Asthma and panic attacks

Panic disorder (PD) and asthma share many common characteristics and have been found in epidemiological studies to be significantly comorbid. To investigate possible reasons for this overlapping, the authors evaluated 51 patients with asthma, assessing the prevalence of PD and sporadic panic attacks, the temporal relationship between these two disorders, and the familial risk for PD in the families of asthmatics. The results showed significantly higher prevalences of PD, sporadic panic attacks, and social phobia in asthmatics than those reported for the general population. In 9 (90%) of the asthmatics with PD, asthma appeared first. Finally, the morbidity risk for PD in families of asthmatics with PD (13.5%) was significantly higher than in families of asthmatics without evidence of panic (2%). Our results suggest that the high prevalence of PD in asthmatics might be related to a facilitating effect of asthma on the development of PD in subjects with familial predisposition to PD.     

Psychophysiology of relaxation-associated panic attacks.

Physiological changes preceding and accompanying panic attacks were observed serendipitously in 2 female anxiety-disordered patients (aged 33 and 34 yrs) who were relaxing during physiological assessment. Both Ss showed decreases in heart rate and frontalis EMG during relaxation, followed by sudden increases on both measures at the onset of panic. Hand-surface temperature showed a similar but less intense pattern of response. Possible mechanisms involved in this phenomenon are discussed, including involvement of the parasympathetic system or through proprioceptive or interoceptive conditioning. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Signal anxiety and panic attacks.

Describes the cases of a young married woman and a middle-aged single man with panic attacks to illustrate how failure to experience signal anxiety may occur even in cases of panic attacks that are psychologically as opposed to biologically generated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family characteristics of subjects with panic attacks

OBJECTIVE: Patients with panic symptoms are heavy users of the health care system, although many do not seek care specifically for those symptoms. This study documents utilization of various sources of health care of subjects with panic symptoms, including those who met criteria for panic disorder and those with infrequent panic, distinguishing between use specifically for panic symptoms and use for reasons not related to panic. METHODS: This community-based sample, predominantly Mexican American and female, included 97 subjects with panic symptoms and 97 matched control subjects with no panic symptoms. Data were collected on two-month utilization of various sources of health care both within and outside the mainstream health care system, barriers to access to care, and levels of medical insurance coverage. RESULTS: Subjects with panic symptoms had higher utilization rates for the services of psychiatrists and psychologists and for ambulance services than control subjects. Subjects who met criteria for panic disorder and who sought care specifically for panic symptoms generally accounted for the differences between the group with panic symptoms and the control group. The two groups differed little in barriers to access, but the control group reported that their medical insurance covered more types of services. CONCLUSIONS: Compared with control subjects, subjects with panic symptoms reported higher rates of health care utilization despite having less insurance coverage and experiencing similar barriers to access. The higher rate was due to increased utilization of health care by subjects who met criteria for panic disorder and to help seeking specifically for symptoms of panic.     

The adaptive capacities of patients with panic disorders (a psychophysiological study)

Contingent-negative deviation (CND) and orientational reaction (OR) were studied in 9 women suffering from typical (according to DSM-III-R) panic disorders (PD) and 12 healthy females. CND recording was made after giving neutral (70 dB, 1000 Hz) and stress (120 dB, 2000 Hz) pairs of sounds. Patients with PD were divided in two groups depending upon CND amplitudes. The first group (4 patients) was distinguished from healthy individuals by high CND amplitude (which significantly decreased after reaction on stress sound), by delay of extinction of cutaneogalvanic reaction (CGR) and by higher electromyogram amplitude. The second group (5 patients with more severe course of PD) was characterized by low amplitudes of CND and electromyogram, by absence of changes in CND after stress sound, by delay of extinction of CGR and nonspecific response. Above-mentioned data were evidence of psychophysiological heterogeneity of typical PD. The results were interpreted from a position of adaptive abilities of patients with PD, using ineffective and immature psychophysiological strategies of overcoming stress.     

