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The objective of this study was to explore the level of personality organization in patients diagnosed with generalized anxiety disorder (GAD) and panic disorder (PD). The study comprised 86 patients undergoing treatment for GAD (n=46) and PD (n=40). Various tools were utilized for data collection including a Sociodemographic Data Collection Form, Personality Organization Diagnostic Form (PODF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A significant difference was observed between the GAD and PD groups regarding the PODF scores for mature defense, anxiety, and depression. However, no significant difference was observed in relation to the PODF identity total score and primitive defense scores. Furthermore, the quality of object relations and the overall level of personality organization according to the PODF did not display any significant differences between the groups. According to the BDI, comorbid depressive symptoms were detected in 67.4% (n=58) of the participants with GAD and PD. There was no significant difference in the PODF scores, quality of object relations, and the overall level of personality organization between the group with comorbid depressive symptoms and the group without it.These findings suggest that while the primary focus of therapeutic interventions should be on targeting the specific type of anxiety disorder, assessing the level of personality organization in patients with GAD and PD could add valuable insights to individual case understanding, selection of psychotherapy approaches, and the treatment process..

Objective: One of the METHODS used to assess autonomic nervous system dysfunction in the etiology of panic disorder (PD) is heart rate variability (HRV). HRV is controlled by the sympathetic and parasympathetic (vagal) branches of the autonomic nervous system and reflects the capacity of autonomic stimulation by the parasympathetic system. The aim of this study was to evaluate heart rate variability (HRV) time domain parameters based on twenty four hour holter ECG analysis among drug-naive patients with panic disorder (PD) without any other medical and psychiatric comorbidity., Method: The study group consisted of 41 patients with PD and 46 healthy controls. Participants were evaluated with SCID-1 for psychiatric diagnoses. Then Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Panic Disorder Severity Scale (PDSS) and Clinical Global Impression Scale (CGI-S) were applied to participants. Twenty four hour Holter ECG outcomes were analyzed on a computer program and time domain parameters were evaluated., Results: Among the parameters analyzed from HRV, SDANN was significantly higher (p <0.001); duration of RMSSD, NN50 and pNN50 were lower in PD group than the control group (p = 0.003, p = 0.005, p = 0.047, respectively). In the correlation analysis, there was a moderate negative correlation between CGI-S and NN50 and pNN50. In logistic regression analysis, the increase in SDNN was found to increase the probability of PD by 1.11 (95% CI, 1.010-1.209); the increase in SDANN was found to decrease the probability of PD by 0.892 (95% CI, 0.818-0.973), and the increase in pNN50 was found to decrease the probability of PD by 0.523 (95% CI, 0.342-0.801)., Conclusion: The data obtained in our study confirm that there is a decrease in some HRV parameters like RMSSD, NN50 and pNN50 reflecting parasympathetic activity among patients with PD.

Objective: Panic disorder (PD) is now recognized as a common and important problem in children, and particularly adolescents, and one that can negatively affect daily well-being and educational performance. The aim of this study was to investigate the relationship between heart rate variability (HRV) and the severity of symptoms before and after treatment with psychotherapy and fluoxetine. Methods: The PD study group consisted of 23 children diagnosed with PD and the healthy control (HC) group comprised 27 healthy children. Panic-anxiety symptoms were measured using 2 assessments performed before and after treatment. HRV was evaluated with a 24-hour Holter examination. Results: According to the analysis of the 24-hour, all-day Holter device recordings, the high frequency (HF) and parasympathetic (%) scores in the PD group were lower than those of the HC group (p

Dissociative symptoms can be observed in non-clinical populations and various clinical cases without meeting the criteria for a distinct clinical diagnosis. These symptoms are associated with poor prognosis and poor response to both pharmacological and psychotherapeutic interventions in panic disorder. As dissociative experiences have strong relationships with early traumas and those experiences can be considered as a maladaptive coping strategy with negativelyloaded emotions, this study aimed to test the mediating role of alexithymia on the relationship between childhood traumas and dissociative symptoms. Through those purposes, 87 participants (56 female, 31 male) aged between 20-50 (35,71±11,02) who were diagnosed with panic disorder, had no comorbid psychiatric disorderswere volunteered and administered Demographic Information Form, Dissociative Experiences Scale, Childhood Trauma Questionnaire and Toronto Alexithymia Scale (TAS-20). Data was analyzed usingthe SPSS 21 program and PROCESS macro plugin. The findings showed that the difficulty in identifying the feelings sub-dimension of alexithymia mediated the relationships between all childhood trauma sub-dimensions, except for sexual abuse and dissociative symptoms. The results underlined the importance of considering unresolved early traumas and processing emotions with panic-disordered patients presenting dissociativesymptoms in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to perform a systematic review and meta-analysis on whether patients with panic disorder (PD) and their healthy first-degree relatives have an increased sensitivity to carbon dioxide inhalation test compared to healthy controls (HC) or patients with psychiatric disorders other than panic disorder., Method: The databases of PubMed, EMBASE and PsycNET were searched using Boolean operators "panic AND carbon dioxide" and "panic AND CO2". Selected research articles were classified according to the carbon dioxide concentrations used in testing and the clinical characteristics of the samples. The assumption of heterogeneity across the studies was assessed by chi square based Q and I2 statistics. Publication biases were explored by Begg-Mazumdar's and Egger's tests in addition to funnel graphics. Odds ratios representing effect size of the carbon dioxide inhalation procedure were calculated according to fixed effect and random effect models after obtaining percent weight effects of each study., Results: Meta-Analysis was conducted on 33 research studies that include 2114 participants totally. Participants with PD experienced significantly more frequent panic attacks (PA) compared to HC following in both 5% (OR=14.713, 95% CI 7.532 - 28.739) and 35% carbon dioxide inhalation (OR=11.507, 95% CI 7.775 - 17.031). HC who have a first-degree relative with PD experienced PA approximately 3 times more than HC who have not a first-degree relative with PD (OR=2.658, 95% CI 1.678 - 4.212) following carbon dioxide inhalation test. Participants with PD experienced significantly more frequent PA than the patients with other psychiatric disorders following the carbon dioxide inhalation test (OR = 3.524, 95% CI 1.945 - 6.384)., Conclusion: There is an increased sensitivity of carbon dioxide inhalation in patients with PD and their healthy first-degree relatives. The role and possible mechanisms of carbon dioxide in etiology and physiopathology of PD should be studied extensively.

