Sociodemographic and Clinical Variables related to Panic Disorder with and without Agoraphobia

Introduction: Panic Disorder (PD) is characterised by sudden episodic attacks of anxiety that are extremely disabling for the patients. It is usually associated with agoraphobia and several other psychiatric comorbid disorders. These not only tend to escalate the severity of primary illness however, also worsen the long term prognosis. An association has also been noticed between presence of stress and severity of PD. In the current study we have tried to include as many factors as possible that affect common and disabling illness like PD. Aim: To compare the severity of illness in the patients of PD with and without agoraphobia, and to further find the association, if any, of psychiatric comorbidities and stress on the severity of symptoms in these two groups. Materials and Methods: A cross-sectional observational study was carried out in a tertiary care psychiatry centre, from November 2013 to January 2015. Patients between 18 and 65 years with PD were divided into two groups PD (Panic Disorder without Agoraphobia) and PDAG (Panic Disorder with Agoraphobia) which were compared for difference in severity of anxiety {Panic Disorder Severity Scale (PDSS) and Hamilton Rating Scale for Anxiety (HAM-A) were used}, presence of comorbidity and stress, and their effect on severity of symptoms. SPSS 22.0 was used for all statistical analyses. Continuous variables were presented on mean, Standard Deviation (SD) or median if data is unevenly distributed. Categorical variables were expressed as frequencies and percentages. The comparison of normally distributed continuous variables between groups has been performed using ANOVA. Nominal categorical data between groups were compared using chi-squared test or fisher’s exact test as appropriate. Non-normal distribution continuous variables have been compared using Kruskal-Wallis test. For all statistical tests a p-value of less than 0.05 has been taken to indicate significant difference. Results: Mean PDSS and HAM-A scores were higher in PDAG group (21.30±3.46 and 23.37±2.91) than in PD group (13.50±4.1 and 18.50±5.070). 43 (71.67%) of the total patients (60) suffered from another psychiatric disorder. Comorbidity was higher in PDAG group with more than 83.3% (n=25) suffering from another mental health condition apart from PD. Depression was the most common comorbidity while Generalised Anxiety Disorder (GAD), alcohol use disorder and Obsessive Compulsive Disorder (OCD) were others. Almost all individuals reported, some stress rated on Perceived Stress Scale (PSS). In individuals experiencing stress, panic and anxiety symptoms were found to be more severe. Conclusion: There was significant difference in the two groups in terms of severity of symptoms as measured on corresponding scale for PD (PDSS score of 21.3 in PDAG, 13.5 in PD group; p=0.035), presence of comorbidity (83.3% in PDAG group, 60% in PD group) and stress {all individual in PDAG group (n=30) reported moderate to high stress levels}. Presence of agoraphobia; comorbid psychiatric disorders and stress were associated with more severe illness, increased severity of panic and other anxiety symptoms.