Treatment of anxiety and panic attacks in geriatric psychiatry

For the treatment of anxiety disorders and panic attacks in elderly patients a multidimensional approach including pharmacotherapy, psychotherapy and behavioral modification is crucial. More than in younger patients side effects of drugs have to be taken into account. For the long-term treatment only a few psychotropic drugs are recommended. Useful substances are antidepressants including tricyclics and the newer class of SSRI. Buspirone may also play a role in the long-term pharmacotherapy of anxiety disorders. Neuroleptics, benzodiazepines and betablockers should only be prescribed after careful evaluation; by and large, they are of minor significance in the long-term strategy due to significant adverse effects. The pharmacological treatment should always be accompanied by psychotherapy. In particular, behavioral therapy and behavioral modification strategies are of benefit.     

Definitions of panic attacks and panic disorder in the DSM-IV: Implications for research.

The authors review various definitions of panic and recent conceptual and empirical evidence that led to the revised definitions of panic in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994). The DSM-IV definitions of panic are more precise and more empirically based than those contained in the DSM-III—R, but are designed primarily for clinicians rather than researchers. Thus, it is possible that definitions of panic used in research under the DSM-IV system will encompass a heterogeneous mix of emotional phenomena. Recommendations on essential components of a conservative definition of panic are proposed for research purposes. Implications of this definition for limited symptom attacks and "nonfearful" panic are elaborated and related to final definitions of panic attacks and panic disorder in the DSM-IV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of people with infrequent panic attacks.

186 adult Ss (aged 18–60 yrs) were asked to complete a specially created anxiety questionnaire (AQ) that assessed current levels of anxiety, frequency of panic attacks, and types of symptoms experienced during a panic attack. Ss also completed the SCL-90. Results show that 34.4% of Ss reported having had 1 or more panic attacks in the past year, and 2.2% reported having had 3 or more panic attacks in the past 3 wks, a frequency that could lead to a diagnosis of panic disorder. The panic symptoms reported as being most severe were heart pounding, trembling, and sweating. When Ss who reported having had 1 or more panic attacks (panickers) were compared with the nonpanickers on the SCL-90, it was found that the infrequent panickers scored signficantly higher on 6 of the 10 subscales. It is suggested that panic attacks often occur in presumably normal people and that these attacks are similar to those of patients with well-defined panic disorders (e.g., agoraphobia). (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and phenomenology of nonclinical panic attacks in adolescent girls

The genome of herpes simplex virus type 1 (HSV-1) strain 17+ contains ten HindIII and four XbaI restriction endonuclease (RE) cleavage sites. We have previously reported the isolation of an HSV-1 mutant, 1702, devoid of all the four XbaI sites. Here we report the isolation of HSV-1 mutants lacking seven of the HindIII sites plus the four XbaI sites. In order to destroy the various HindIII sites, mutagenic oligonucleotides were synthesized and introduced in to the plasmids containing HSV-1 restriction endonuclease fragments spanning these HindIII sites. All the seven HindIII sites were removed by site-directed mutagenesis. Two methods of site-directed mutagenesis were used: 1) the HindIII site at 0.91 map coordinates (mc) of HSV-1 strain 17+ genome was deleted using a gapped, heteroduplex molecule of DNA, and 2) uracil-rich single-stranded DNA templates were used in in vitro mutagenesis reactions to remove the HindIII sites at 0.08, 0.1, two at 0.18, 0.26 and 0.64 mc. These HindIII site deletions were then marker transferred back in to the 1702 genome to generate virus mutants devoid of specific HindIII sites. No other deletions and/or insertions were observed within the viral genomes of mutant viruses as allowed by restriction endonuclease analysis of their 32P-labelled DNAs. All the HindIII site-deletion mutants, 1721-1733, showed comparable growth properties and polypeptide profiles to those of the parental 17+ and 1702 viruses.     

The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress.

[Correction Notice: An erratum for this article was reported in Vol 107(3) of Journal of Abnormal Psychology (see record 2008-09589-001). The article contained an error in the scoring of the Anxiety Sensitivity Index (ASI). A data conversion error led to transformation of ASI scores that dramatically truncated this measure (scores of 0-2 recoded to 0, 3 receded to 1, and 4 recoded to 2). The corrected values (items scored 0-4), revised statistics, and amended conclusions are presented in the corrected text.] Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N?=?1, 401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicted versus unpredicted panic attacks: Acute versus general distress.