This study aims to review empirical studies that evaluate effectiveness of cognitive-behavioral group therapy programs for treatment for panic disorder. Articles in English and Turkish that were published between the years of 2000 and 2015 (February) have been searched in the national and international databases. The articles that were not therapy effectiveness studies, and group therapies that not based on cognitive behavioral approach were eliminated. The remaining 19 studies that were met the criteria were introduced in terms of method, therapy characteristics and results. The results of the studies showed that cognitive behavioral group therapies have similar efficacy with individual cognitive behavioral therapy on panic disorder symptoms (panic attacks frequency, the level of agoraphobia etc.) and comorbid disorders (depression, anxiety sensitivity). However, cognitive behavioral group therapy is more cost-effective. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(Supplement 1): 79-94]

Purpose: Panic Disorder is a common psychiatric condition which is higher risk for substance abuse, suicide attempts and functional disability. It is 2 and ndash;3 times more common in women and estimated to range from 1,4% to 3,8% of the general population. Studies reported that quality of life in Panic Disorder is negatively affected and overall health (emotional and psyhical health), social activities, risk of unemployment increases. The aim of this study was investigate the affects of quality of life on panic disorder and depression and follow the treatment response after the 3 months. Material and Methods: 22 women and 9 men (total 31) within in age range of 20-73(mean age 40,3+/-12,9) diagnosed as Panic Disorder; 27 women and 15 men (total 42) within in age range of 18- 57(mean age 33,6 +/-11,5) diagnosed as Panic Disorder with Agoraphobia; 54 women and 19 men (total 73) within in age 20-69(mean age 38,5 +/-11,7) diagnosed on Major Depression were included to study.Psychiatric interview were carried out using Structured Clinical interview for Diagnose(SCID-I), Sociodemographic Data Form, Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale(HAM-D), Panic and Agoraphobia Scale and Endicott's Work Productivity Scale (EWPS) were applied in 0.,1.,3. months. Results: Quality of life had negatively affected in all of the groups. In this study we found significant impairment in pain, general health, energy, social function, emotional role disability and mental health subgroups of quality of life scale (SF and ndash;36) in Depression group than Panic Disorder group. Panic Disorder with Agoraphobia had affected the quality of life worse than comparison with Panic Disorder without Agoraphobia. Conclusion: At the end of the treatment, there were no differences in quality of life between all of the groups statistically. [Cukurova Med J 2015; 40(2.000): 288-297]

Objective: The aim of this study is assessment of sexual dysfunction in female patients with major depressive disorder and panic disorder and compare the two groups. Methods: Total 76 female patients with primary diagnosis of major depressive disorder ( 46 patients) and panic disorder ( 30 patients) according to DSM-IV, who is sexually active and not use psychotropic medication were inclued. Sociodemographic data aqcusition form and the Arizona Sexual Experiences Scale (ASEX) were administered to all patients. The study was carried out retrospectively by analyzed patient files. Results: According to the suggested criteria to identify any sexual dysfunction in the original form of Arizona Sexual Experiences Scale, sexual dysfunction is determined to be more frequent in major depressive disorder group than panic disorder group. Arizona Sexual Experiences Scale sub-item score assessing sexual desire and Arizona Sexual Experiences Scale total score is significantly higher in major depressive disorder patients than panic disorder patients. Conclusion: Sexual dysfunction is frequent both in major depressive disorder patients and panic disorder patients. In female major depressive disorder patients any of sexual function and sexual dysfunction can be said to be more affected than in panic disorder patients. In depressive patients, especially sexual desire, is disrupted more significantly than patients with panic disorder. [JCBPR 2014; 3(2.000): 94-98]

Objective: Health anxiety is the fear of being or getting seriously sick due to the misinterpretation of physical symptoms. Severe health anxiety is also named as hypochondriasis. Belief of having a disease due to the misinterpretation of physical symptoms is also seen in panic disorder and somatization disorder. The aim of this study is to search the health anxiety in panic disorder, somatization disorder and hypochondriasis and compare it with healthy volunteers. Method: SCID-I was used to determine psychiatric disorders in patient group. In order to assess the clinical state and disease severity of the patient group; Panic and Agoraphobia Scale, Hamilton Anxiety Rating Scale, Inventory of Depressive Symptomatology were used for patients with panic disorder and Symptom Interpretation Questionnaire, Hamilton Anxiety Rating Scale, Inventory of Depressive Symptomatology were used for patients with somatization disorder and hypochondriasis. Brief Symptom Inventory was used to assess psychopathology in healthy group. In order to evaluate health anxiety of both groups, Health Anxiety Inventory-Short Form was used. Results: Results of this study support that health anxiety is a significant major component of hypochondriasis. On the other hand, health anxiety seems to be common in panic disorder and somatization disorder. Health anxiety also may be a part of depression or present in healthy people. Conclusion: Further studies are needed in order to search how to manage health anxiety appropriately and which psychotherapeutic interventions are more effective. [JCBPR 2012; 1(1.000): 43-51]

