ansiedade pode gerar, num círculo vicioso, preocupações excessivas com saúde, auto-observação seletiva e antecipação do pior. Apesar do viés catastrófico comum, no TP sintomas autonômicos aumentam rapidamente até culminar num ataque, a catástrofe temida é iminente, com comportamentos de esquiva e busca imediata de socorro. Na hipocondria, temem-se doenças mais insidiosas, predominam comportamentos de hipervigilância e busca de reafirmação, as crenças são mais disfuncionais, é pior a relação médico-paciente e maior o foco de sensações erroneamente interpretadas catastroficamente. O medo patológico da morte e a alexitimia estariam presentes nos dois quadros. Conclusão: A sobreposição clínica entre TP/agorafobia e hipocondria é relevante, mas não completa. A relação entre os dois quadros é complexa e possivelmente bidirecional, um aumentando a vulnerabilidade ao outro. Há diferenças fenomenológicas identificáveis e relevantes, com implicações diagnósticas e terapêuticas.

Panic disorder with agoraphobia associated with dizziness: characteristic symptoms and psychosocial sequelae

The aim of this study was to assess the prevalence of symptoms of panic disorder in a representative community sample of people with dizziness and to compare the profile of those whose panic was consistently linked to attacks of dizziness with those in whom dizziness was just one of many, variable somatic symptoms of panic. Validated questionnaires assessing physical and psychological symptoms, occupational disability, and handicap were administered to 128 people reporting dizziness in an epidemiological survey. Nearly two thirds of the sample reported having panic attacks, and one in four met key criteria for panic disorder. People whose panic symptoms were consistently associated with dizziness reported higher rates of vertigo than those with panic unrelated to dizziness, and higher rates of fainting, agoraphobic behavior, and occupational disability than either comparison group. Explanation of perceptual-motor triggers for disorientation may increase the predictability of attacks, thus reducing vulnerability to dizziness-provoked panic.