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BACKGROUND: Studies have documented high use of tobacco, alcohol and illicit drugs in patients with panic disorder (PD). The comorbid substance use disorders worsen the prognosis of mood and anxiety disorders. The respiratory subtype (RS) of PD seems to represent a more severe and distinct form of this disorder associated with higher familial history of PD and more comorbidity with other anxiety disorders. OBJECTIVES: Describe the patterns of tobacco, alcohol or illicit drug use in PD patients, and also to ascertain if patients with the RS use these substances more than those of the non-respiratory subtype. METHODS: This is a cross-sectional study with 71 PD patients. The Alcohol Use Disorders Identification Test and Fagerstrom Tobacco Questionnaire were used in the evaluation. Patients with four or five respiratory symptoms were classified in the RS, the remaining patients were classified as non-respiratory subtype. RESULTS: In our sample 31.0% were smokers, 11.3% were hazardous alcohol users and none of them was using illicit drugs. There were no differences between the respiratory and non-respiratory subtypes regarding the use of tobacco, alcohol, cannabis, cocaine, stimulants and hallucinogens. DISCUSSION: The RS was not correlated to the use of tobacco, alcohol and illicit drugs. Additional epidemiological and clinical studies focusing the relationship between PD and substance use are warranted.

CONTEXTO: Estudos sugerem associação entre zumbidos e transtornos psiquiátricos. OBJETIVO: Identificar a presença de transtorno de pânico em uma amostra de pacientes com queixas de zumbido. MÉTODO: Foram avaliados 50 pacientes com queixa primária de zumbido de um serviço ambulatorial de otorrinolaringologia, durante um período de dois meses. A identificação de transtornos psiquiátricos e do impacto do zumbido na qualidade de vida foi feita por meio do Mini International Neuropsychiatric Interview (MINI versão 5.0) e do Tinnitus Handicap Inventory. Todos os pacientes foram submetidos à avaliação audiológica e responderam a um questionário clínico-demográfico desenvolvido para este estudo. RESULTADOS: Vinte (40%) pacientes apresentaram transtorno de pânico, sendo 8 com e 12 sem agorafobia; 41 (82%) pacientes apresentaram pelo menos um diagnóstico psiquiátrico, sendo os mais prevalentes: transtorno de pânico (40%), depressão maior (40%) e transtorno de ansiedade generalizada (34%). CONCLUSÃO: A prevalência de transtorno de pânico em nossa amostra de pacientes com zumbidos foi elevada, o que ratifica a importância da avaliação psiquiátrica nesses pacientes. BACKGROUND: Many studies suggest there is an association between tinnitus and psychiatric disorders. OBJECTIVE: To identify the prevalence of panic disorder in a tinnitus patients' sample. METHOD: We evaluated 50 patients with the main complaint of tinnitus of an Otorhinolaryngology outpatient unit for two consecutive months. The evaluation of psychiatric disorders was made with the Mini International Neuropsychiatric Interview (M.I.N.I version 5.0) and the evaluation of the tinnitus' impact was made with the Tinnitus Handicap Inventory. All patients also were submitted to an audiological evaluation and answered a clinical-demographic questionnaire elaborated for this study. RESULTS: Twenty (40%) patients had panic disorder, 8 with agoraphobia and 12 without agoraphobia; 41 patients (82%) had at least one psychiatric disorder, and the most prevalent were: panic disorder (40%), major depression (40%) and generalized anxiety disorder (34%). DISCUSSION: The prevalence of panic disorder in this sample of tinnitus' patients was high, which reinforces the importance of a psychiatric evaluation on these patients.