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Objective: The present study, is aimed to investigate the distributiondispersion of panic attack symptoms, the possible subtypes of panic disorder, and the clinical features related to these subtypes in patients with panic disorder., Material and Methods: The study included 105 patients that presented to the Ondokuz Mayıs University Faculty of Medicine Psychiatric Outpatient Clinic and met the DSM-IV-TR diagnostic criteria for panic disorder. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), Panic Attack Symptom Checklist (PASC), Structured Clinical Interview for DSM-III-R (SCID-II), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Panic Disorder Severity Scale (PDSS), and Panic and Agoraphobia Scale (PAS) were administered to all the patients. This study examined the correlation between clinical scales and the factors based on factor analysis using PASC., Results: The 3 most frequently observed symptoms during panic attacks were palpitation, sensations of shortness of breath, and sensation of choking, and the 3 most severe were palpitation, chest pain, and sensation of shortness of breath. The 3 most frequently observed non-DSM-IV-TR symptoms were feeling of discomfort, dry mouth, and blurred vision. As a result of our analysis, 3 factors were defined: respiratory-circulatory, cognitive, and autonomic. Panic attack severity, panic attack frequency, and grade of agoraphobia were strong predictors of the respiratory-circulatory subtype; anticipatory anxiety was a strong predictor of the cognitive subtype. Grade of being anxious for health was stronger predictor for respiratory-circulatory subtype, predictor for the "autonomic" subtype, and a reverse predictor for the cognitive subtype., Conclusion: It should be considered that the panic attack symptoms in DSM-IV-TR are insufficient to determine the panic disorder subtypes that are based on symptom profiles. The determination of subtypes could contribute in prognosis of disorder and studies about treatment methods.

Introduction: The attachment processes give us a theoretical frame work to understand the psychopathological development. Unsafe attachment type is often associated with the emergence of psychopathology in the later periods of life., Method: This study includes 65 patients from psychiatry outpatient clinic with a diagnosis of panic disorder and 65 healthy volunteers as a control group. In order to determine clinical status and disease severity of patients with panic disorder according to SCID-I (Structured Clinical Interview for DSM Disorders-I) Panic-Agoraphobia Scale, Adults Separation Anxiety Scale, Relationship Scale Questionnaire were used., Results: Separation anxiety levels showed statistically significant difference among panic disorder group and control group. According to means of attachment style solely obsessive sub-dimension showed statistical significance difference among the two groups. In panic disorder group separation anxiety showed significant difference according to gender and the presence of agoraphobia. When attachment styles of patients with an early parent loss or divorce of parents assessed anxious and obsessive sub-dimensions the difference were found to be statistically significant., Conclusion: High Comorbidity of panic disorder (dominantly coexisting with agoraphobia) and adult separation anxiety was observed. This comorbidity was even higher in females. In both groups obsessive attachment style was the highest among the attachment styles. In patients with panic disorder there was no significant correlation between adult separation anxiety and/or existence of agoraphobia and attachment styles. Coexistence of adult separation anxiety and panic disorder was found to result in higher depression comorbidity rates.

Objective: Adenosine deaminase and dipeptidyl peptidase IV are enzymes connected to T cells that play an important role in immune system functioning. In this study, in order to understand the immune processes in panic disorder, we determined the serum levels of adenosine deaminase and dipeptidyl peptidase IV in medication-free panic disorder patients and compared them to those of healthy controls., Method: Enzymes levels were determined in blood samples of 24 healthy controls and 33 panic disorder patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV that were medication free during the previous month and medically healthy., Results: Levels of both enzymes were significantly higher in panic disorder patients than in the controls (P<0.001 for adenosine deaminase and P<0.05 for dipeptidyl peptidase IV). The levels of the enzymes did not correlate with sociodemographic variables, duration of the disorder, presence of agoraphobia, presence of stressors, number of panic attack symptoms, and Hamilton depression and anxiety rating scale scores. In addition, the 2 enzymes? levels did not correlate with each other. There was a correlation between Hamilton anxiety rating scale score and the number of panic attack symptoms (P<0.001); however, Hamilton anxiety rating scale scores were not correlated with the other variables., Conclusion: Our results suggest that there may be a primary or secondary impaired immune state in the course of panic disorder, as there is in many other psychiatric disorders, such as major depression. Future studies with larger samples are needed to clarify the relationship between the immune system and panic disorder.

Introduction: Schema therapy (ST) is a form psychoterapy combining existential, cognitive-behavioral, psychodynamic and object relation techniques that was developed by Jeffrey Young for personality disorders and severe behavioral pathology which are resistant to other therapy techniques . Altough the technique was originally developed for axis II disorders, in recent years there are studies proving it also being effective in axis I disorders. In this paper we report the schema formulation of a female patient who had an axis I panic disorder with B class personality and chronic life problems. Case: 36 years old female patient with collage degree. She was introduced to the clinic with severe panic attack symptoms which had been effecting her functionality. We started schematherapy for the patient as she had no improvement on her panic disorder symptoms with medical treatment due to her maladaptive schemas and schema modes thet she had used frequently. Her panic attack symptoms dissappeared during the advanced sessions of the treatment as her maladaptive schemas and the schema modes she had been using were emphasized during schema therapy, even though her personal interaction problems continued to exist. She started to deal with life stressors and was able to pacify herself. Discussion: Early maladaptive schemas and inadaptive ways of behaviors that has been developed by patients to handle these schemas may underly the axis I disorder symptoms such as anxiety, depression, drug abuse and psychosomatic disorders. As we look have a look at our patient, it can be said that her seperation with parents before elementary school may have led to her schemas of desertion and distrust and also teacher being over guarding at the levels of harming sovereignty to compensate the absence of the parents forms the basis of schemas of dependence / incompatence, being harmed and weakness against ilnesses. These schemas may be the reason of the patient's inability to handle certain life problems that may be triggering her panic attack symptoms. Schema therapy led to awareness of the patient about her schemas. Patient who had been thought of more functional ways coping instead of inadaptive ways was free of her panic attack symptoms which were resistant to medical treatment. The schema therapy proceess that has been going on with our patient is a good example for schema therapy that was originally developed for treatment for axis II disorders may also be effective for axis 1 disorders. [JCBPR 2014; 3(2.000): 109-115]