Acute and longer term effects of unpredicted and predicted panic attacks were examined in a sample of patients with panic disorder who self-monitored their panic attacks over a 2-week interval. The study assessed the degree to which experimental observations of the effects of predictability over aversive events are paralleled in the clinical phenomenon of panic. For patients who experienced predicted and unpredicted panics, daily ratings of anxiety and worry about panic increased the day following unpredicted panic attacks and decreased or stabilized the day following predicted panic attacks. These patterns were not replicated in patients who experienced only 1 type of panic; nor were these patterns influenced by the frequency with which panic attacks occurred. Acute distress indexes did not differ during predicted and unpredicted panics, although patients who experienced predicted panic attacks exhibited more pervasive agoraphobic avoidance. The findings are discussed in relation to the safety-signal theory of prediction and alternative conceptualizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic disorder and agoraphobia with panic attacks: Covariation along the dimensions of panic and agoraphobic fear.

Tested the validity of the distinction made in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) between the diagnoses of "panic disorder" and "agoraphobia with panic attacks" by examining the pattern of covariation between panic symptoms and agoraphobic fear in a group of individuals presenting with panic attacks as a prominent symptom. Ss were 17 patients (mean age 34.4 yrs) who had been diagnosed as having panic disorder and 56 patients (mean age 36.4 yrs) diagnosed as having agoraphobia with panic attacks, and who had completed at the time of diagnosis both the Fear Survey Schedule and the SCL-90-R. Analyses of the panic-related items and the agoraphobia-related items of these 2 inventories revealed that irrespective of diagnosis, the degree of panic was highly correlated with the degree of agoraphobic fear. Although panic patients tended to experience more severe panic and milder agoraphobic fear than agoraphobics, the groups overlapped with respect to both kinds of symptoms. Findings are discussed in terms of whether panic disorder and agoraphobia should be classified as qualitatively distinct conditions. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The clinical characteristics of panic attacks in adolescents with the cardiac form of the autonomic dystonia syndrome

Peculiarities of paroxysmal course of autonomic dystonia of cardiac type were studied in 148 juveniles aged 14-15 years. It was found that frequency of panic attacks was very high, i.e. they occurred in 67-92.4% of the cases in dependence on severity of the disease. Panic attacks had no definite clinical picture at the onset. However, as the intensity of the main clinical manifestation of the disease (chest-pain syndrome) increased they acquired clear-cut sympatho-adrenal or vago-insular direction. Short duration and incomplete nels are typical for panic attacks in these patients.     

Somatic symptoms and panic attacks: a retrospective study of learning experiences

To determine the clinical significance of ST-segment depression observed in paroxysmal supraventricular tachycardia (PSVT), we evaluated the 12-lead electrocardiogram (ECG) during spontaneous PSVT in 54 patients (27 men and 27 women: mean age +/- SD; 47 +/- 18 years), who came to our clinic for the treatment of PSVT. Coronary angiography was performed in 16 patients (16 to 74 years; mean = 50 +/- 18) and treadmill exercise testing was performed in 21 patients. A cardiac electrophysiological study was carried out in 24 patients. During PSVT, ST-segment score was calculated as the sum of the ST-segment depression in 12 leads. The correlations between the ST-segment score, PSVT rate and age of the patient were analyzed as follows: The most significant positive correlation was observed between the ST-segment score and the PSVT rate (r = 0.615, p < 0.000001). The next most significant correlation was found between the PSVT rate and the age of the patient (r = -0.500, p = 0.00011). A negative correlation was also observed between the ST-segment score and the age of the patient (r = -0.429, p = 0.0012). In 13 of 16 patients, coronary angiography did not reveal any significant (> or = 75% in area) stenosis. Exercise testing induced significant ST-segment depression in 3 patients, of whom two had significant coronary artery lesions. PSVT was due to atrioventricular reentry via an overt (n = 3) or concealed accessory pathway (n = 15), atrioventricular nodal reentry (n = 5) and sinus node reentry (n = 1). In conclusion, patients with a faster PSVT rate revealed more pronounced ST-segment depression than did those with a slower PSVT rate, possibly reflecting the modified repolarization process instead of coronary artery involvement.     

