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1.
Medicine (Baltimore). 2018 Sep;97(38):e12422. doi: 10.1097/MD.0000000000012422.

Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder.

Author information

1
Department of Psychiatry, Seoul National University Hospital.
2
Department of Medicine, Seoul National University College of Medicine.
3
Department of Psychiatry and Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Republic of Korea.

Abstract

Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.

PMID:
30235717
PMCID:
PMC6160091
DOI:
10.1097/MD.0000000000012422
[Indexed for MEDLINE]
Free PMC Article
Icon for Wolters Kluwer Icon for PubMed Central
2.
Health Psychol. 2018 Sep;37(9):828-838. doi: 10.1037/hea0000632.

The Revised-Panic Screening Score for emergency department patients with noncardiac chest pain.

Author information

1
School of Psychology.
2
University Affiliated Hospital Hotel- Dieu de Levis Research Centre.
3
Department of Family Medicine and Emergency Medicine.

Abstract

OBJECTIVES:

We sought to reduce the 90% rate of missed diagnoses of panic-like anxiety (panic attacks with or without panic disorder) among emergency department patients with low risk noncardiac chest pain by validating and improving the Panic Screening Score (PSS).

METHOD:

A total of 1,102 patients with low risk noncardiac chest pain were prospectively and consecutively recruited in two emergency departments. Each patient completed a telephone interview that included the PSS, a brief 4-item screening instrument, new candidate predictors of panic-like anxiety, and the Anxiety Disorder Interview for the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition to identify panic-like anxiety.

RESULTS:

The original 4-item PSS demonstrated a sensitivity of 51.8% (95% CI [48.4, 57.0]) and a specificity of 74.8% (95% CI [71.3, 78.1]) for panic-like anxiety. Analyses prompted the development of the Revised-PSS; this 6-item instrument was 19.1% (95% CI [12.7, 25.5]) more sensitive than the original PSS in identifying panic-like anxiety in this sample (χ2(1, N = 351) = 23.89 p < .001) while maintaining a similar specificity (χ2(1, N = 659) = 0.754, p = .385; 0.4%, 95% CI [-3.6, 4.5]). The discriminant validity of the Revised-PSS proved stable over the course of a 10-fold cross-validation.

CONCLUSIONS:

The Revised-PSS has significant potential for improving identification of panic-like anxiety in emergency department patients with low risk noncardiac chest pain and promoting early access to treatment. External validation and impact analysis of the Revised-PSS are warranted prior to clinical implementation. (PsycINFO Database Record

PMID:
30138020
DOI:
10.1037/hea0000632
[Indexed for MEDLINE]
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3.
Expert Opin Pharmacother. 2018 Aug;19(12):1357-1368. doi: 10.1080/14656566.2018.1504921. Epub 2018 Jul 31.

Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years.

Author information

1
a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy.
2
b Humanitas Clinical and Research Center , Milan , Italy.
3
c Department of Biomedical Sciences , Humanitas University , Rozzano, Milan , Italy.
4
d Department of Psychiatry and Neuropsychology, Faculty of Health , Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands.
5
e Department of Psychiatry and Behavioral Sciences , Leonard Miller School of Medicine, Miami University , Miami , FL , USA.

Abstract

Several effective medications are available for treating panic disorder (PD). However, outcomes are unsatisfactory in a number of patients, suggesting the usefulness of expanding the array of antipanic drugs and improving the quality of response to current recommended treatments. Areas covered: The authors have performed an updated systematic review of pharmacological studies (phase III onwards) to examine whether advances have been made in the last five years. Only four studies were included. D-cycloserine no longer seemed promising as a cognitive-behavioral therapy (CBT) enhancer. Some preliminary findings concerning the optimization of recommended medications deserved consideration, including: the possibility that SSRIs are more effective than CBT alone in treating panic attacks, combined therapy is preferable when agoraphobia is present, and clonazepam is more potent than paroxetine in decreasing panic relapse. Expert opinion: Given the lack of novel treatments, expanding a personalized approach to the existing medications seems to be the most feasible strategy to improve pharmacotherapy outcomes regarding PD. Recent technological progress, including wearable devices collecting real-time data, 'big data' platforms, and application of machine learning techniques might help make outcome prediction more reliable. Further research on previously promising novel treatments is also recommended.

KEYWORDS:

Clonazepam; d-cycloserine; panic disorder; paroxetine; personalized; pharmacotherapy; selective serotonin reuptake inhibitors (SSRIs)

PMID:
30063164
DOI:
10.1080/14656566.2018.1504921
[Indexed for MEDLINE]
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4.
Med Sci Law. 2018 Jul;58(3):147-155. doi: 10.1177/0025802418779934. Epub 2018 Jun 4.

