Improvement of Quality of Life in Panic Disorder with Escitalopram, Citalopram, or Placebo (original) (raw)
Current Opinion in Psychiatry, 1998
A protocol for the assessment of panic disorder is developed. Deriving from a conceptualisation that panic disorder is one manifestation of a General Neurotic Syndrome, an assessment is outlined that covers measures of neurotic symptoms, the underlying vulnerability, diagnosis-relevant information, a treatment-sensitive assessment of panic and its consequences, and indices of panic-related symptoms and cognitions. Assessment of Panic Disorder 3 Assessing Panic Disorder 1 American Psychiatric Association: The diagnostic and statistical manual of mental disorders edn 4. Washington: Author 1994. 2 Page AC: Distinguishing panic disorder and agoraphobia from social phobia. J Nerv Ment Dis1994, 182: 611-617. 3 Fyer AJ, Mannuzza S, Chapman TF, Lipsitz J, Martin LY, Klein DF: Panic disorder and social phobia: Effects of comorbidity on familial transmission. Anxiety 1996, 2: 173-8. 4 Krystal JH, Deutsch DN, Charney DS: The biological basis of panic disorder. J Clin Psychiatry 1996, 57(Suppl.): 23-31. 5 Clark DM: Panic disorder: From theory to therapy. In PM Salkovskis (Ed.), Fronteirs of cognitive therapy 1996: 318-334. 6 Clark DM, Salkovskis PM, Öst L-G, Breitholtz E, Keohler KA, Westling BE, Jeavons A, Gelder M: Misinterpretation of body sensations in panic disorder. J Consult Clin Psychol 1997, 65: 203-213. Describes the development of a promising test (the Body Sensations Interpretation Questionnaire) and relates it to cognitive theories of the origins of panic disorder. 7 Kamieniecki GW, Wade T, Tsourtos G: Interpretive bias for benign sensations in panic disorder and agoraphobia. J Anx Dis 1997, 11: 141-156. 8 Maidenberg E, Chen E, Craske M, Bohn P, Bystritsky AB: Specificity of attentional bias in panic disorder and social phobia. J Anx Dis 1996, 6: 529-541. Assessment of Panic Disorder 12 9 Goldberg DA: A dimensional model for common mental disorders. Br J Psychiatry 1996, 30(Suppl): 44-49. A good discussion of the structure of neurotic symptoms. Presents a dimensional model, while also reviewing recent relevant research. 10 Lovibond PF, Lovibond SH: The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995, 33: 335-343. 11 Ormel J, Oldehinkel AJ, Goldberg DP, Hodiamont PP, Wilmink FW, Bridges K: The structure of common psychiatric symptoms: How many dimensions of neurosis?. Psychol Med 1995, 25: 521-530. 12 Page AC, Bennett K, Carter O, Smith J, Woodmore K: The Blood-Injection Symptom Scale (BISS): Assessing a structure of phobic symptoms elicited by blood and injections. Behav Res Ther 1997, 35: 457-464. 13 Zinbarg RE, Barlow DH: Structure of anxiety and the anxiety disorders: A hierarchical model. J Ab Psychol 1996, 105: 181-93. A thorough analysis of the structure of anxiety symptoms in adults. 14 Spence SH: Structure of anxiety symptoms among children: A confirmatory factor-analytic study. J Ab Psychol 1997, 106: 280-297. A thorough analysis of the structure of anxiety symptoms in children. Assessment of Panic Disorder 13 15 Andrews G: Comorbidity and the general neurotic syndrome. Br J Psychiatry 1996, 30 (Suppl): 76-84. An excellent review of the current status of the General Neurotic Syndrome. 16 Cassano GB, Michelini S, Shear MK, Coli E, Maser JD, Frank E:, The panicagoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms. Am J Psychiatry 1997, 154 (Suppl): 27-38. An interesting development in the conceptualisation of anxiety symptoms. They present an argument that contrasts with Andrews [18], suggesting that the personality vulnerability arises out of symptoms, rather than symptoms arising out of personality vulnerability. 