Treatment of posttraumatic stress disorder with comorbid panic attacks: Combining cognitive processing therapy with panic control treatment techniques.

A large proportion of patients who present for treatment of posttraumatic stress disorder (PTSD) experience comorbid panic attacks, yet currently available PTSD treatment programs do not address this problem. This report provides an initial evaluation of a newly developed treatment, multiple channel exposure therapy (M-CET), for comorbid PTSD and panic attacks. The treatment uses elements of cognitive processing therapy treatment for PTSD and elements of panic control treatment to target physiological, cognitive, and behavioral symptoms. Results suggest that M-CET may be a promising treatment program for a subset of PTSD patients who experience panic attacks. Preliminary guidelines for conducting M-CET in a group format with participants exposed to diverse traumatic events are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case study: Treatment of herpes genitalis phobia and agoraphobia with panic attacks.

A 25-yr-old woman with incapacitating hypochondriasis (disease phobia and conviction of being infected with herpes genitalis) for 4 yrs and agoraphobia with panic attacks for 2 yrs was well after 6 mo of treatment and at 14-mo follow-up. Agoraphobia was treated with a combination of desensitization in imagery, aided by relaxation training using electromyogram (EMG) and skin temperature biofeedback, followed by exposure in vivo. Hypochondriasis was treated by psychotherapeutic techniques and presentation of medical facts. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress": Correction to Schmidt et al. (1997).

Reports an error in "The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress" by Norman B. Schmidt, Darin R. Lerew and Robert J. Jackson (Journal of Abnormal Psychology, 1997[Aug], Vol 106[3], 355-364). The article contained an error in the scoring of the Anxiety Sensitivity Index (ASI). A data conversion error led to transformation of ASI scores that dramatically truncated this measure (scores of 0-2 recoded to 0, 3 receded to 1, and 4 recoded to 2). The corrected values (items scored 0-4), revised statistics, and amended conclusions are presented in the corrected text. (The following abstract of the original article appeared in record 1997-05214-001.) Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N?=?1, 401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of anxiety sensitivity to higher and lower order personality dimensions: Implications for the etiology of panic attacks.

The relation of anxiety sensitivity (AS) to personality dimensions has received little attention. In this study, 4 AS indexes were administered along with measures of personality, fears, and panic attacks to 220 undergraduates. At the higher order level, AS was positively correlated with negative emotionality (NE) but was largely unrelated to either positive emotionality or constraint. At the lower order level, AS was positively correlated with absorption and NE indexes. Most of these correlations were significant even among participants with no panic attack history. AS exhibited incremental validity above and beyond a number of personality variables, including absorption and trait anxiety, in the prediction of fears and panic attack history. These findings are consistent with the hypothesis that a propensity toward immersion in sensory experiences is a diathesis for panic attacks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity.

Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this study was to analyze pathways of change in theoretically distinct interventions using longitudinal, moderated mediation analyses. Method: Forty-one patients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of training aimed at altering either respiration (capnometry-assisted respiratory training) or panic-related cognitions (cognitive training). Changes in respiration (PCO?, respiration rate), symptom appraisal, and a modality-nonspecific mediator (perceived control) were considered as possible mediators. Results: The reductions in panic symptom severity and panic-related cognitions and the improvements in perceived control were significant and comparable in both treatment groups. Capnometry-assisted respiratory training, but not cognitive training, led to corrections from initially hypocapnic to normocapnic levels. Moderated mediation and temporal analyses suggested that in capnometry-assisted respiratory training, PCO? unidirectionally mediated and preceded changes in symptom appraisal and perceived control and was unidirectionally associated with changes in panic symptom severity. In cognitive training, reductions in symptom appraisal were bidirectionally associated with perceived control and panic symptom severity. In addition, perceived control was bidirectionally related to panic symptom severity in both treatment conditions. Conclusion: The findings suggest that reductions in panic symptom severity can be achieved through different pathways, consistent with the underlying models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)