On distinguishing types of panic (original) (raw)
The phenomenology of the first panic attack in clinical and community-based samples
Journal of Anxiety Disorders, 2014
The purpose of the study was to contrast first panic attacks (PAs) of patients with panic disorder (PD) with vs. without agoraphobia and to explore differences between first PAs leading to the development of PD and those that remain isolated. Data were drawn from a community survey (N = 2260 including 88 isolated PAs and 75 PD cases). An additional sample of 234 PD patients was recruited in a clinical setting. A standardized interview assessed the symptoms of the first PA, context of its occurrence and subsequent coping attempts. Persons who developed PD reported more severe first PAs, more medical service utilization and exposure-limiting coping attempts than those with isolated PAs. The context of the first PA did not differ between PD and isolated PAs. PD with agoraphobia was specifically associated with greater symptom severity and occurrence of first attacks in public. Future research should validate these findings using a longitudinal approach.
A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia
Comprehensive Psychiatry, 2016
Objective: The quality of life of individuals with panic disorder and agoraphobia can be improved by the alleviation of agoraphobia. In other words, examining panic disorder in terms of whether agoraphobia is present is crucial. The current study examined panic disorder from this perspective. Methods: Subjects were 253 patients who met the diagnostic criteria for panic disorder (lifetime) according to the Mini International Neuropsychiatric Interview (MINI). Of those patients, 179 had agoraphobia and 74 did not. Statistical analysis was used to examine gender differences in the presence (or absence) of agoraphobia, comorbidities, and the effects of the presence of agoraphobia (severity, assessment of depression, assessment of anxiety, and personality) in these patients. Results: Results indicated gender differences in the presence (or absence) of agoraphobia. Compared to patients without agoraphobia, significantly more patients with agoraphobia were female (p b .001), and had a higher prevalence of comorbidities. Patients with agoraphobia had a higher suicide risk (p b .05), more hypomanic episodes (current) (p b .05), and more frequent episodes of social phobia (p b .05). In addition, patients with agoraphobia had more severe panic disorder and a higher level of neuroticism, sensitivity to anxiety, and trait anxiety [PDSS-J, P&A, NEON: p b .01, ASI, STAI (Trait Anxiety): p b .05]. Conclusions: The current findings suggest that when treating a panic disorder, diagnosing the presence of agoraphobia is extremely important.
American Journal of Epidemiology, 1990
and W. W. Eaton. Risk factors for the onset of panic disorder and other panic attacks in a prospective, population-based study. Am J Epidemiol 1990;131:301-11. A total of 383 cases of incident panic attack were identified among 12,823 participants in the Epidemiologic Catchment Area Program over various 12-month periods in 1980-1983. These cases not phobia-stimulated were compared with 766 controls. Risk factors were examined for the onset of panic attacks, with attacks categorized as panic disorder, severe and unexplained panic attacks, or other panic attacks. Risk factors were also examined for the onset of attacks in which cardiovascular symptoms were experienced and those in which psychologic symptoms were experienced. Females were at greater risk than males for each category of attacks (relative odds ranged from 1.36 to 2.25). Persons aged 65 years or older were at lower risk than younger persons (relative odds, compared with 30-to 44-year-olds, ranged from 0.26 to 0.71). A history of cardiac symptoms, shortness of breath, depression or a major grief episode, drug abuse or dependence, alcohol abuse or dependence, and seizures were each strongly associated with panic attacks. A history of cardiac symptoms was more strongly associated with attacks in which cardiovascular symptoms were experienced than with attacks in which psychologic symptoms were experienced (relative odds, 8.36 vs. 2.23). A history of seizures was more strongly associated with attacks with psychologic symptoms than with attacks with cardiovascular symptoms (relative odds, 5.21 vs. 1.58).
A Prospective Study of Panic and Anxiety in Agoraphobia with Panic Disorder
British Journal of Psychiatry, 1992
The features of panic and anxiety in the natural environment were studied by prospective self-monitoring in 39 patients with chronic agoraphobia and panic disorder. Panics overlapped greatly with anxiety episodes but were more intense. Panics occurred more often in public places than did anxiety episodes, but had otherwise similar symptom profile, time of occurrence, and antecedents. Most panics surged out of a pre-existing plateau of tonic anxiety which lasted most of the day. Spontaneous panics were less frequent than situational panics and occurred more often at home but were otherwise similar. These findings do not support the sharp distinction between panic and anxiety in DSM–III–R, not its emphasis on spontaneous panic in classifying anxiety disorders. Thoughts of dying and ‘going crazy’/losing control accompanied only a minority of panic/anxiety episodes and seemed to be a product of intense panic rather than a cause.
BioPsychoSocial Medicine, 2012
Background: The place where a patient experiences his/her first panic attack (FPA) may be related to their agoraphobia later in life. However, no investigations have been done into the clinical features according to the place where the FPA was experienced. In particular, there is an absence of detailed research examining patients who experienced their FPA at home. In this study, patients were classified by the location of their FPA and the differences in their clinical features were explored (e.g., symptoms of FPA, frequency of agoraphobia, and severity of FPA). Methods: The subjects comprised 830 panic disorder patients who were classified into 5 groups based on the place of their FPA (home, school/office, driving a car, in a public transportation vehicle, outside of home), The clinical features of these patients were investigated. Additionally, for panic disorder patients with agoraphobia at their initial clinic visit, the clinical features of patients who experienced their FPA at home were compared to those who experienced their attack elsewhere. Results: In comparison of the FPAs of the 5 groups, significant differences were seen among the 7 descriptors (sex ratio, drinking status, smoking status, severity of the panic attack, depression score, ratio of agoraphobia, and degree of avoidance behavior) and 4 symptoms (sweating, chest pain, feeling dizzy, and fear of dying). The driving and public transportation group patients showed a higher incidence of co-morbid agoraphobia than did the other groups. Additionally, for panic disorder patients with co-morbid agoraphobia, the at-home group had a higher frequency of fear of dying compared to the patients in the outside-of-home group and felt more severe distress elicited by their FPA. Conclusion: The results of this study suggest that the clinical features of panic disorder patients vary according to the place of their FPA. The at-home group patients experienced "fear of dying" more frequently and felt more distress during their FPA than did the subjects in the other groups. These results indicate that patients experiencing their FPA at home should be treated with a focus on the fear and distress elicited by the attack.