Introduction: In this study, probable differences in affective temperament among anxiety disorders were investigated via a comparison of panic disorder (PD) and obsessive-compulsive disorder (OCD). Method: 44 patients with OCD and 42 patients with PD, who were admitted to Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery outpatient clinics with complaints of OCD and PD and were diagnosed according to DSM IV criteria, were consecutively included in the study after informed consent was taken. A sociodemographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory, Panic and Agoraphobia Scale, Yale- Brown Obsessive-Compulsive Scale (Y-BOCS) and the temperament evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were given to the patients. PD and OCD patients were compared in terms of affective temperament characteristics. Results: Mean age, educational status and gender distribution of OCD and PD patients were similar (p>0.05). Dominant depressive temperament was more prominent in OCD group than in PD group (p=0.021). Hyperthymic temperament scores were higher in PD group than in OCD group (p=0.002). Dominant hyperthymic temperament was not encountered in either group. Conclusion: Dominant depressive temperament was more prominent in OCD group whereas hyperthymic temperament scores were higher in PD group. These findings should be evaluated in studies with larger sample sizes. [ABSTRACT FROM AUTHOR]

Panic disorder is an anxiety disorder that involves recurrent panic attacks, which emerge when a harmless stimulus is interpreted as "catastrophic". In an attempt to avoid the panic attack or prevent confrontation, the patient exhibits a dysfunctional attitude and behavior, such as evasion and safety-seeking behavior (SSB). Dysfunctional behavior leads to an increase in the recurrence of panic attacks and affects the patient's life in a negative way. According to the cognitive behavioral therapy model, SSB contributes to the continuation of unrealistic beliefs (e.g. physical experiences) regarding and prevents the patient from grasping new information that may potentially contradict the unrealistic cognitions. In this paper, we present a case with a primary diagnosis of panic disorder. Interestingly, this patient developed diabetes mellitus (DM) type 2 and psychogenic polydipsia (PPD) as a consequence of his SSB. PPD is a common occurrence in patients with psychiatric disorders, especially in schizophrenia. Up to now, no case of a panic disorder with either DM or PPD has been reported in the literature. While it is accepted that major depression poses a risk for DM type 2, panic disorder may also increase this risk. Treatment of the panic disorder with cognitive behavioral therapy (CBT) resulted in improvement of PPD and DM type 2. In conclusion, the role of SSB in medical disorders accompanied by psychiatric disorders should be kept in mind when treating these patients.

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Objective: Panic disorder is a psychiatric disorder whose properties of diagnosis were well-determined, can be classified in anxiety disorders. Recently, in neuroimaging studies, some abnormalities that may be related to the signs and symptoms of the disease have been shown. In our study we aimed to investigate the morphometric alterations of caudate nucleus in panic disoerder patients to understand the pathophsiology. Material and Method: The study comprised 20 panic disordered patients who had applied to Firat University Hospital Department of Psychiatry as out- or in- patients and had been diagnosed with panic disorder according to the criteria of DSM-IV and 20 healthy controls. The patients were administered the sociodemographical data form, Hamilton Depression Rating Scale, Hamilton Anxiete Rating Scale and SCID. The volumetric measurement of total brain, gray matter, white matter, caudate nucleus was performed on patients and control group by using MRI. Results: For the whole brain volume, total white and gray matter volumes, there were no differences observed between the patients and healthy controls while the patient group had significantly smaller left and right caudate nucleus volumes compared with healthy controls. Conclusion: This can be considered caudate nucleus has an important relationship with both pathophysiology and clinical course of the disease. We suggest that the investigations which use together the visualisation technique that examine the functional qualifications of this area and the tests research the cognitive functions, make us to provide to reach more important and effective results. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study aimed to assess the reliability and validity of the Turkish version of the DSM-5 Panic Disorder Severity Scale-Child Form. Method: Study group consisted of 34 patients that have been treated in a child psychiatry unit and diagnosed with panic disorder and 100 healthy volunteers that were attending middle or high school during the study period. For assessment, Screen for Childhood Anxiety and Related Emotional Disorders (SCARED) and DSM-5 Panic Disorder Severity Scale- Child Form were used. Results: Regarding reliability analyses, Cronbach alpha internal consistency coefficient was calculated as 0.912 while item- total score correlation coefficients were measured between 0.520 and 0.810. Test-retest correlation coefficient was calculated as r=0.562. As for construct validity, one factor that explained 56.9% of the variance was obtained. As for concurrent validity, the scale showed a high correlation (r=0.702 p<0.0001) with panic disorder subscale of screen for child anxiety and related emotional disorders (SCARED). In ROC analysis, area under ROC curve was calculated as 0.947. Conclusion: It was concluded that Turkish version of the DSM-5 Panic Disorder Severity Scale - Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes. [ABSTRACT FROM AUTHOR]

