Search

Objective: Panic disorder is a modestly heritable condition. Currently, diagnosis is based only on clinical symptoms; identifying objective biomarkers and a more reliable diagnostic procedure is desirable. We investigated whether people with panic disorder can be reliably diagnosed utilizing combinations of multiple polygenic scores for psychiatric disorders and their intermediate phenotypes, compared with single polygenic score approaches, by applying specific machine learning techniques. Methods: Polygenic scores for 48 psychiatric disorders and intermediate phenotypes based on large-scale genome-wide association studies (n = 7556–1,131,881) were calculated for people with panic disorder (n = 718) and healthy controls (n = 1717). Discrimination between people with panic disorder and healthy controls was based on the 48 polygenic scores using five methods for classification: logistic regression, neural networks, quadratic discriminant analysis, random forests and a support vector machine. Differences in discrimination accuracy (area under the curve) due to an increased number of polygenic score combinations and differences in the accuracy across five classifiers were investigated. Results: All five classifiers performed relatively well for distinguishing people with panic disorder from healthy controls by increasing the number of polygenic scores. Of the 48 polygenic scores, the polygenic score for anxiety UK Biobank was the most useful for discrimination by the classifiers. In combinations of two or three polygenic scores, the polygenic score for anxiety UK Biobank was included as one of polygenic scores in all classifiers. When all 48 polygenic scores were used in combination, the greatest areas under the curve significantly differed among the five classifiers. Support vector machine and logistic regression had higher accuracy than quadratic discriminant analysis and random forests. For each classifier, the greatest area under the curve was 0.600 ± 0.030 for logistic regression (polygenic score combinations N = 14), 0.591 ± 0.039 for neural networks (N = 9), 0.603 ± 0.033 for quadratic discriminant analysis (N = 10), 0.572 ± 0.039 for random forests (N = 25) and 0.617 ± 0.041 for support vector machine (N = 11). The greatest areas under the curve at the best polygenic score combination significantly differed among the five classifiers. Random forests had the lowest accuracy among classifiers. Support vector machine had higher accuracy than neural networks. Conclusions: These findings suggest that increasing the number of polygenic score combinations up to approximately 10 effectively improved the discrimination accuracy and that support vector machine exhibited greater accuracy among classifiers. However, the discrimination accuracy for panic disorder, when based solely on polygenic score combinations, was found to be modest. [ABSTRACT FROM AUTHOR]

Objective: Panic disorder (PD) may cause serious cardiac arrhythmias by causing electrical abnormalities. Abnormal P-wave axis (aPwa), presence of fragmented QRS (fQRS), wide frontal QRS-T angle (fQRSTa), QRS duration corrected (QRSdc) and log/ logQRS duration/RR interval (log/logQRS/RR) have been correlated with increased risk of serious supraventricular and ventricular cardiac arrhythmias in a general population. The purpose of this study was to compare these newly explored atrial and ventricular arrhythmia indicators in patients with PD and in healthy subjects. Method: A total of 169 newly diagnosed PD patients and 128 healthy subjects were included in the study. The Panic and Agoraphobia Scale (PAS) was administered, and 12-lead electrocardiography (ECG) measurements were obtained. Electrocardiographic parameters including aPwa, fQRSTa, presence of fQRS, QRS duration corrected (QRSdc), and log/logQRS duration/RR distance (log/logQRS/RR) were compared between the two groups. Results: aPwa and fQRS, in addition to fQRSTa, QRSdc, and log/ logQRS/RR ratio values, were significantly increased in the PD group compared to healthy controls. Correlation analyses revealed that wider fQRSTa, number of fQRS derivation, number of total fQRS, wider QRSdc, and log/logQRS/RR ratio significantly correlated with PAS score. Logistic regression analysis demonstrated that fQRSTa and the number of total fQRS were independently associated with PD. Conclusion: PD is associated with wider fQRSTa, QRSdc, and log/logQRS/RR in addition to the increased abnormal aPwa and presence of fQRS. These findings suggest that untreated PD patients may be susceptible to supraventricular and ventricular arrhythmia, indicating that ECG should be routinely obtained in the management of PD patients. [ABSTRACT FROM AUTHOR]

Anxiety disorders are the most prevalent among the mental health disorders and have a negative impact on an individual's life. Cognitive behaviour therapy (CBT) is documented as the most effective treatment for anxiety disorders. However, challenges associated with implementing diagnosis-specific CBT have led to transdiagnostic approaches of CBT (tCBT). tCBT uses a single protocol with core elements of CBT for treatment of anxiety disorders broadly. The aim of the current study is to examine whether participants with different principal anxiety diagnoses demonstrate similar anxiety reduction. The current study involved a secondary analysis of 117 participants randomly allocated to receive tCBT for anxiety disorders in a pragmatic randomised effectiveness trial. Beck Anxiety Inventory (BAI) and Clinician Severity Ratings (CSR) scales were administered at pre- and post-treatment and one-year follow-up, while the Anxiety Disorder Diagnostic Questionnaire – Weekly (ADDQ-W) was administered each session. Mixed-factorial analyses of variance (ANOVAs) indicated that participants with GAD, SAD and PD/A improved to post-treatment and maintained to follow-up, with no differential improvement across principal diagnoses. Mixed effect regression modelling of session by session measures indicated non-differential negative slopes across principal diagnoses of GAD, SAD and PD/A. Overall, results indicate that group tCBT for anxiety disorders shows equal effectiveness for GAD, PD/A, and SAD in real-world conditions. [ABSTRACT FROM AUTHOR]

The DSM-5ʹs new conception of post-traumatic stress disorder (PTSD) includes, as a diagnostic criterion, the presence of persistent and exaggerated negative beliefs, thoughts, or expectations about oneself, others, the world, and one's guilt. These symptoms increase the symptomatic similarity with major depressive disorder (MDD) and with the negative cognitive triad of Beck's cognitive theory of depression and allow us to assume that the dysfunctional attitudes that this theory proposes as a vulnerability factor for MDD could also refer to PTSD. This study aims to examine the relationship between depressive dysfunctional attitudes and the symptoms and diagnosis of PTSD. A sample of 378 adult victims of terrorism completed measures of depressive dysfunctional attitudes (DAS-A), DSM-IV post-traumatic stress symptoms (PCL-S), depressive symptoms (BDI-II), and DSM-IV diagnosis of emotional disorders (SCID-I). A significant relationship was found between depressive dysfunctional attitudes and PTSD symptomatology, even after controlling for the effect of depression, sex, age, education level, anxiety, and previous depressive episodes. It was also found that victims with PTSD, with or without MDD, had more depressive dysfunctional attitudes than those without emotional disorders and more achievement-perfectionism attitudes than victims with emotional disorders other than PTSD or MDD. The results suggest that depressive dysfunctional attitudes could be a vulnerability factor for PTSD. The results also suggest the need to refine Beck's cognitive theory proposals about dysfunctional attitudes common and specific to each emotional disorder and identify potential therapeutic targets of cognitive therapies for these disorders. [ABSTRACT FROM AUTHOR]