17 Kendler KS: Major depression and generalised anxiety disorder. Same genes (partly)different environments-revisited. Br J Psychiatry 1996, 30 (Suppl): 68-75. 18 Hunt C, Andrews G: Comorbidity in the anxiety disorders: The use of a life-chart approach. J Psychiatr Res 1995, 29: 467-480. 19 Goldenberg IM, White K, Yonkers K, Reich J, Warshaw MG, Goisman RM, Keller MB: The infrequency of "pure culture" diagnoses among the anxiety disorders. J Clin Psychiatry 1996, 57: 528-533. 20 Gorman JM, Coplan JD: Comorbidity of depression and panic disorder. J Clin Psychiatry 1996, 57 (Suppl.): 34-41. 21 Leopola U, Koponen H, Leinonen E: A naturalistic 6-year follow-up study of patients with panic disorder. Acta Psychiat Scand 1996, 93: 181-183. Assessment of Panic Disorder 14 22 Andrews G, Stewart GW, Morris-Yates A, Holt P, Henderson S: Evidence for a general neurotic syndrome. Br J Psychiatry 1990, 157: 6-12. 23 Andrews G, Moran C: Exposure treatment of agoraohobia with panic attacks: Are drugs essential? In I, Hand H-U Wittchen (Eds.) Panic and phobias II: Treatment variables affecting course and outcome. Heidelberg: Springer-Verlag 1988: 89-99. 24 Brown TA, Chorpita BF, Korotitsch W, Barlow DH: Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther 1997, 35: 79-89. A comprehensive analysis of the DASS' psychometric properties. 25 Osman A, Kopper BA, Barrios FX, Osman JR, Wade T: The Beck Anxiety Inventory: Reexamination of factor structure and psychometric properties. J Clin Psychol 1997, 53: 7-14. 26 Eysenck HJ, Eysenck SBG: Eysenck Personality Questionnaire (Junior and Adult). Essex: Hodder Stoughton, 1975. 27 Page AC, Andrews G: Do specific anxiety disorders show specific drug problems?. Aust NZ J Psychiatry 1996, 30: 410-414. 28 Wittchen H-U: Critical issues in the evaluation of comorbidity of psychiatric disorders. Br J Psychiatry 1996, 168 (Suppl.): 9-16. 29 Scarvalone PA, Cloitre M, Spielman LA, Jacobsberg L, Fishman B, Perry SW: Distress reduction during the structured clinical interview for DSM-III-R. Psychiatry Res 1996, 59: 245-249. Assessment of Panic Disorder 15 30 Di Nardo PA, Barlow DH: Anxiety disorders interview schedulerevised. LH: The composite international diagnostic interview: An epidemiological instrument suitable for use in conjunction with different diagnostic systems and different cultures. Arch Gen Psychiatry 1989, 45: 1069-1077. 34 Shear MK, Maser JD: Standardized assessment for panic disorders research: A conference report. Arch Gen Psychiatry 1994, 51: 346-354. 35 Davidson JR: Quality of life and cost factors in panic disorder. Bull Menninger Clinic 1996, 60 (Suppl A): 5-11. 36 Ettigi P, Meyerhoff AS, Chirban JT, Jacobs RJ, Wilson RR: The quality of life and employment in panic disorder. J Nerv Ment Dis 1997, 185: 368-372. 37 Katerndahl DA, Realini JP: Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder. J Clin Psychiatry 1997, 58: 153-158.
Anchoring the Panic Disorder Severity Scale
Assessment, 2012
The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression–Severity Scale (CGI-S) and to extend its clinical meaningfulness by examining its association with quality of life. A total of 63 individuals with a primary diagnosis of panic disorder were assessed on completion of a 6- or 8-week psychotherapy or pharmacotherapy trial for the treatment of panic disorder. As expected, the PDSS was correlated with both the CGI-S and quality of life. These results provide further support for the validity and clinical utility of the PDSS and provide simple anchors to help guide the potential use of the PDSS scale to measure treatment progress in clinical practice.