Objective: This study is to demonstrate the reliability and validity of the Turkish form of Panic Disorder Scale dev- eloped according to DSM-5 criteria to measure the severity of panic disorder. Methods: This study was carried out with patients with a diagnosis of any anxiety disorder according to DSM-5 criteria who are under treatment in Celal Bayar University Faculty of Medicine Psychiatry Inpatient or Outpatient Clinics. Patients with any mental or physical disease except for anxiety disorders were excluded. Accordingly, 50 patients with anxiety disorder were included in the study and these were distributed as panic disorder in 14 patients, generalized anxiety disorder in 10 patients, agoraphobia and obsessive-compulsive disorder in four patients, post-traumatic stress disorder in one patient and not otherwise specified anxiety disorder in 18 patients. As the healthy control group 103 volunteers without any mental or physical disease were included. Beside Panic Disorder Scale the most widely used self-rated scale, Spiel-berger’s State-Trait Anxiety Inventory was used for concurrent validity. In reliability analysis internal consistency coefficient and item-total correlation analysis; in validity analyses factor analysis and correlation analysis with the Spearman Correlation Analysis (SCA) was performed for validation. Results: The mean age of the study group was 29.0±11.8 years and 60.1% of the sample group (n=92) were female. 66.0% of the group were college gra-duates, 19.0% primary school graduates, 15.0% is also high school graduates. Disease duration of anxiety disorder group was 17.1±9.7 years. The internal consistency coefficient of the Panic Disorder Scale was 0.96 and, item-total correlation coefficients of the Panic Disorder Scale were between 0.68 and 0.88.In the exploratory factor analysis, for sample adequacy Kaiser-Meier-Olkin (KMO) coefficient was calculated as 0.92 and Bartlett coefficient was 1.57. Single-factor solution was obtained and the eigenvalue was 7.38, explaining 73.8% of the total variance. Factor loadings of the items were between 0.73 and 0.91. Coefficient of correlation analysis with SCA was calculated as r=0.32. Conclusion: These findings have been shown that the Panic Disorder Scale is reliable and valid for Turkish. [ABSTRACT FROM AUTHOR]

In the current case study, 11 sessions of Cognitive Behavioral Therapy process of a 19 years old male who had panic disorder symptoms according to DSM-5 was presented. Safety and avoidance behaviors of the client in order to cope with the acute panic attack symptoms were abolished with a behavioral approach, and the misinterpretations about his bodily sensations were changed with a cognitive approach. Homeworks based on exposure was planned for the other complaint of the client that was the fear of being alone at home. As a result of the treatment, the client realized that he did not experience the expected catastrophe in the lack of safety or avoidance behaviors. The treatment that included psycho-education about panic disorder, cognitive restructuring, exposure, breathing and relaxation exercises, supporting the expression of emotions and the outcome of the treatment was detailed in the light of the relevant literature. [ABSTRACT FROM AUTHOR]

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Objective: Assessment of the systemic inflammatory response of the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) is shown as a new biomarker. Red cell distribution width (RDW) is the size of red blood cells and have been found related to adverse events in many diseases. Mean platelet volume (MPV) indicates platelet volume and platelet volume is a potential indication of platelet activity. The aim of our study is to investigate hemato logical changes in patients with panic disorder (PD) through readily available markers such as NLR, PLR, RDW and MPV. Methods: Thirty-nine patients between the ages of 18 and 75 who were diagnosed with PD according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and forty healthy control subjects were included in the study. MPV, NLR, PLR and RDW were measured and recorded for groups. Hamilton Depression Scale, Hamilton Anxiety Scale, Clinical Global Impressions Scale (CGI-S) and Panic Disorder Severity Scale were applied to the patients. Results: There were no statistically significant differences between groups in terms of sociodemographic characteristics. No significant correlation was found between NLR, PLR and RDW values and clinical scales. MPV was negatively correlated with the severity of panic disorder. There was no correlation between MPV and other variables. Conclusion: Our study is the first study to examine NLR, PLR and RDW associations in PD patients. There are studies showing that increased sympathetic activity leads to increased MPV. In our study, the MPV value did not differ between PD and control group. However, there was a negative correlation between the severity of panic disorder and MPV. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to determine the difference between the symptoms of social phobia, and the sociodemographic variables among panic disorder (without agoraphobia) patients. For this aim, panic disorder patients was compared with participants who were not diagnosed any pscyhiatric disorders. Method: The research sample consist of 300 patients, 1 50 of them who diagnosed with panic disorder according to DSM-IV criteria and the other 150 of the participants who were not diagnosed any psychiatric disorders (compared group). The participants sampled from 3 psyciatry clinics. All of the participants were given a sociodemographic data form and the Liebowitz Social Anxiety Scale (LSAS). Results: According to the findings of this study, patients with panic disorder reported significantly higher LSAS social fear scores than the scores of the compared group. However, LSAS avoidance scores showed no statistically significant difference between the panic disorder patients group and the compared group. Additionally, within this study, some of the sociodemographic characterisics were found significantly different. Women have higher social fear scores than men. In the same way, low educated participants had higher social fear scores than high educated ones. These findings were consistent with the literature. Conclusion: Consequently, the results of this study highlight that panic disorder patients has higher comorbidity with social phobia rates than individuals who were not diagnosed any psychiatric disorders. Also, it was associated with some sociodemographic characteristics. The results of this study will discussed with previous findings in the literature. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the relationship between childhood physical/sexual abuse, suicide attempts, self-harming behavior and sexual functioning in patients with panic disorder. Method: 81 patients with panic disorder were included in the study. Participants were evaluated by using Childhood Trauma Questionnaire, sociodemographic form and Arizona Sexual Experiences Scale (ASEX). Results: The frequency of physical abuse history was 48.1% and the frequency of sexual abuse was 9.9% in the sample. Female participants with a history of physical abuse had significantly higher scores in the items of sexual desire, arousal, ability to reach orgasm, satisfaction from orgasm and total ASEX scores than those without a history of physical abuse. Female participants with a sexual abuse history also had higher scores in the items of arousal, ability to reach orgasm and total ASEX scores. No significant difference was found between male participants with regard to physical/sexual abuse history. In a regression model, comorbid major depressive disorder rather than abuse history was found to be a predictor of poor sexual functioning. Conclusion: Female patients with panic disorder who have physical/sexual abuse history have inhibited sexual desire, arousal and orgasm. Sexuality in patients with panic disorder is affected by depression comorbidity as well as sexual and physical abuse history. [ABSTRACT FROM AUTHOR]