Anxiety/PD is common in the general population and often presents to the ED. The emergency physician must be able to identify the underlying cause for the presentation, which could be either a primary mental illness or an underlying medical condition presenting with the symptoms of anxiety/PD to initiate proper treatment. Basic investigations help in the assessment of the symptoms. If the cause is an underlying medical illness, referral to the concerned specialist would be helpful and if symptoms are purely due to a primary mental illness, the patient can be screened for an anxiety or PD. Early and timely recognition of primary anxiety disorder helps in avoiding unnecessary investigations and can be treated with both pharmacological and non-pharmacological options. The main aim is to calm down the patient and abort the panic attack. Benzodiazepines and SSRIs remain the mainstay of treatment. Reassurance and psychoeducation of the patient as well as his caregivers help a long way in the management of the symptoms. Judicious use of medication, patient education, and referral to a physician whenever necessary improve the outcome of patients with this otherwise potentially disabling disorder. [ABSTRACT FROM AUTHOR]

Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence. [ABSTRACT FROM AUTHOR]

This paper presents STAT Protocol, which is an interview protocol or a self-reflection tool for differentiating typology of mental health concerns in statistics-related experiences. The main objective of the tool is to adopt clinical interview procedures for finding out typology of four mental health concerns including depression, panic disorder, generalized anxiety disorder, and stress-related adaptation syndrome. Based on network analysis of interview transcripts on statistics related experiences, relationship of the variables including procrastination, prior mathematics performance, difficulty in understanding formulas, and the four mental health concerns were analysed. The STAT Protocol comprises 18 checkpoints (yes/ no questions) under 6 different domains (specificity, depression, anxiety, stress, state-anxiety, and academic concerns). The implications of STAT protocol are illustrated with case studies. [ABSTRACT FROM AUTHOR]

The role of schemas is well established in personality disorders. Their influence on therapy outcome of patients with Axis I disorders remains unclear. Therefore, patients with a panic disorder (PD) with/without agoraphobia varying in their expression of early maladaptive schemas were examined regarding therapy outcomes after exposure therapy. In this study, a sample of 216 patients with panic disorder with/without agoraphobia were recruited in a day clinic. After the initial diagnosis with the Structured Clinical Interview, the patients filled out the Young Schema Questionnaire (YSQ-S2), Beck Depression Inventory and Revised Symptom Checklist. Afterwards, they participated in a five-week manualized exposure therapy by Lang et al. (2011). Subjects with high schema scores showed lower therapeutic success rates than subjects with a weaker pattern score. In addition, it was found that high schema levels, especially of schemas regarding impaired autonomy and achievement (YSQ-S2: domain 2), influenced therapy outcome by either predicting more/severe or less/milder anxiety-, phobicrelated and general symptoms after therapy. The results of this study emphasize the role of schemas not only for personality disorders but also for disorders on Axis I. For PD with/without agoraphobia, schemas regarding impaired autonomy and achievement seem to play the most important role regarding the influence on therapy outcome.

Panic disorder (PD) is a severe anxiety disorder characterized by recurrent and unexpected panic attacks that cause intense distress. Despite the high prevalence of panic disorder and its significant impact on life, limited research has been conducted on its prevalence and their associated factors in Saudi Arabia. This study seeks to contribute to the understanding of PD among adults in Saudi Arabia by examining its prevalence and associated factors, using an online survey method. A validated questionnaire-based cross-sectional study was conducted targeting 1276 Saudi adults. Data were collected electronically via Google Forms from the eligible participants. The questionnaire comprised three sections: sociodemographic information, medical history, and a validated diagnostic tool for PD. The prevalence of PD among Saudi adults was 13.1%. Most individuals with PD experienced their first panic attack before the age of 18. Only 38.3% individuals with PD sought medical attention, and approximately one-third of those who sought help did not receive a diagnosis. Multiple logistic regression analysis revealed that significant risk factors for PD included being female; having chronic health problems, a comorbid psychiatric disorder, a high body mass index; and experiencing suicidal ideation (P < 0.05). The highest risk was associated with chronic diseases (adjusted odds ratio = 3.1, 95% confidence interval: 2.1-4.6). This study demonstrates that PD is a prevalent and debilitating mental health condition among Saudi Arabian adults. Non-mental health physicians should be aware of PD, as many cases remain undiagnosed., (© 2024. The Author(s).)

Background: Panic disorder is an anxiety disorder presenting panic attacks as a defining feature, with cognitive and behavioral symptoms that are associated with the panic attacks. Recently, the use of network analysis is increasing to determine the symptoms and mutual reinforcing patterns that conceptualize a mental disorder. This study aimed to improve our understanding of panic disorder by estimating a network structure of its symptoms.Method: Data from 257 patients diagnosed with panic disorder who visited the outpatient psychiatric clinic from 2018 to 2020 were collected. Panic attacks, cognitive and behavioral symptoms concerning the panic attacks, depression, and anxiety sensitivity dimensions such as fear of cardiovascular symptom, fear of publicly observable anxiety reaction, fear of respiratory symptom, and fear of cognitive dyscontrol were computed. Bootstrapping was applied to estimate the 95% confidence intervals for each edges.Results: The resulting network indicated fear of cognitive dyscontrol, impairment in social functioning, phobic avoidance of situations, and panic-focused anticipatory anxiety to be central symptoms in panic disorder. Interestingly, panic attacks and distress during panic did not emerge as central. Depression was strongly linked to fear of cognitive dyscontrol.Limitations: The sample size limits network comparison tests between those with comorbid depression or agoraphobia. In addition, the cross-sectional design limits the opportunity to draw causal conclusions regarding the symptoms.Conclusions: These results have implications in etiology of panic disorder and support the efficaciousness of Cognitive Behavioral Therapy. Future network analyses may employ longitudinal designs to investigate causal relationships between the symptoms. [ABSTRACT FROM AUTHOR]

Background: This study investigated the lifetime suicide attempt and ideation rates among patients with panic disorder (PD).Methods: Online databases regarding lifetime suicide attempt and ideation rates in patients with PD were searched up to May 2021.Results: The suicide attempt and ideation rates were 0.17 (95% CI: 0.16, 0.18) and 0.23 (95% CI: 0.22, 0.25). The suicide attempt rates among female and male patients were 0.17 (95% CI: 0.14, 0.20) and 0.15 (95% CI: 0.12, 0.19). When PD was comorbid with anxiety, depression, substance abuse, and personality disorders, the suicide attempt rates increased to 0.23 (95% CI: 0.20, 0.26), 0.23 (95% CI: 0.18, 0.27), 0.25 (95% CI: 0.20, 0.31), and 0.25 (95% CI: 0.23, 0.28), respectively.Limitations: The suicide attempt and ideation by age, suicide ideation by sex, and suicide ideation by comorbidity with other mental disorders were passed in our meta-analysis as sample size was small. Stratification analysis on ethnicity, marital status, education levels, resident location, and severity of PD should be considered in the future.Conclusion: The lifetime suicide ideation and attempt rates in patients with PD were higher than general populations but lower than patients with bipolar or depression. The lifetime suicide attempt rate in female patients was slightly higher than male patients. When PD was comorbid with one other mental illness, the lifetime suicide attempt rate increased by about 50%. [ABSTRACT FROM AUTHOR]