"Panic Disorder and Its Underlying Causes: An In-depth Exploration"
Panic Disorder and Panic Atack, 2023
Panic Disorder (PD), classified as an anxiety disorder, presents as recurrent, unanticipated panic attacks characterized by intense fear and discomfort. This research work delves into the intricacies of PD and explicates its underlying causes. Drawing from clinical criteria and relevant scholarly literature, this paper examines the symptoms, impact on quality of life, subtypes, diagnostic criteria, and differentiation from other anxiety disorders. It explores the multifaceted origins of PD, focusing on four primary risk factors-temperament, environment,
An examination of levels of agoraphobic severity in panic disorder
Behaviour Research and Therapy, 1995
Based on the results of previous studies, several factors believed to be related to the development of agoraphobia were simultaneously assessed in 195 panic disorder patients (57 males, 138 females) with various levels of DSM-III-R-defined agoraphobia: none, mild, moderate, or severe. The four groups of patients significantly differed from each other on self-reports of phobic avoidance, although all the groups reported a similar type of panic attack. The four groups also did not significantly differ on catastrophic panic cognitions (e.g. fear of dying), fear of anxiety symptoms (anxiety sensitivity), or variables related to spontaneous panic. Neither severity or frequency of panic was predictive of severity of agoraphobia. The anticipation of panic only in relation to agoraphobic situations was predictive of severity of agoraphobia, followed by perceived lifestyle restrictions due to panic, and trait anxiety regarding ambiguous or novel situations. Regardless of level of agoraphobia, patients tended to avoid situations where they anticipated panic would occur, indicating that panic and agoraphobia do not share a unique or exclusive relationship. Panic disorder with various levels of phobic avoidance, rather than just agoraphobia, would appear to be a more valid diagnostic category.
Panic disorder: Assessment and treatment
Clinical Psychology Review, 1983
Current research on anxiety has supported the c~~s~fication qf panic disorder as a distinct clinical entity &hara~ter~~ed by spo?~taneo~~y o~cu?~~ng panic attacks in the absence of recognizable fear-provoking stimuli. The problems of psychological and medical differential diagnosis are reviewed. Psychodynamic, psychobiologGx1, and behavioral theories of panic disorder are reviewed and evaluated as to treatment outcome. Psychodynamic treatment is found to lack empirical support. While psychopharmacolog.caL treatmen,ts, such as tricyclic antidepressants, have proven successfuE in dealing with panic attacks associated with debilitating agor~~phob~a, treat~lent effects do not last. ~~~o~-eo~ler, the drugs do not appear to reduce anticipator anxiety, n key ,feature of panic disorder. Beh~v~~r~~ co~~~eptu~~iz~t~o~~, and treutment of panic disorder has been confined to panic in agoraphobia. It is suggested that CL cognitive-behavioral conceptualization could lead to fffective treatment of panic disorder. Anxiety, as a common basis of emotional distress, has always attracted a large amount of attention from mental health professionals. Beginning with Freud (19331 1965), who identified anxiety as the key pathological process in neurosis, the 20th century has seen biologists, psychiatrists, and psychologists invoke scores of theories and treatments to explain and control anxiety (Klein 8c Rabkin, 198 1; Lader, 1969; Lader & Marks, 1971). One of the greatest dif~c~~lties in understanding anxiety is that the term encompasses a diverse array of clinical manifestations. While all of these exhibit certain shared characteristics (e.g., sympathetic arousal and verbal report of discomfort), there also are distinguishing characteristics which permit differential diagnosis of anxiety subtypes. One of the more interesting and less understood subtypes is panic disorder (Barlow & Wolfe, 1981).
The substantive effect of variations in panic measurement and agoraphobia definition
Journal of Anxiety Disorders, 1989
The authors argue that "panic" as both a clinical concept and a phenomenological experience is not as easily identifiable as has been assumed. We posit three types of panic-situationally bound, situationally predisposed, and spontaneous-and argue that the faiiure of most measurement instruments to adequately distinguish between them results in unreliable data. We select psychopharmacological, epidemiological, behavioral, and treatment studies in which the definition and measurement of panic significantly affected substantive conclusions. Moreover, we show how alternative definitions of panic and agoraphobia could lead to different conclusions. PANIC MEASUREMENT AND AGORAPHOBIA Definition In 1894 Freud observed that anxiety can. .. erupt suddenly into consciousness without being called forth by any train of thought, and thus bring about an onriety-attack. An anxiety attack of this kind either consists of a feeling of anxiety alone without any associated idea, or associated with the nearest interpretation, such as sudden death, a stroke, or approaching insanity; or else the feeling of anxiety is combined with paraesthesias (similar to the hysterical aura); or finally, together with the feeling of anxiety there is an accompanying disturbance of any one or more of the bodily functions, such as respiration, heart's action, vasomotor innervation, or glandular activity.