Evidence‐based guidelines for interpretation of the Panic Disorder Severity Scale
Depression and Anxiety, 2009
Background-The Panic Disorder Severity Scale (PDSS) is promising to be a standard global rating scale for panic disorder. In order for a clinical scale to be useful, we need a guideline for interpreting its scores and their changes, and for defining clinical change points such as response and remission. Methods-We used individual patient data from two large randomized controlled trials of panic disorder (total n=568). Study participants were administered the PDSS and the Clinical Global Impression (CGI)-Severity and-Improvement. We applied equipercentile linking technique to draw correspondences between PDSS and CGI-Severity, numeric changes in PDSS and CGI-Improvement, and percent changes in PDSS and CGI-Improvement. Results-The interpretation of the PDSS total score differed according to the presence or absence of agoraphobia. When the patients were not agoraphobic, score ranges 0-1 corresponded with "Normal," 2-5 with "Borderline", 6-9 with "Slightly ill", 10-13 with "Moderately ill", and 14 and above with "Markedly ill." When the patients were agoraphobic, score ranges 3-7 meant "Borderline ill," 8-10 "Slightly ill," 11-15 "Moderately ill," and 16 and above "Markedly ill." The relationship between PDSS change and CGI-Improvement was more linear when measured as
Reliability and validity of the Panic Disorder Severity Scale: replication and extension
Journal of Psychiatric Research, 2001
The Panic Disorder Severity Scale (PDSS) is a recently developed seven-item instrument to rate overall severity of Panic Disorder. The scale has previously shown good psychometric properties in a sample of Panic Disorder patients with no more than mild agoraphobia. The purpose of this paper is to confirm reliability and validity, to provide an estimate of a cut-score discriminating the presence or absence of current DSM-IV Panic Disorder, and to determine the factor structure of the instrument. Procedures: 104 psychiatric outpatients, including 54 with current Panic Disorder, underwent structured diagnostic assessment and the PDSS interview. The PDSS was repeated within 3-17 days. Results: we confirmed reliability and validity of the instrument and found a one-factor solution fit the data. A cut-off score of eight identifies patients with current panic with a sensitivity of 83.3%, and a specificity of 64%. Conclusion: the PDSS is a simple, reliable instrument for use in Panic Disorder studies. A cut-score of eight may be useful as a tool to screen patients in settings such as primary care, for diagnosis-level symptoms. #
Multicenter Collaborative Panic Disorder Severity Scale
American Journal of Psychiatry, 1997
Objective: To address the lack of a simple and standardized instrument to assess overall panic disorder severity, the authors developed a scale for the measurement of panic disorder severity. Method: Ten independent evaluators used the seven-item Panic Disorder Severity Scale to assess 186 patients with principal DSM-III-R diagnoses of panic disorder (with no or mild agoraphobia) who were participating in the Multicenter Collaborative Treatment Study of Panic Disorder. In addition, 89 of these patients were reevaluated with the same scale after short-term treatment. A subset of 24 patients underwent two independent assessments to establish interrater reliability. Internal consistency, convergent and discriminant validity, and sensitivity to change were also determined. Results: The Panic Disorder Severity Scale was associated with excellent interrater reliability, moderate internal consistency, and favorable levels of validity and sensitivity to change. Individual items showed good convergent and discriminant validity. Analysis suggested a two-factor model fit the data best. Conclusions: The Panic Disorder Severity Scale is a simple, efficient way for clinicians to rate severity in patients with established diagnoses of panic disorder. However, further research with more diverse groups of panic disorder patients and with a broader range of convergent and discriminant validity measures is needed.
5-Year prospective, naturalistic follow-up study of panic disorder
Comprehensive Psychiatry, 1995
Ninety-nine patients with panic disorder (PD) not comorbid with other psychiatric disorders were evaluated for 5 years using a naturalistic prospective design. The probability of achieving full remission, albeit transitory, was 37.5%, whereas 72.8% of cases showed a consistent amelioration. However, among patients with an initial positive outcome, the probability of remaining well was 41.4% after 5 years. When the general course of the disorder during the follow-up period was considered, only 12.12% of the subjects had a complete and stable remission of symptoms, whereas 47.47% had a generally positive but not fully satisfactory amelioration either due to infrequent recur-rences of the illness or to chronic continuation of symptoms at a mild level. On the other hand, 40.40% of the subjects reported an overall poor outcome because of the presence of a recurrent pattern of illness (11.11%) or because the periods of well-being did not represent more than 40% of the time being considered (29.29%). Among the predictors taken into consideration, only duration of illness before intake showed a strict relationship with long.term outcome, with patients having a lesser duration of illness at the moment of the index episode showing a significantly better outcome.
Cognitive Behaviour Therapy, 2008
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