Caffeine has been purported to have anxiogenic and panicogenic properties, specifically salient in patients with panic disorder (PD). However, compilations of the magnitude of the effect of caffeine on anxiety and panic attacks are lacking and potential dose-response relationships have not been examined. In the present systematic review and meta-analysis, we aimed to examine the acute effects of placebo-controlled caffeine challenge on occurrence of panic attacks and subjective anxiety in patients with PD and healthy controls (HC), including dose-response relationships. Systematic searches were performed in six databases. We included blinded placebo-controlled studies of acute caffeine challenge on panic attacks and/or subjective anxiety in adult patients with PD. Of the 1893 identified articles, ten met our inclusion criteria. The 9 studies investigating panic attacks included 237 patients, of which 51.1% had a panic attack following caffeine, but none after placebo. Six of these studies compared 128 patients with 115 healthy controls (HC), finding that patients (53.9%) were more vulnerable than HC (1.7%) for panic attacks following caffeine (log RR: 3.47; 95% CI 2.06–4.87). Six studies investigated subjective anxiety in 121 patients and 111 HC following caffeine, with an overall effect indicating increased sensitivity to the anxiogenic effects of caffeine in the patient group (Hedges' g = 1.02 [95% CI: 0.09–1.96]). The restricted range of caffeine employed [400–750 mg] and few studies (3) not using 480 mg prevented any meaningful analysis of a dose-response relationship. Of the ten studies included, only 2 reported anxiety data for the placebo condition, precluding a proper meta-analysis comparing anxiogenic effects of caffeine and placebo. The restricted dose range used prevented assessment of dose-response relationships. The results confirm that caffeine at doses roughly equivalent to 5 cups of coffee induces panic attacks in a large proportion of PD patients and highly discriminates this population from healthy adults. Caffeine also increases anxiety in PD patients as well as among healthy adults at these doses although the exact relationship between caffeine-induced anxiety and panic attacks remains uncertain. The results suggest that caffeine targets important mechanisms related to the pathophysiology of PD. Future studies should employ a wider range of caffeine doses and investigate contributions of biological and psychological mechanisms underlying the anxiogenic and panicogenic effects of caffeine. In the clinic, patients with PD should be informed about the panicogenic and anxiogenic effects of caffeine, with the caveat that little is known regarding smaller doses than 480 mg. Registration. PROSPERO (www.crd.york.ac.uk/prospero) registration number CRD42019120220. [ABSTRACT FROM AUTHOR]

Generalized Anxiety Disorder (GAD) presents a significant personal and societal burden and is associated with chronic medical comorbidities and markedly lower quality of life. Effective treatments exist, less than half of individuals with lifetime GAD will ever seek psychotherapeutic or pharmacological treatment. A thorough understanding of the factors that influence treatment seeking for GAD is warranted. The present study investigates the correlates of GAD treatment seeking, using data from the National Epidemiological Survey on Alcohol and Related Disorders-III (NESARC-III), which assessed for psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version (AUDADIS-5). A series of logistic regressions were run to identify demographic, diagnostic, and symptom-level correlates of treatment seeking in those meeting DSM-5 diagnostic criteria for GAD. Comorbid depression, panic disorder, and PTSD were all uniquely associated with higher rates of GAD-related treatment seeking. Additionally, several accompanying anxiety symptoms were also uniquely predicted treatment seeking, including fatigue, panic attacks, reassurance-seeking, and interpersonal avoidance. Findings underscore the multi-factorial nature of treatment seeking behavior in GAD and highlight the need for further research to fully understand these relationships and devise effective strategies to improve treatment seeking in this population., Competing Interests: Declaration of Competing Interest JZ, TP, and JC have no conflicts of interest to report., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p <.01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β =.346; p <.01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. Practitioner points: Somatic symptoms were associated with a higher probability of be in the PD + MDD group.Cognitive variables do not play a relevant role in the differentiation of both groups.A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group. [ABSTRACT FROM AUTHOR]

Anxiety disorders are the most prevalent mental health problem worldwide. Collectively, these disorders are at the core of 20% of primary care visits in the United States. This article reviews in-depth several common disorders of anxiety — GAD, PD, and SAnD — with a focus on diagnosis and treatment relevant to the primary care provider. [ABSTRACT FROM AUTHOR]

This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent (n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated that passive smartphone and wearable sensor data collected throughout daily life can predict anxiety symptoms cross-sectionally. However, to date, no research has demonstrated the capacity for these digital biomarkers to predict long-term prognosis.Methods: We utilized deep learning models based on wearable sensor technology to predict long-term (17-18-year) deterioration in generalized anxiety disorder and panic disorder symptoms from actigraphy data on daytime movement and nighttime sleeping patterns. As part of Midlife in the United States (MIDUS), a national longitudinal study of health and well-being, subjects (N = 265) (i) completed a phone-based interview that assessed generalized anxiety disorder and panic disorder symptoms at enrollment, (ii) participated in a one-week actigraphy study 9-14 years later, and (iii) completed a long-term follow-up, phone-based interview to quantify generalized anxiety disorder and panic disorder symptoms 17-18 years from initial enrollment. A deep auto-encoder paired with a multi-layered ensemble deep learning model was leveraged to predict whether participants experienced increased anxiety disorder symptoms across this 17-18 year period.Results: Out-of-sample cross-validated results suggested that wearable movement data could significantly predict which individuals would experience symptom deterioration (AUC = 0.696, CI [0.598, 0.793], 84.6% sensitivity, 52.7% specificity, balanced accuracy = 68.7%).Conclusions: Passive wearable actigraphy data could be utilized to predict long-term deterioration of anxiety disorder symptoms. Future studies should examine whether these methods could be implemented to prevent deterioration of anxiety disorder symptoms. [ABSTRACT FROM AUTHOR]

Although complete blood count (CBC) parameters in panic disorder (PD) are frequently studied, there is no data on panic attacks (PA). In this retrospective study, CBC parameters of patients diagnosed with PD (n=63) and PA (n=61) were compared with the data of healthy subjects (n=41). The groups were similar in terms of age (p=0.395) and gender (p=0.567). There were significant differences between the PD and the PA groups in terms of percentage of lymphocyte (p<0.001), lymphocyte count (p<0.001), neutrophil to lymphocyte ratio (p<0.001), platelet to lymphocyte ratio (p<0.001), basophil to lymphocyte ratio (BLR) (p<0.001), and monocyte to lymphocyte ratio (MLR) (p<0.001). Our findings suggested that the lymphocyte parameters were significantly higher and lymphocyte-related ratios were significantly lower in the PA group compared to the control and PD groups. Low basophil parameters were suggested to be significantly associated with PA, while neutrophil-related parameters were significantly increased in PD. [ABSTRACT FROM AUTHOR]

Background: Anxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress.Design/method: This is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files.Discussion: This study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions. [ABSTRACT FROM AUTHOR]