Complex regional pain syndrome type 1 in the medico-legal setting: High rates of somatoform disorders, opiate use and diagnostic uncertainty.

Author information

1
1 Department of Psychological Medicine, John Radcliffe Hospital, UK.
2
2 The London School of Medicine and Dentistry, UK.

Abstract

Objective The aim of this study was to review demographic and clinical characteristics of patients with complex regional pain syndrome type 1 (CRPS) seen in a UK medico-legal setting - particularly the relationship between CRPS and somatoform disorders. Methods Fifty consecutive cases of CRPS (interviewed 2005-2016) undergoing psychiatric assessment were reviewed. A systematic assessment of mental states was conducted via interview and examination of medical/psychiatric records. Thirty patients also completed the Brief Illness Perception Questionnaire (BIPQ). Results Sixty per cent of patients ( n = 30) were female, and the mean age was 43 years. Twenty-two per cent ( n = 11) were employed, and 60% ( n = 30) received disability benefits. Symptoms were reported in the upper limb (62%; n = 31), lower limb (30%; n = 15), both (6%; n = 3) or elsewhere (2%; n = 1). Eighty-four per cent ( n = 42) satisfied DSM-5 criteria for current somatoform disorder. A history of more than two pain-related functional somatic syndromes (e.g. non-cardiac chest pain) was found in 42% ( n = 21) and functional neurological symptoms (e.g. 'claw-hand') in 42% ( n = 21). BIPQ scores resembled those associated with somatoform disorders and disorders mediated by psychological factors (e.g. irritable bowel syndrome). In 38% ( n = 19), the CRPS diagnosis was disputed among experts. A history of depression was noted in 60% ( n = 30), panic attacks in 20% ( n = 10) and alcohol/substance misuse in 18% ( n = 9). Opiates were prescribed to 64% ( n = 32). Conclusions Patients diagnosed with CRPS involved in litigation have high rates of prior psychopathology (mainly somatoform disorders) and pain-related disability for which opiate use is common. They risk an adverse reaction to limb pain 'shaped' by maladaptive illness beliefs. The CRPS diagnosis lacks reliability in medico-legal settings and may cause iatrogenic harm.

KEYWORDS:

Complex regional pain syndrome (CRPS); iatrogenic illness; somatisation; somatoform disorders

PMID:
29865933
DOI:
10.1177/0025802418779934
[Indexed for MEDLINE]
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5.
Seizure. 2018 Jul;59:108-115. doi: 10.1016/j.seizure.2018.05.007. Epub 2018 May 19.

The association of panic and hyperventilation with psychogenic non-epileptic seizures: A systematic review and meta-analysis.

Author information

1
University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, 3084, Australia.
2
Department of Neurology, Austin Health, Heidelberg, VIC, 3084, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, 3084, Australia.
3
University of Otago, Dunedin, 9016, New Zealand.
4
Institute for Breathing and Sleep, Bowen Centre, Austin Health, Heidelberg, VIC, 3084, Australia.
5
University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC, 3084, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, 3084, Australia; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Denmark Hill, London, SE5 9RJ, UK. Electronic address: richard.kanaan@unimelb.edu.au.

Abstract

INTRODUCTION:

Psychogenic Non-Epileptic Seizures (PNES) are events that appear epileptic but are instead thought to have a psychological origin. Increased rates of several psychiatric disorders have been reported in PNES, including anxiety and panic disorders. Some theories suggest panic and/or hyperventilation have aetiological roles in PNES, though these remain unproven.

METHODS:

We conducted a systematic review of associations of panic and hyperventilation with PNES using Ovid Medline and PubMed, and a meta-analysis where appropriate.

RESULTS:

We found eighteen studies reporting rates of panic in PNES and eight studies reporting hyperventilation. The reported rate of panic attacks in PNES ranged from 17% to 83%, with physical symptoms more commonly reported, and affective symptoms less so. 'Dizziness or light-headedness' was found to be more prevalent than 'fear of dying' by random-effects meta-analysis (68% vs. 23%). A proportion meta-analysis found a weighted occurrence of 20% of panic disorder in PNES. A pooled meta-analytic rate of PNES events following voluntary hyperventilation induction was 30%, while the clinically observed rates of peri-ictal hyperventilation in PNES without induction varied from 15 to 46%.

CONCLUSIONS:

Previous studies have reported moderate rates of association of panic in PNES, though the proportions varied considerably across the literature, with physical symptoms more commonly reported than affective. Hyperventilation is an effective inducer of PNES events in a minority, and can be observed occurring in a minority of patients without induction. These results support an important, albeit not essential, role for panic and hyperventilation in the pathogenesis of PNES events.