Sleep disturbance is a common clinical problem in panic disorder. A few studies attempting to validate the subjective sleep complaints in panic disorder using polysomnography have demonstrated inconsistent results. Such discrepant polysomnography findings could be due to some additional confounding factors. Therefore, we aimed to investigate the sleep structure in a group of homogeneous patients with panic disorder. Fifteen non-medicated young adult male patients diagnosed to have panic disorder according to DSM-IV criteria were studied in the sleep laboratory on two consecutive nights. The sleep variables were compared with 13 age-and sex-matched healthy controls. The patients had decreased sleep efficiency and delta sleep, and moderately increased stage 1 and 2 sleep. These results demonstrate that delta sleep deficiency and disturbance in sleep continuity are mild in patients with panic disorder. [ABSTRACT FROM AUTHOR]

Although most patients with panic disorder readily respond to serotonin reuptake inhibitors, some patients are treatment resistant to standard pharmacological treatments. Switching to another antidepressant, drug combination and augmentation strategies were suggested to overcome the treatment resistance. There were few case reports in the literature addressing the usage of atypical antipsychotics in the treatment of resistant panic disorder patients. In the most of the cases, olanzapine were added to selective serotonin reuptake inhibitors. There is no report on augmentation therapy with quetiapine in patients with panic disorder. In this report we presented a patient with panic disorder and agoraphobia who responded well to quetiapine added to ongoing paroxetine treatment. [ABSTRACT FROM AUTHOR]

Objective: Metacognitions can be effective in occurrence and maintaining of mental illnesses. The objective of this study is to reveal the metacognitions in patients with panic disorder (PD) and to reveal the relations between metacognitions and clinical features in PD. Methods: Eighty-four patients with panic disorder and sixty-five healthy controls were enrolled to the study. Metacognition Scale (MCQ), Panic Agoraphobia Scale (PAS) and Beck Anxiety Inventory (BAI) were applied to PD patients. MCQ were applied to control group. Results: It was detected that PD patients, compare to healthy controls had more dysfunctional metacognitions and they were using more 'uncontrollability and danger' metacognition in large effect size, where as 'the need to control thoughts' in moderate effect size than healthy control. Significant mild degree positive correlation was found between total score of PAS and 'uncontrollability and danger' subscale of MCQ. In subscale of PAS only anticipatory anxiety was significantly correlated with metacognitions. This correlation was between anticipatory anxiety with 'uncontrollability and danger' and 'need to control thoughts' metacognitions in positive direction, mild degree. Also significant correlations between BAI with 'uncontrollability and danger,' and 'the need to control thoughts' and total score of MCQ were found. Discussion: Dysfunctional metacognitions were high in PD patients. In PD 'uncontrollability and danger' and 'need to control thoughts' have important role. There was a mild but significant correlation with these two metacognition and anticipatory anxiety. [ABSTRACT FROM AUTHOR]

Background: Cognitive models highlight the role of obsessive beliefs in the development of obsessive-compulsive disorder (OCD) and the prognosis. But some studies suggested that these beliefs are not specific to OCD; generally may be a common feature of anxiety disorders and depression. In these studies, anxiety disorders were not studied separately, but were used as mixed samples. This study aims to investigate obsessive beliefs only in patients with panic disorder. Method: In this study, we enrolled 101 patients who were diagnosed with panic disorder and 155 healthy volunteers. The patients were divided into two subgroups according to the cut-off point of the panic and agoraphobia scale (PAS) scores:, group 1 - with scores ⩽11 and group 2 - with scores ⩾12. Both subgroups and control group were compared for obsessive beliefs assessed with the Obsessive Beliefs Questionnaire-44 (OBQ-44) and also compared while evaluating the mixed effects of state-trait anxiety and depression. Results: Group 2 had higher total and subscale scores on OBQ-44 than group 1 and controls. Presence of agoraphobia made a statistically significant difference only for the "responsibility/threat estimation" subscale scores. When trait anxiety level was under control, significant difference was maintained for OBQ-44 subscales, while when state anxiety level and depression were under control, only "importance of thought/controlling thoughts" was statistically significant. Conclusion: Trait anxiety and depression affect all obsessive beliefs except for 'importance of thought/controlling thoughts' subscale of OBQ-44. We think that obsessive beliefs are not specific to OCD. Obsessive beliefs may have a common role in the development of trait anxiety and depression. We assume that further studies investigating obsessive beliefs in other anxiety disorders and depression might be enlightening. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine serotonergic system activity in patients with panic disorder and generalized anxiety disorder by investigating the responses of cortisol, dehydroepiandrosteronesulfate, and prolactin to escitalopram challenge. Method: Serum concentrations of cortisol, dehydroepiandrosteronesulfate, and prolactin were measured at baseline and after escitalopram administration in patients with panic disorder (n=24) and generalized anxiety disorder (n=21), and in healthy controls (n=20). Results: Hormonal responses to escitalopram administration in the patients with panic disorder and generalized anxiety disorder were found similar to those of the control group. The baseline dehydroepiandrosterone-sulfate levels were lower in patients with panic disorder and generalized anxiety disorder than those of the control group. Furthermore, dehydroepiandrosterone-sulfate levels were lower in women than those of men in both patients and control groups. Conclusions: There was no significant hormonal response to escitalopram in the patients and control groups, and there was no difference between the groups. The finding that basal dehydroepiandrosterone-sulfate level was lower in the patients with panic disorder and generalized anxiety disorder suggests that this hormone might play a role in the pathophysiology of these disorders. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the relationship between adult attachment dimensions and different types of psychopathologies. One hundred and four individuals who were diagnosed with depression, obsessivecompulsive disorder, or panic disorder; and 77 individuals who were not diagnosed with a psychopathology (i.e., control group) participated in the study. Participants completed self-report measures of adult attachment. All three disorder groups reported higher attachment anxiety as compared to the control group. Moreover, patients diagnosed with depression reported higher avoidant attachment as compared to the other disorder groups. A discriminant function analysis was conducted to test if adult attachment dimensions discriminate among different disorder groups and the control group. First function, which was defined by attachment anxiety, discriminated the control group from the three psychopathology groups and the second function, which was defined by attachment avoidance, discriminated the depression group from the other groups. These findings indicate that high attachment anxiety and avoidance emerge as risk factors to develop psychopathology. Possible mechanisms mediating the link between adult attachment and psychopathology are discussed in light of findings of the current study and cultural factors. [ABSTRACT FROM AUTHOR]