Backgrounds: Panic disorder is a highly prevalent psychiatric disorder that substantially impairs quality of life and psychosocial function. Panic disorder arises from neurobiological substrates and developmental factors that distinguish it from other anxiety disorders. Differential diagnosis between panic disorder and other anxiety disorders has only been conducted in terms of a phenomenological spectrum.Methods: Through a machine learning-based approach with heart rate variability (HRV) as input, we aimed to build algorithms that can differentiate panic disorder from other anxiety disorders. Five algorithms were used: random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), artificial neural network (ANN), and regularized logistic regression (LR). 10-fold cross-validation with five repeats was used to build the final models.Results: A total of 60 patients with panic disorder and 61 patients with other anxiety disorders (aged between 20 and 65 years) were recruited. The L1-regularized LR showed the best accuracy (0.784), followed by ANN (0.730), SVM (0.730), GBM (0.676), and finally RF (0.649). LR also had good performance in other measures, such as F1-score (0.790), specificity (0.737), sensitivity (0.833), and Matthews correlation coefficient (0.572).Limitations: Cross-sectional design and limited sample size is limitations.Conclusion: This study demonstrated that HRV can be used to differentiate panic disorder from other anxiety disorders. Future studies with larger sample sizes and longitudinal design are required to replicate the diagnostic utility of HRV in a machine learning approach. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the effects of escitalopram on the peripheral expression of hypothalamic-pituitary-adrenal (HPA) axis-related genes (FKBP51, HSP90, NR3C1 and POMC) and HPA-axis hormones in patients with panic disorder (PD)., Methods: Seventy-seven patients with PD were treated with escitalopram for 12 weeks. All participants were assessed for the severity of panic symptoms using the Panic Disorder Severity Scale (PDSS). The expression of HPA-axis genes was measured using real-time quantitative fluorescent PCR, and ACTH and cortisol levels were measured using chemiluminescence at baseline and after 12 weeks of treatment., Results: At baseline, patients with PD had elevated levels of ACTH and cortisol, and FKBP51 expression in comparison to healthy controls (all p < 0.01). Correlation analysis revealed that FKBP51 expression levels were significantly positively related to cortisol levels and the severity of PD (all p < 0.01). Furthermore, baseline ACTH and cortisol levels, and FKBP51 expression levels were significantly reduced after 12 weeks of treatment, and the change in the PDSS score from baseline to post-treatment was significantly and positively related to the change in cortisol (p < 0.01)., Conclusions: The results suggest that PD may be associated with elevated levels of ACTH and cortisol, and FKBP51 expression, and that all three biomarkers are substantially decreased in patients who have received escitalopram treatment., (© 2024. The Author(s).)

Introduction: Due to a dearth of evidence, we examined the effectiveness of brief-intensive CBT on symptom severity and catastrophic cognition in patients with panic disorder (PD)., Materials and Methods: In this randomized controlled trial, 155 patients were assigned to either the experimental group (2 successive days of brief-intensive CBT-3 h per day) or the control group (regular pharmacotherapy only). After excluding ineligible participants, 20 patients in the brief intensive CBT group and 18 patients in the control group completed the study and were included in the final analysis. The primary outcome was symptom severity, and the secondary outcome was catastrophic cognition, assessed by the Panic Disorder Severity Scale (PDSS) for symptoms severity and the Agoraphobic Cognition Scale (ACS) for cognitive assessment, respectively., Results: The study showed that after one month of treatment, the PDSS (1.70 vs. 4.78; p  = 0.0172) in the brief-intensive CBT group was significantly lower compared to the control group in contrast with the ACS (5.10 vs. 5.44; p  = 0.8533). The mean score of PDSS and ACS significantly decreased from 21.60 to 1.7 ( p  < 0.0001) and from 22.55 to 5.10 ( p  < 0.0001) in the brief CBT group and from 19.44 to 4.78 ( p  < 0.0001) and 20.00 to 5.44 ( p  < 0.0001) in the control group, respectively. After treatment, the mean scores of PDSS and ACS significantly decreased in the brief intensive CBT and control groups. Both higher ACS and lower education levels contributed to higher PDSS in the brief intensive CBT group. However, only the PDSS correlated to the ACS in the control group., Conclusions: The study showed that brief-intensive CBT is an effective technique for reducing the severity of symptoms among PD patients. But, it was not effective to improve the cognitive level in PD patients at one month.

Background: Panic disorder is experienced by around 1% of adolescents and has a significant impact on social and academic functioning. Preliminary evidence supports the effectiveness of panic disorder‐specific treatment in adolescents with panic disorder; however, panic disorder may be overlooked in adolescents due to overlapping symptoms with other anxiety disorders and other difficulties being more noticeable to others. The aim of this study was to establish what training National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) clinicians have received in psychological therapies and panic disorder and how they identify and treat panic disorder in adolescents. Method: CAMHS clinicians from a range of professions (n = 427), who were delivering psychological treatments to children and adolescents with anxiety disorders, participated. They completed a cross‐sectional, online survey, including a vignette describing an adolescent with panic disorder, and were asked to identify the main diagnosis or presenting problem. Results: Less than half the clinicians (48.6%) identified panic disorder or panic symptoms as the main presenting problem from the vignette. The majority of clinicians suggested CBT would be their treatment approach. However, few identified an evidence‐based treatment protocol for working with young people with panic disorder. Almost half the sample had received no training in cognitive behaviour therapy (CBT), and around a fifth had received no training in delivering psychological treatments. Conclusions: Only half of CAMHS clinicians identified panic disorder from a vignette and although CBT treatments are widely offered, only a minority of adolescents with panic disorder are receiving treatments developed for and evaluated with young people with panic disorder. There is a vital need for clinician training, the use of tools that aid identification and the implementation of evidence‐based treatments within CAMHS. Key Practitioner Message: Panic disorder affects around 1% of adolescents, adversely impacting social, academic and long‐term life functioning.There is preliminary evidence for the effectiveness of a panic disorder‐specific treatment of panic disorder in adolescents.Clinicians struggle to identify panic disorder or suitable treatment protocols for treating adolescents, although most would use CBT as the treatment approach.There is a vital need for clinician training, tools that aid identification of young people with panic disorder and evidence‐based treatments that can be delivered in routine clinical settings. [ABSTRACT FROM AUTHOR]

Background: Pakistan is a Lower and Middle Income Country with a scarcity of resources for mental health services but high prevalence of mental health problems particularly anxiety and depression. Cognitive behavioral therapy (CBT) has been deemed an empirically supported treatment for anxiety disorders among children, but evidence is lacking from countries like Pakistan. Objective: The present project translated and adapted the Coping Cat Program, a CBT based program for children and adolescents having anxiety disorders, for Pakistani children. Method: The translated (Urdu) version of Coping Cat program was tested (N = 24) using repeated measure and a between group design in an orphanage school setting over a period of 6 months. The outcome measures were the Screen for Children Anxiety Related Disorders and the Childhood Anxiety Sensitivity Index. Results: Intent-to-Treat analysis indicated significant decreases in self-reported anxiety sensitivity (η2 =.69); anxiety (η2 = 0.50); generalized anxiety disorder (η2 =.44) and panic disorder (η2 =.30) in the treated group from pre- to follow-up compared to the control group. Therapists rated treatment protocol as easy to implement and 80% of participants rated the treatment manual as useful and effective. Conclusion: The Coping Cat program appeared culturally appropriate for this group, has implementation feasibility and clinical utility for the children having anxiety related problems. Further research is needed to evaluate its effectiveness as an indicated preventive intervention for Pakistani children. [ABSTRACT FROM AUTHOR]

Background: The Extended Strengths and Weaknesses Assessment of Normal Behavior (E‐SWAN) reconceptualizes each diagnostic criterion for selected DSM‐5 disorders as a behavior, which can range from high (strengths) to low (weaknesses). Initial development focused on Panic Disorder, Social Anxiety, Major Depression, and Disruptive Mood Dysregulation Disorder. Methods: Data were collected from 523 participants (ages 6–17). Parents completed each of the four E‐SWAN scales and traditional unidirectional scales addressing the same disorders. Distributional properties, Item Response Theory Analysis (IRT), and Receiver Operating Characteristic (ROC) curves were used to assess and compare the performance of E‐SWAN and traditional scales. Results: In contrast to the traditional scales, which exhibited truncated distributions, all four E‐SWAN scales had symmetric distributions. IRT analyses indicate the E‐SWAN subscales provided reliable information about respondents throughout the population distribution; traditional scales only provided reliable information about respondents at the high end of the distribution. Predictive value for DSM‐5 diagnoses was comparable to prior scales. Conclusions: E‐SWAN bidirectional scales can capture the full spectrum of the population distribution of behavior underlying DSM disorders. The additional information provided can better inform examination of inter‐individual variation in population studies, as well as facilitate the identification of factors related to resiliency in clinical samples. [ABSTRACT FROM AUTHOR]