CONTEXTO: A terapia cognitivo-comportamental é a modalidade psicoterapêutica mais estudada no transtorno de pânico (TP) e demonstrou, nos mais diferentes estudos experimentais, ser bastante eficaz, inclusive quando comparada a grupos-controle, tratamentos psicofarmacológicos e outras formas de psicoterapias não estruturadas. A literatura sobre o tratamento cognitivo-comportamental do TP contempla comparações entre as técnicas mais utilizadas nesse tipo de psicoterapia. OBJETIVOS: Revisar a literatura que compara a eficácia dos enfoques cognitivo, comportamental e cognitivo-comportamental do TP e que destaca as limitações referentes a esses tratamentos psicológicos e às metodologias de pesquisa aplicadas. MÉTODOS: Revisão sistemática da literatura, principalmente por meio da base de dados PubMed. RESULTADOS: Verificou-se que, na maioria dos estudos, a eficácia das intervenções cognitiva, comportamental e de sua combinação equiparou-se e hipóteses a esse respeito foram levantadas. CONCLUSÕES: Deve-se atentar para o aprimoramento de importantes aspectos metodológicos, visando a resultados cada vez mais fidedignos que possam apontar direcionamentos que contribuam para o refinamento das técnicas utilizadas.BACKGROUND: Cognitive-behavioral therapy is the most studied psychotherapeutic modality in panic disorder (PD) and has demonstrated, in the most different experimental studies, to be sufficiently efficient when compared with control groups, psychopharmacological treatments and other forms of unstructured psychotherapies. Literature on the cognitivebehavioral treatment of PD contemplates comparisons between the most used techniques. OBJECTIVES: Revise the literature that compares the effectiveness of the cognitive, behavioral and cognitive-behavioral approaches of PD, detaching the referring limitations to these psychological treatments and the applied research methodologies. METHODS: Literature systematic review, mainly revised in PubMed database. RESULTS: The effectiveness of the cognitive and behavioral interventions and its combination were equalized and hypotheses to this respect have been raised. DISCUSSION: We should attempt to improve important methodological aspects aiming at results even more trustworthy, pointing out directions to contribute to the refinement of the used techniques.

BACKGROUND: Panic disorder (PD) patients show more physical and psychological impairment, than the general population. OBJECTIVES: Our aims are to compare quality of life between PD patients during treatment and healthy subjects and to associate social, demographic and clinical factors with quality of life scores. METHODS: It is a cross-sectional study with 20 PD patients and 20 healthy controls. Anxiety levels assessment: Beck Anxiety Inventory, Hamilton Anxiety Rating Scale, STAIT - Form Y. Panic severity; Panic Agoraphobia Scale; social and environmental problems and global assessment functioning (Axis IV and V, DSM-IV-TR) and quality of life by WHOQOL-BREF. RESULTS: PD patients were 65% female. Mean age = 37.55 ± 9.06. Quality of life domain scores: physical = 57.86 ± 17.56; psychological = 56.04 ± 18.31; social = 56.25 ± 25.92; and environmental = 47.03 ± 16.92; smokers = 20%; BAI = 23.40 ± 15; STAI-S= 43.50 ± 8.79; STAI-T = 50.10 ± 9.19; PAS = 13.60 ± 9.40. DISCUSSION: No significant differences were observed between groups about gender, age, schooling, religion, marital status nor individual income, but family income was significantly higher among controls. All domains of quality of life are significantly impaired among PD patients, compared to healthy controls. Panic disorder compromises well being. Psychosocial problems and high levels of anxiety can also negatively impact quality of life of PD patients.CONTEXTO: Pacientes com transtorno de pânico (TP) apresentam maior comprometimento físico e psicológico que a população geral. OBJETIVOS: Comparar escores de qualidade de vida entre pacientes com TP em tratamento e indivíduos normais. MÉTODOS: Trata-se de estudo transversal com 20 portadores de TP e 20 controles normais. Avaliação da ansiedade inclui: Inventário de Ansiedade de Beck, Escala de Ansiedade de Hamilton, Inventário de Estado e Traço Ansioso, Escala de Pânico e Agorafobia; além de avaliação de problemas sociais e ambientais e funcionamento global (eixos IV e V, DSM-IV-TR) e de qualidade de vida pela WHOQOL-BREF. RESULTADOS: Dos pacientes com TP, 65% eram do sexo feminino. A média de idade foi de 37,55 ± 9,06 anos. Os escores de qualidade de vida foram: físico = 57,86 ± 17,56; psicológico = 56,04 ± 18,31; social = 56,25 ± 25,92; e ambiental 47,03 ± 16,92. Tabagistas = 20%. BAI = 23,40 ± 15; STAI-S = 43,50 ± 8,79; STAI-T = 50,10 ± 9,19; PAS = 13,60 ± 9,40. Não houve diferenças significativas entre os grupos em relação a sexo, idade, escolaridade, religião, estado civil, nem renda individual, porém a renda familiar do grupo-controle foi significativamente maior. Todos os domínios de qualidade de vida foram bem piores entre os pacientes com TP em tratamento, quando comparados aos controles. CONCLUSÕES: TP, mesmo em tratamento, compromete a qualidade de vida. Problemas psicossociais e altos níveis de ansiedade podem ter impacto negativo na qualidade de vida dos pacientes com TP.