Objectives: Placing obsessive-compulsive disorder (OCD) among anxiety disorders in current diagnostic and classification systems has been an issue of discussion for many years. The purpose of this study is to compare OCD patients with panic disorder (PD) patients with regard to symptoms of eating disorders, which exist in so called "obsessive-compulsive spectrum". Method: 31 PD, 33 OCD patients were given sociodemographic information form, Eating Attitudes Test (EAT), Hospital Anxiety Scale (HAS), Hospital Depression Scale (HDS), Panic-Agorophobia Scale (PAS) and Maudsley Obsessive Compulsive Questionnaire (MOCQ), their heights and weights were evaluated and their body-mass index (BMI) was calculated, obtained data was compared by statistical analysis. Results: There was no statistically significant difference between two groups with regard to BMI, EAT, HAS, HDS. EAT scores of PD patients did not show any significant correlation with HAS, HDS, PAS (P>0.05). HAS, HDS and MS scores of OCD patients positively (r=.406, .392 ve .590) and significantly (p=0.000) correlated with EAT scores. Conclusion: These results show that, obsessive compulsive symptoms may be subclinically, but not clinically, related to eating attitudes pathology. A similar relation was not observed with panic symptoms, so it may be considered that OCD should be classified under a different subtype than PB and our results give further support to the concept of "obsessive-compulsive spectrum". [ABSTRACT FROM AUTHOR]

Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disorders. They present both categorical and dichotomous approaches to mental disorders. However, rigid usage of diagnostic criteria may cause high comorbidity rates. Moreover, these classification systems fail to identify subthreshold conditions, atypical signs and symptoms, and personality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are clinically meaningful in terms of disability and effects on quality of life. For these reasons, many researchers have begun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of panic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separation sensitivity, 2) panic-like symptoms, 3) stress sensitivity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypochondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.

Objective: To evaluate the differences in regional cerebral blood flow (rCBF) and rCBF asymmetry index values of panic disorder patients and a control group, using Tc99m-HMPAO SPECT. In addition, the influence of comorbid agoraphobia on the rCBF and rCBF asymmetry index values of the panic disorder patients was also investigated., Method: The rCBF and rCBF asymmetry index values of 22 panic disorder patients, 9 with agoraphobia and 13 without agoraphobia, and 19 healthy controls were obtained using SPECT. Both (1) the panic disorder and control groups and (2) panic disorder groups with and without agoraphobia were compared in terms of the measured values., Results: A decrease in blood perfusion in the bilateral frontal region, a relative increase in blood perfusion in the right medial frontal and right superior frontal regions and a relative blood flow increase in the right medial frontal region according to rCBF asymmetry index values were determined in panic disorder patients. In the patients with agoraphobia, the decrease in blood perfusion in the right occipital region, and the relative increase in the right superior temporal region according to rCBF asymmetry index values were significantly higher than those in subjects without agoraphobia., Conclusion: The decrease in the rCBF in the bilateral inferior frontal regions in panic patients may be related to the amygdala activation decreasing cerebral blood flow in the frontal region and/or the hyperactivation of the locus ceruleus. The explanations of the etiology of panic disorder are valid only if they are supported with clinical evidence from future studies.

Amaç: Çalışmamızın birincil amacı panik bozukluğu hastalarında çocukluk çağı travmalarının varlığını saptamak, ikincil amacımız panik bozukluğu hastalarında duygusal işlev bozukluğunun varlığını tespit etmek ve üçüncü amacımız panik bozukluğu hastalarında çocukluk travması ile duygu işlev bozukluğu arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem: Çalışmaya, DSM-5 kriterlerine göre çalışma kriterlerini karşılayan 80 hasta ve rastgele seçilmiş benzer sosyo-demografik özelliklere sahip 80 sağlıklı birey dahil edildi. Katılımcılara Panik Agorafobi Ölçeği, Çocukluk Çağı Travma Ölçeği (CTQ-28) ve Duygu Düzenleme Zorluk Ölçeği (DERS) uygulandı. Bulgular: Çalışmaya 18-53 yaş arası 80 hasta grubu ve 19-61 yaş arası 80 kontrol grubu dahil toplam 160 olgu dahil edildi. Hasta grubunda Duygusal Düzenleme Zorluk Ölçeği (DERS) ve Farkındalık, Açıklık, Anlaşmazlık, Stratejiler, Dürtü ve Amaç alt ölçeklerinin toplam puanı kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu. CTQ skoru ≥35 olanların oranı hasta grubunda %47.5 ve kontrol grubunda %26.3 idi, bu da hasta grubunda istatistiksel olarak anlamlı derecede yüksekti. Anlaşmazlık, Farkındalık, Amaç skorlarında yükselme hasta grubunda olmayı öngörmekte olduğu tespit edilmiştir. Sonuç: Etkilenen alanları hedefleyen farmakolojik ajanlar ve tedaviler ile çocukluk ve buna bağlı duygusal düzenleme güçlüklerinin panik bozukluğu hastaları üzerindeki olumsuz etkileri azaltılabilir. Tedavi başarısı ve yaşam kalitesi arttırılabilir.