Objective: To examine changes in diagnoses/treatment for 12 mental health (MH) conditions, previous use of campus MH services, and willingness to seek MH services in the future. Participants: ACHA–NCHA II participants from 2009 to 2015 (n = 454,029). Methods: Hierarchical binary logistic regression with step 1 controlling for demographics and step 2 considering time. Results: Time was significant except for bipolar disorder, bulimia, and schizophrenia with increases for all conditions except substance abuse. Anxiety (OR = 1.68), panic attacks (OR = 1.61), and ADHD (OR = 1.40) had the highest odd ratios. Use of MH services at current institution (OR = 1.30) and willingness to utilize services in the future (OR = 1.37) also increased over time. Conclusions: Based on a national sample, self-reported diagnoses/treatment of several MH conditions are increasing among college students. This examination of a variety of MH issues can aid college health professionals to engage institutional stakeholders regarding the resources needed to support college students' MH. [ABSTRACT FROM AUTHOR]

Background: Personalization is considered an important principle in virtual reality (VR) exposure therapy. We aimed to identify whether personalized VR exposure could provoke increased anxiety in patients with panic disorder and agoraphobia as it is considered the first step in successful treatment for anxiety., Methods: We performed a double-arm, one-day preliminary study among 28 patients with panic disorder and agoraphobia. Three sessions of VR exposure, including a theater, train, and elevator scenario, were conducted in two groups. In the personalized group (n = 14), the brightness and crowd density were customized based on a pre-assessment. In the control group (n = 14), these conditions were fully randomized. Self-reported anxiety, heart rate, skin conductance, and electroencephalography were measured before, during, and after the VR sessions., Results: In the later VR sessions, higher self-reported anxiety levels measured by the Visual Analogue Scale were observed in the personalized exposure group. Increased heart rates during and after the VR sessions were observed in the personalized group. The changes in skin conductance peaks were not significantly different between the groups, but the increase in skin conductance was associated with the participants' perception of presence. The electroencephalogram showed widespread increases in alpha waves in the frontal and temporal areas of the brain in the personalized group than in the control group., Conclusion: Personalized VR exposure elicits stronger anxiogenic effects in patients with panic disorder and agoraphobia as suggested by self-report and neurophysiological data. Personalization of VR exposure has the potential for effective behavioral therapy., Competing Interests: Declaration of Competing Interest This study was conducted on the basis of a proof-of-concept (POC) version of a virtual-reality-based treatment program for panic disorder and agoraphobia. This version was commissioned by Hallym University and developed by Orcasoft (Chuncheon, Gangwon, Republic of Korea). The technical advice and support for this study were provided by nGarden (Daegu, Republic of Korea). Currently, Hallym University College of Medicine has no direct affiliation with Orcasoft and nGarden, but the treatment principles or concepts established in this study may influence future digital therapeutics for panic disorder and agoraphobia that are being developed at Hallym University., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: This study aimed to investigate whether separation anxiety (SA) constitutes a dimension related to age at onset of panic disorder (PD), in homogeneous subgroups of outpatients with PD, based on their age of onset and symptom severity., Methods: A sample of 232 outpatients with PD was assessed with the Panic Disorder Severity Scale (PDSS) and the Sheehan Disability Scale (SDS) for functional impairments. Separation anxiety was evaluated using structured interviews and questionnaires. We applied a K-Means Cluster Analysis based on the standardized "PD age of onset" and "the PDSS total score" to identify distinct but homogeneous groups., Results: We identified three groups of patients: group 1 ("PD early onset/severe", N = 97, 42%, onset 23.2 ± 6.7 years), group 2 ("PD early onset/not severe", N = 76, 33%, onset 23.4 ± 6.0 years) and group 3 ("PD adult onset/not severe", N = 59, 25%, onset 42.8 ± 7.0 years). Patients with early onset/severe PD had significantly higher scores on all SA measures than PD late-onset/not severe. Regression analyses showed that SA scores, but not PDSS scores, were predictive of impairment in SDS work/school, social life, and family functioning domains., Conclusions: Our data indicate a significant relationship between SA and PD with an earlier age of onset and an impact on individual functioning. This may have important implications for implementing preventive interventions targeting early risk factors for the subsequent onset of PD., (© 2023 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: Anxiety sensitivity (AS) refers to the tendency to fear physical sensations associated with anxiety due to concerns about potential physical, social, or cognitive consequences. Many previous studies were limited by the use of the anxiety sensitivity index (ASI) or the ASI-revised (ASI-R), which are both measurements with unitary or unstable structures. No recent study that has utilized the ASI-3 examined the relations between AS dimensions and depression. Thus, we examined multiple relationships between AS and anxiety disorders and depression using the ASI-3.Methods: The total sample consisted of 667 outpatients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth text revision as assessed by a structured clinical interview. There were eight patient groups: multiple anxiety disorder, major depressive disorder (MDD), panic disorder (PD), social phobia (SP), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and anxiety disorder not otherwise specified (AD NOS). We conducted one-way analysis of variances and post hoc tests to compare the ASI-3 total and subscale scores across the groups.Results: The physical concern score was higher in patients with PD than patients with MDD, SP, OCD, or GAD. The social concern score was higher in the SP group than those with MDD, PD, GAD, and AD NOS. Patients with GAD and PTSD showed higher cognitive concern scores than the patients with PD.Conclusion: Results partially replicated the relationship between PD and physical concern, between SP and social concern, and between GAD and cognitive concern examining the relationships between AS dimensions and anxiety disorders. [ABSTRACT FROM AUTHOR]

Objective: Body mass index undergoes a substantial change in some psychiatric disorders. This study aimed to explore the status of body mass index (BMI) in different psychiatric disorders in a national survey among children and adolescents and to identify the role of gender in this regard. Method: A total of 30 532 children and adolescents were randomly selected using cluster sampling method with equal blocks of three age groups and two genders. Psychiatric disorders were assessed using a standardized face-to-face diagnostic interview of Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (KSADSPL), and Body Mass Index (BMI) was measured for each participant. Results: In this study, 22 730 children and adolescents (109 46 boys and 11784 girls), with valid data of BMI, completed the KSADS-PL interview. The prevalence of psychiatric disorders was 21.2% among underweight participants, 22.8% among overweight participants, and 22.2% among obese participants, which was significantly higher than normal weight participants with 19.6% (X2 = 17.55; p = 0.001). In boys' subgroup, depression and separation anxiety were mostly seen among the underweight category, while tic disorder was mostly seen in the obese category. In girls' subgroup, on the other hand, generalized anxiety was mostly observed in the underweight category, while oppositional defiant disorder (ODD), depression, and mental retardation were mostly observed in the obese category. In total, the highest mean BMI rates were among the children and adolescents with alcohol abuse disorder, mania, and panic disorder. However, the lowest BMI rates were among those with attention deficit hyperactivity disorder (ADHD), separation anxiety disorder (SAD), and enuresis. Conclusion: This study gives an overall picture of BMI status in different psychiatric disorders according to gender. Furthermore, in a multidisciplinary approach, the results of this study drew the attention of child psychiatrists to the status of BMI in their clients. [ABSTRACT FROM AUTHOR]

The anxiety and autism realms are each complicated and heterogeneous, and relationships between the two areas are especially complex. Network analysis offers a promising approach to the phenotypic complexities of typical and atypical human behavior. The Revised Children's Anxiety and Depression Scale (RCADS) was used to assess anxiety in 126 high-functioning 9–13 year-olds with ASDs. Network graphs of Autism Diagnostic Observation Schedule items and RCADS anxiety total score, social, generalized, panic and separation anxiety subscores consistently found the anxiety node (score) to be highly peripheral. Also, the networks of RCADS anxiety items themselves were similar for the ASDs group and a general population comparison group (n = 2017). The results suggest anxiety is not a central part of autism and that anxiety is dynamically similar (aspects of anxiety relate to one another in a similar manner) in high-functioning autism and the general population. [ABSTRACT FROM AUTHOR]

Co-occurring internalizing symptoms are common and important to assess in children with attention-deficit/hyperactivity disorder (ADHD). One frequently used child self-report measure of internalizing symptoms is the Revised Child Anxiety and Depression Scales (RCADS), yet the psychometric properties of the RCADS remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS in 117 children (ages 8-12; 66% male) evaluated for suspected ADHD at an ADHD specialty clinic (83% met criteria for ADHD). In addition to the RCADS, children completed measures of social anxiety and depression. Parents completed the RCADS-Parent Version (RCADS-P) in addition to other measures of internalizing and externalizing symptoms. Children and parents both completed a measure of aggression. Factor structure, reliability, and convergent/discriminant validity of the RCADS were examined. Results supported the six-factor structure of the child-report RCADS (Separation Anxiety, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder, and Major Depressive Disorder). The RCADS demonstrated adequate reliability as well as convergent and discriminant validity with other child ratings. The total anxiety score on the RCADS also demonstrated convergent and discriminant validity with parent measures, though the depression score on the RCADS did not. Findings provide preliminary psychometric support for the RCADS in children referred for ADHD. [ABSTRACT FROM AUTHOR]

Background: Heart Rate Variability (HRV) parameters have been used to evaluate the autonomic nervous system. We hypothesized that patients with major depressive disorder (MDD) and panic disorder (PD) showed different HRV profiles compared to healthy controls. We also hypothesized that we could predict the responder groups in the MDD and PD patients, using differences in HRV indices between the stress and rest phases.Methods: 28 MDD patients and 29 PD patients were followed for 12 weeks, and we also followed 39 healthy control subjects. We measured HRV parameters at the rest, stress, and recovery phases.Results: Patients with MDD and PD demonstrated lower pNN50 than controls during the stress (F = 7.49, p = 0.001), and recovery phases (F = 9.43, p = 0.0001). Patients with MDD and PD also showed higher LF/HF ratio than controls during the stress phase (F = 6.15, p = 0.002). Responders in the PD group presented a lower level of LF/HF ratio during the stress phase compared to non-responders (F = 10.14, p = 0.002), while responders in the MDD group showed a lower level of heart rate during all three phases, compared to non-responders. Additionally, we could predict treatment response in patients with MDD using ΔLF/HF ratio (OR: 1.33, 95% CI = 1.07-1.65, p = 0.011) and ΔpNN50 (OR: 1.49, 95% CI 1.09-1.77, p = 0.014).Conclusion: The changes of HRV parameters of pNN50 and LF/HF ratio between the stress and recovery phase may be clinical markers of predictors of treatment responsiveness in MDD and PD patients. [ABSTRACT FROM AUTHOR]

The thalamus is believed to play crucial role in processing viscero-sensory information, and regulating the activity of amygdala in patients with panic disorder (PD). Previous functional neuroimaging studies have detected abnormal activation in the thalamus in patients with PD compared with healthy control subjects (HC). Very few studies, however, have investigated for volumetric abnormalities in the thalamus in patients with PD. Furthermore, to the best of our knowledge, no previous study has investigated for shape abnormalities in the thalamus in patients with PD. Twenty-five patients with PD and 25 HC participants (all female) were recruited for the study. A voxel-wise volume comparison analysis and a vertex-wise shape analysis were conducted to evaluate structural abnormalities in the PD patients compared to HC. The patients with PD demonstrated significant gray matter volume reductions in the thalamus bilaterally, relative to the HC. The shape analysis detected significant inward deformation in some thalamic regions in the PD patients, including the anterior nucleus, mediodorsal nucleus, and pulvinar nucleus. PD patients showed shape deformations in key thalamic regions that are believed to play a role in regulating emotional and cognitive functions. [ABSTRACT FROM AUTHOR]

Backround: Recent data suggest a reduction in the prevalence of polygamy in the southeastern region in Turkey where this type of marriage is common. According to previously studies, polygamous wives, especially senior ones have more intense psychological distress. Aim: This study aims to study the relationship between polygamous marriage and various socio-demographic variables, self-esteem, depressive symptoms and psychiatric disorders. Method: The study consisted of a total of 108 women above the age of 18, of whom 72 were involved in polygamous marriages (30 women were senior wives and 42 women were junior wives) and 36 were in monogamous marriages. Participants were assessed using the Rosenberg Self-Esteem Scale (RSE) and Beck Depression Inventory (BDI). Psychiatric disorders were diagnosed by DSM5-based psychiatric interview. Results: The average age was 45.73 ± 15.22 years for senior wives, 36.57 ± 10.26 years for juniors and 33.94 ± 9.08 years for monogamous ones. Although the senior and junior wives were scored higher in the RSE, the difference was not statistically significant. Senior wives tended to score higher in BDI. In the analysis of variance (ANOVA), a significant difference was found between senior wives and monogamous wives but not between junior wives and monogamous wives. The frequencies of dysthymia, posttraumatic stress disorder, somatic symptom disorder and panic disorder among senior wives were significantly higher than in the other groups. Moreover, the frequency of dysthymia was significantly higher among the junior wives compared to the monogamous wives. Conclusion: Polygamous wives are designated to be a disadvantaged subgroup in respect to mental health practices. Mental health professionals, lawmakers and policy planners should put an effort to increase awareness of the relation of polygamy with psychiatric disorder. [ABSTRACT FROM AUTHOR]

Introduction: It is well-known that autonomic function is impaired in panic disorder (PD). Heart rate variability (HRV) is a reliable and noninvasive method to evaluate autonomic functions. The aim of this study is to evaluate 24-hour heart rate variability (HRV) parameters in drug-free panic disorder patients. These results are compared with those obtained from healthy controls. Methods: Thirty-two (mean age 33.12±11.94 years, 20 female, 12 male) drug-free patients for at least 2 weeks, (for fluoksetin 3 weeks) diagnosed with panic disorder (PD) on the basis of DSM-IV criteria were included in the study. The control group comprised of 24 age and gender-matched healthy individuals (mean age 33.45±8.6 years, 17 female and 7 male) without any cardiac, endocrine (including diabetes), and neurological disease. Two groups were evaluated for any axis-I diagnosis with SCID-I. We used Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Panic Disorder Severity Scale (PDSS) and Anxiety Sensitivity Index-3 (ASI-3) tests in both groups. After the psychiatric evaluation 24 hours Holter ECG monitoring was performed in all participants for the determination of HRV including frequency and time domain parameters. Results: The time domain RMSSD and PNN50 values tended to be lower in panic patients but this difference did not reach significance (p=0.229, p=0.571). There was no significant difference in mean values for all time and frequency domain HRV measures over the total 24-hours recording between patients and controls. RMSSD, pNN50 and HF was increased to reflect the parasympathetic predominance in the sleeping period (p=0.0001) but there was no significant difference between groups. However LF value which showing sympathetic activity was increased significantly in healthy control and patients in the sleeping period (p=0.0001) but there was no significant difference between two groups (p=0.905). Correlation analysis in the panic disorder patients presented a negative correlation between disease age at onset HF value (p=0.004) and positive correlation between LF/HF value (p=0.007). When both smokers and non-smokers were compared in terms of HRV values, smoking significantly decreased HRV in both groups [SDNN (p=0,18)]. Conclusion: HRV parameters of panic disorder patients were not different from healthy controls. To better clarify the effects of panic disorder on HRV, factors effecting HRV should be minimized and more Holter ECG studies with longer records should be obtained to reflect the daily life activities. [ABSTRACT FROM AUTHOR]