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Introduction Studies generally indicate that panic disorder patients have reduced heart rate variability (HRV), diminished vagal tone and relative sympathetic dominance. Despite a consistent profile of reduced HRV in PD patients during daytime assessments, sleep-based HRV studies have yielded inconsistent results. For this reason, we aimed to investigate cardiac autonomic function in PD patients using polysomnographic records. Materials and Methods 15 non-medicated PD patients and 15 age- and sex-matched normal controls were studied on polysomnography on two consecutive nights. Data were extracted from the second night for analysis. Results Patients showed poor sleep efficiency, increased the number of the awakenings, and longer sleep latency than controls. Comparison of time domain and frequency domain HRV parameters between PD patients and control subjects revealed that there were no statistically significant differences. Discussion The results indicate that the sympathovagal balance might not be influenced in drug-free patients with panic disorder in the early stage of illness.

Background: Cognitive models highlight the role of obsessive beliefs in the development of obsessive-compulsive disorder (OCD) and the prognosis. But some studies suggested that these beliefs are not specific to OCD; generally may be a common feature of anxiety disorders and depression. In these studies, anxiety disorders were not studied separately, but were used as mixed samples. This study aims to investigate obsessive beliefs only in patients with panic disorder. Method: In this study, we enrolled 101 patients who were diagnosed with panic disorder and 155 healthy volunteers. The patients were divided into two subgroups according to the cut-off point of the panic and agoraphobia scale (PAS) scores:, group 1 - with scores ≤11 and group 2 - with scores ≥12. Both subgroups and control group were compared for obsessive beliefs assessed with the Obsessive Beliefs Questionnaire-44 (OBQ-44) and also compared while evaluating the mixed effects of state-trait anxiety and depression. Results: Group 2 had higher total and subscale scores on OBQ-44 than group 1 and controls. Presence of agoraphobia made a statistically significant difference only for the 'responsibility/threat estimation' subscale scores. When trait anxiety level was under control, significant difference was maintained for OBQ-44 subscales, while when state anxiety level and depression were under control, only 'importance of thought/controlling thoughts' was statistically significant. Conclusion: Trait anxiety and depression affect all obsessive beliefs except for 'importance of thought/controlling thoughts' subscale of OBQ-44. We think that obsessive beliefs are not specific to OCD. Obsessive beliefs may have a common role in the development of trait anxiety and depression. We assume that further studies investigating obsessive beliefs in other anxiety disorders and depression might be enlightening. (Archives of Neuropsychiatry 2013; 50: 141-146) [ABSTRACT FROM AUTHOR]

Virtual reality (VR) applications have been increasingly utilized in the field of psychology over the past 15 years, particularly within cognitive-behavioral therapy, where VR is now a preferred method in multiple exposure techniques. This study conducted a metaanalysis to assess the effectiveness of VR in treating various mental disorders. The metaanalysis followed PRISMA guidelines and included 17 studies out of 1,029 initially identified. Based on the heterogeneity test results, the studies were found to be homogeneously distributed (Q=23.09, p>.01), with a low level of heterogeneity (I²=30.71). The random effects model revealed a statistically significant overall effect size (η²= 0.73) for VR's effectiveness. This corresponds to a Hedges' g value indicating a medium to large effect size. The results suggest that VR is an effective treatment for a wide range of disorders, including stress-related conditions, post-traumatic stress disorder, social anxiety, fear of public speaking, agoraphobia, specific phobias (e.g., spiders, heights, flying), and panic disorder. Additionally, VR has shown promise in empathy development interventions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate if the nocturnal panic attack has different features and might be considered as a subtype or not. Methods: Sociodemographic data form, SCID-I, SCID-II, Panic and Agoraphobia Scale (PAS), Hamilton Depression Scale (HAM-D), Beck Anxiety Scale, and Bakırköy Panic Disorder Behavioral Changes Form are applied to the participants. 51 of the 98 patients were suffering from Nocturnal Panic Attacks according to the inclusion/exclusion criteria. Results: It was revealed that 47.9% of the panic disorder patients were suffering from nocturnal panic attacks. The most frequent symptoms in nocturnal panic disorder cases were experiences of feelings like drowning, lethargy, palpitation, vertigo, fear of death, and anxiety. The existence of nocturnal panic attacks is found to be related with severity of the disorder and comorbid depression. Moreover, comorbid sleep disturbances characterized with troubles in falling asleep, difficulty in sustaining sleep, feeling tired in the morning, were observed. There were sleep related avoidances and behavioral changes. Panic disorder patients with nocturnal panic attacks were found to avoid sleeping, or going to bed alone. Conclusions: Panic disorder cases with nocturnal panic attacks had more severe symptoms. From here, it can be concluded that it might be a subtype of panic disorder. [ABSTRACT FROM AUTHOR]

There is a high risk for most of the psychiatric disorders during pregnancy and postpartum period. In recent years, this phenomenon has been emphasized and attemps to explain mechanism of etiology have been made. Many studies had been conducted on psychosis and mood disorder during pregnancy and postpartum period but there have been only few studies on anxiety disorders and their relationship with female reproductive functions. Early case reports have reported that pregnancy had a prophylactic effect for panic disorder whereas in postpartum period the risk and severity of panic symptoms increase. Later studies have emphasized that panic disorder could have different prognosis during pregnancy. When studies of the last 30 years have been overviewed, it has been evident that the effect of pregnancy on panic disorder may be quite different and the exacerbation of panic symptoms in postpartum period has important effects on the mental and physical health of the baby and the mother. Studies about the use of psychotropics during pregnancy and puerperium and about their teratogenity have been overviewed. The effect of anxiety that panic disorder causes on drug free mothers and their babies have been examined. [ABSTRACT FROM AUTHOR]

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Copyright of Anatolian Journal of Psychiatry / Anadolu Psikiyatri Dergisi is the property of Anatolian Journal of Psychiatry and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)