Introduction: It is known that dysfunctional beliefs are important in the onset and maintenance of symptoms of Obsessive Compulsive Disorder (OCD) according to the cognitive model of OCD. OCD patients with higher obsessive beliefs would be expected to have greater deficits in cognitive flexibility. In this study, we aimed to examine the relationship between obsessive belief levels and cognitive flexibility in OCD patients. Methods: Patients with OCD (50) and Panic Disorder (30) as a control group were evaluated and diagnosed using Structured Clinical Interview for DSM-IV Axis I Disorders. A socio-demographic data form, Beck Depression Inventory, Beck Anxiety Inventory and Wisconsin Card Sorting Test (WCST) were administered to all the patients. The Yale-Brown Obsessive Compulsive Scale and Obsessive Beliefs Questionnaire-44 (OBQ-44) were administered to the OCD group. The OCD group was divided into two subgroups as higher obsessive beliefs (OCD-H) (n=29) and lower obsessive beliefs (OCD-L) (n=21) according to a cluster analytic approach. Results: When the subgroups were compared according to WCST; the number of completed categories was statistically significantly lower, and the numbers of total errors, perseverative errors and non-perseverative errors were significantly higher in the OCD-H group. Conclusion: The results of our study show that cognitive flexibility is impaired in OCD patients with higher obsessive beliefs. [ABSTRACT FROM AUTHOR]

Introduction: Symptomatic heterogeneity in the clinical presentation of Panic Disorder (PD) has lead to several attempts to identify PD subtypes; however, no studies investigated the association between temperament and character dimensions and PD subtypes. The study was aimed to verify whether personality traits were differentially related to distinct symptom dimensions. Methods: Seventy-four patients with PD were assessed by the Mini-International Neuropsychiatric Interview (M.I.N.I.), and the Temperament and Character Inventory (T.C.I.). Thirteen panic symptoms from the M.I.N.I. were included in a factor analysis with varimax rotation. A correlation analysis (Pearson's correlation), a linear regression analysis, and a forward stepwise regression analysis between the identified factors and T.C.I. variables were performed for evaluating the association between panic subtypes and personality features. Results: Three factors were obtained: "Somato-dissociative", "Respiratory", and "Cardiologic" explaining respectively 18.31%, 13.71%, and 12.78% of the total variance. Correlations analyses showed that only "Somato-dissociative" factor was significantly correlated with T.C.I. "Self-directedness" (p<0.0001) and "Cooperativeness" (p=0.009) variables. Results from the regression analysis indicate that the predictor models account for 33.3% and 24.7% of the total variance respectively in "Somatic-dissociative" (p<0.0001) and "Cardiologic" (p=0.007) factors, while they do not show statistically significant effects on "Respiratory" factor (p=0.222). After performing stepwise regression analysis, "Selfdirectedness" resulted the unique predictor of "Somato-dissociative" factor (R²=0.186; β=-0.432; t=-4.061; p<0.0001). Conclusion: Current results, although preliminary, suggest the importance of assessing personality and temperament features that may be potentially related to poor treatment response for a better understanding and characterization of PD subtypes. [ABSTRACT FROM AUTHOR]

The article focuses on the differences in clinical decision-making and resource utilization between rural and urban emergency departments (EDs). It discusses the concept of deliberate clinical inertia and how it can be more readily applied in rural settings due to less diagnostic certainty and limited resources. It is further noted that urban EDs with greater access to resources may lead to more testing and potentially unnecessary interventions.

Purpose: This study aimed to compare the clinical features of panic disorder (PD) with comorbid agoraphobia to those of PD alone. We focused on autonomic nervous system (ANS) alterations reflected in heart rate variability (HRV) and executive function deficits reflected in the Stroop test., Materials and Methods: We retrospectively compared psychometric features, Stroop test results, and resting-state HRV across three groups: a subclinical group with anxiety attack history, a PD group without agoraphobia, and a PD group with agoraphobia. The subclinical group included 10 male and 34 female, the PD without agoraphobia group included 17 male and 19 female, and the PD with agoraphobia group included 11 male and 18 female., Results: The PD with agoraphobia group had higher Symptom Checklist-95 scores than the other groups. Both PD groups had longer reaction times in the Stroop test than the subclinical group. There were no significant differences in HRV parameters between the PD groups with and without agoraphobia. Compared with the subclinical group, the PD with agoraphobia group showed significantly lower values of the natural logarithm of low-frequency HRV., Conclusion: Our results do not support that executive function deficits and ANS alterations are more pronounced with comorbid agoraphobia among PD groups. However, PD with agoraphobia patients showed more complex and severe clinical symptoms in their self-reports. Compared with the subclinical group, PD patients with agoraphobia showed specific features in the natural logarithm of low-frequency HRV. Our findings suggest that agoraphobia comorbidity should be considered when evaluating or treating patients with PD., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2023.)

Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed., (©2023 American Association of Critical-Care Nurses.)

Introduction: Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety., Objective: Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients., Method: Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted., Results: Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy., Discussion and Conclusion: Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

Background: Panic disorder (PD), major depressive disorder (MDD), and the comorbidity (PD&MDD) in college students have caused a heavy disease burden for individuals and families. However, little was known for the comorbidity, especially the impact of parental rearing style on the incidence of the PD&MDD comorbidity., Methods: A cohort study was conducted among 6652 Chinese college students. Composite International Diagnostic Interview (CIDI-3.0) was used for disease diagnosis. The parental rearing styles were measured by the Egna Minnen Beträffande Uppfostran (EMBU) scale and factor analysis was used to reduce the dimension of the EMBU scale. Multinomial logistic regression models were used to determine the relationships between parenting styles and disease incidence. SPSS version 26.0 was used for all statistical analyses., Results: The 1-year incidence of PD, MDD, and PD&MDD comorbidity was 0.27 %, 2.04 %, and 0.21 %, respectively. Emotional warmth mode (OR = 0.753, 95%CI: 0.631-0.899, P < 0.01) were only negatively correlated with major depressive disorder. However, punishment denial mode (OR = 1.857, 95%CI: 1.316-2.620, P < 0.01) and over-participation mode (OR = 1.862, 95%CI: 1.176-2.949, P < 0.01) were positively correlated with the comorbidity of panic disorder and major depressive disorder., Limitations: The limited follow-up period was only 1 year in this study which had impacted the collection of new onset cases., Conclusions: Parental rearing style has a long-term influence on the psychiatric status of college students. Parenting style interventions working as the second level of mental disorder prevention will play an important role in MDD, PD and comorbidity prevention., Competing Interests: Declaration of competing interest We declare that we have no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: It has been suggested that gender differences in anxiety and depressive symptoms characterize panic disorder (PD) in terms of vulnerability to stressful life events, anxiety, depressive symptom patterns, and brain structure. However, few studies have investigated the gender differences in PD using a network approach., Methods: This study included 619 participants with PD (313 men). The Panic Disorder Severity Scale, Albany Panic and Phobia Questionnaire, and Beck Depression Inventory-II were used to evaluate symptomatology. To investigate the PD-related white matter (WM) neural correlates, tract-based spatial statistics were used. The PD-related clinical scales and WM neural correlates were included in the network analysis to identify associations between variables. To evaluate network differences between genders, network comparison tests were conducted., Results: Our findings revealed that agoraphobia in men was the strongest central symptom. In addition, loss of pleasure, and not anxiety or panic symptoms, was the strongest central symptom in women with PD. The network comparison test revealed that the bridge strength score was higher in agoraphobia and tiredness in men and in self-criticalness in women. Furthermore, in the network that includes neural correlates of WM, the bridge strength score was higher in the cingulate gyrus WM in men and the cingulum hippocampus in women., Limitations: Since this is a cross-sectional network study of PD patients, the causal relationship between interactions in this network analysis for both genders may not be accurately determined., Conclusion: Network structures of anxiety and depressive symptomatology and related WM neural correlates can differ according to gender in PD patients., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial of financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Cognitive behavioral therapy (CBT) and pharmacotherapy with antidepressants are both a highly effective treatment for agoraphobia and/or panic disorder; however, a combination of CBT and antidepressants is under debate due to potentially unfavorable interference effects. The associations of existing antidepressant medication with panic and agoraphobia symptom burden and their change in the context of a structured 5‑week day hospital and exposure-focused treatment in a naturalistic setting were investigated., Methods: Out of a total of n = 488 patients medication use during treatment was retrospectively determined for n = 380: n = 100 (26.3%) were taking antidepressants of different drug classes. Calculations were performed using multiple linear regression analysis, t‑tests, response analyses, and χ 2 -tests., Results: Patients with existing antidepressant medication more often met the criteria for comorbid depressive disorder (p < 0.001). The measure of symptom change and treatment response rates did not differ between patients with and without antidepressants with respect to anxiety symptoms., Discussion: In the context studied, patients with and without existing antidepressant medication benefited equally from CBT with respect to anxiety symptoms., (© 2023. The Author(s).)

Repeated panic attacks are the core symptom of panic disorder and severely stressful for patients. Additional to the psychological response, the physiological symptoms are an important aspect of the experienced panic. However, data on the extent of hypothalamic-pituitary-adrenal (HPA)-axis activation during panic attacks is inconsistent. Therefore, in the present study, we aimed at investigating the stress-axis activity in more detail by including Copeptin (CoP) as a stable surrogate parameter for the vasopressinergic hypothalamic activity during experimentally induced panic attacks in healthy adults (N = 21). During a placebo-controlled panic challenge with 35% CO 2 compared to normal air inhalation, we measured CoP and the peripheral effector hormones Adrenocorticotropic Releasing Hormone (ACTH) and cortisol in plasma along with the psychological response to panic anxiety. We analyzed hormonal secretion patterns, their correlations and individual panic ratings over time and explored differences between female and male participants. We found a significant CO 2 -induced increase of CoP plasma levels and psychological panic symptoms after CO 2 -administration, while no positive correlations of CoP levels with the peripheral HPA-axis hormones and with panic symptoms were present. No differences between female and male participants concerning their psychological response nor their baseline CoP levels, the release of CoP or its increase during the experiment were found. CoP could be a sensitive indicator for an organism's physiologic acute hypothalamic response during stress and panic attacks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The aim is to measure the association between fibromyalgia syndrome (FMS) and post-traumatic stress disorder (PTSD), mood and anxiety disorders using reliable psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and with a case–control design. Methods: Case–control study with cases (71 consecutive female patients with FMS) and controls (284 subjects without FMS), randomly drawn after a gender- and age-matching technique from the database of an epidemiological survey. Psychiatric diagnoses were conducted according to DSM-IV and carried out by clinical staff using a structured interview (Advanced Neuropsychiatric Tools and Assessment Schedule). QoL was measured by Short Form Health Survey (SF-12). Results: The lifetime prevalence of major depressive disorder (MDD; 43.7% vs 8.1%, p < .0001), bipolar disorder (BD; 21.1% vs 0.7%, p < .0001), PTSD (8.4% vs 1.4%, p < .0001) and panic disorder (28.2% vs 5.6%, p < .001) was higher in people with FMS than in controls. People with FMS showed a poorer QoL than controls on the SF-12 (26.43 ± 6.04 vs 37.45 ± 5.80, p < .0001). Those with comorbidity with MDD and BD showed a mean SF-12 score of 24.75 ± 6.31 versus 29.52 ± 4.84 (N = 25) of people with FMS without any mood disorder (p = .002). The attributable burden of FMS in worsening QoL was found comparable to that of serious chronic diseases such as multiple sclerosis. Conclusion: FMS is a disorder that ‘in itself’ can have a devastating impact on an individual’s life. The frequency of the association with major depressive and bipolar disorders increases the impact on the QoL of people with FMS. One of the causes of this association appears to be the extreme vulnerability to chronic stress that this disorder involves. The findings have important clinical significance: the physician must interpret in the right dimension and with dignity the suffering of the people with FMS. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents, relative to adults, show impairments in learning to reduce or extinguish fear. Furthermore, they may struggle with the use of reappraisal techniques to regulate affect. Both learning and reappraisals are critical to cognitive-behavioural treatments (CBT) for anxiety disorders leading to the hypothesis that adolescents may respond more poorly to CBT than adults.Methods: We use meta-regression to explore whether variability in the mean age of participants in trials of CBT for anxiety predicted variability between studies in symptom change effect sizes. PsycARTICLES, PsycINFO, MEDLINE and Embase databases were searched with the terms exposure and each of anxiety, phobia, or panic disorder diagnostic terms and cognitive behav* therapy with each of the diagnostic terms. Data were pooled from CBT trials for anxiety disorders (excluding anxiety-related disorders - obsessive compulsive disorder and posttraumatic stress disorder) where participants' mean age was 11 years or older. 149 studies were selected and data on change in symptoms from pre-treatment to post-treatment (k = 195), pre-treatment to follow-up (k = 108) and post-treatment to follow-up (k = 107) were extracted.Results: Several possible confounding variables were also accounted for (e.g., proportion of females, number of sessions). Younger age was associated with smaller improvement in anxious symptoms from pre-to post-treatment. However, younger age was also associated with greater improvement in symptoms from post-treatment to follow-up.Conclusions: CBT is effective at reducing anxious symptoms, however, younger people may respond more slowly to treatment than older people. [ABSTRACT FROM AUTHOR]

Anxiety disorders are among the most prevalent mental health diagnoses. Moreover, comorbid anxiety psychopathology is common among these disorders, pointing to a need for treatments designed to treat multiple anxiety disorders concurrently. This case study illustrates the use of an eight-session transdiagnostic treatment protocol for anxiety, False Safety Behavior Elimination Treatment (F-SET), that focuses on the elimination of safety aids (i.e., strategies used to reduce anxiety). This article provides an overview of the F-SET protocol with a focus on the use of specific treatment techniques, such as developing exercises to fade safety aids and creating antiphobic exercises. Use of the F-SET protocol is demonstrated by following the course of treatment for a client given a primary diagnosis of panic disorder with agoraphobia and a secondary diagnosis of generalized anxiety disorder. The client's treatment progress is discussed session by session and at formal assessment points: midtreatment, posttreatment, and 11-month follow-up. [ABSTRACT FROM AUTHOR]