KEYWORDS:

Hyperventilation; Panic; Panic attack; Panic disorder; Panic symptoms; Psychogenic non-epileptic seizures

PMID:
29787922
DOI:
10.1016/j.seizure.2018.05.007
[Indexed for MEDLINE]
Icon for Elsevier Science
6.
Evid Based Ment Health. 2018 May;21(2):53-60. doi: 10.1136/eb-2017-102858. Epub 2018 Apr 10.

Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis.

Author information

1
Genneruxi Medical Center, Cagliari, Italy.
2
Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy.
3
Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia.
4
Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
5
Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.
6
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Abstract

QUESTION:

Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid with BD has been systematically reviewed and subject to meta-analysis.

STUDY SELECTION AND ANALYSIS:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were thoroughly followed for literature search, selection and reporting of available evidence. The variance-stabilising Freeman-Tukey double arcsine transformation was used in the meta-analysis of prevalence estimates. Both fixed-effect and random-effects models with inverse variance method were applied to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I2 statistics.

FINDINGS:

Overall, 15 studies (n=3391) on cross-sectional prevalence and 25 independent lifetime studies (n=8226) were used to calculate pooled estimates. The overall random-effects point prevalence of PD in patients with BD, after exclusion of one potential outlier study, was 13.0% (95% CI 7.0% to 20.3%), and the overall random-effects lifetime estimate, after exclusion of one potential outlier study, was 15.5% (95% CI 11.6% to 19.9%). There were no differences in rates between BD-I and BD-II. Significant heterogeneity (I2 >95%) was found in both estimates.

CONCLUSIONS:

Estimates that can be drawn from published studies indicate that the prevalence of PD in patients with BD is higher than the prevalence in the general population. Comorbid PD is reportedly associated with increased risk of suicidal acts and a more severe course. There is no clear indication on how to treat comorbid PD in BD. Findings from the current meta-analysis confirm the highly prevalent comorbidity of PD with BD, implicating that in patients with BD, PD might run a more chronic course.

PMID:
29636354
DOI:
10.1136/eb-2017-102858
[Indexed for MEDLINE]
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7.
Cochrane Database Syst Rev. 2018 Apr 5;4:CD010676. doi: 10.1002/14651858.CD010676.pub2.

Antidepressants versus placebo for panic disorder in adults.

Author information

1
Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, Munich, Germany.

Abstract

BACKGROUND:

Panic disorder is characterised by repeated, unexpected panic attacks, which represent a discrete period of fear or anxiety that has a rapid onset, reaches a peak within 10 minutes, and in which at least four of 13 characteristic symptoms are experienced, including racing heart, chest pain, sweating, shaking, dizziness, flushing, stomach churning, faintness and breathlessness. It is common in the general population with a lifetime prevalence of 1% to 4%. The treatment of panic disorder includes psychological and pharmacological interventions. Amongst pharmacological agents, the National Institute for Health and Care Excellence (NICE) and the British Association for Psychopharmacology consider antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), as the first-line treatment for panic disorder, due to their more favourable adverse effect profile over monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). Several classes of antidepressants have been studied and compared, but it is still unclear which antidepressants have a more or less favourable profile in terms of effectiveness and acceptability in the treatment of this condition.

OBJECTIVES:

To assess the effects of antidepressants for panic disorder in adults, specifically:1. to determine the efficacy of antidepressants in alleviating symptoms of panic disorder, with or without agoraphobia, in comparison to placebo;2. to review the acceptability of antidepressants in panic disorder, with or without agoraphobia, in comparison with placebo; and3. to investigate the adverse effects of antidepressants in panic disorder, with or without agoraphobia, including the general prevalence of adverse effects, compared to placebo.

SEARCH METHODS:

We searched the Cochrane Common Mental Disorders' (CCMD) Specialised Register, and CENTRAL, MEDLINE, EMBASE and PsycINFO up to May 2017. We handsearched reference lists of relevant papers and previous systematic reviews.

SELECTION CRITERIA:

All double-blind, randomised, controlled trials (RCTs) allocating adults with panic disorder to antidepressants or placebo.

DATA COLLECTION AND ANALYSIS:

Two review authors independently checked eligibility and extracted data using a standard form. We entered data into Review Manager 5 using a double-check procedure. Information extracted included study characteristics, participant characteristics, intervention details and settings. Primary outcomes included failure to respond, measured by a range of response scales, and treatment acceptability, measured by total number of dropouts for any reason. Secondary outcomes included failure to remit, panic symptom scales, frequency of panic attacks, agoraphobia, general anxiety, depression, social functioning, quality of life and patient satisfaction, measured by various scales as defined in individual studies. We used GRADE to assess the quality of the evidence for each outcome MAIN RESULTS: Forty-one unique RCTs including 9377 participants overall, of whom we included 8252 in the 49 placebo-controlled arms of interest (antidepressant as monotherapy and placebo alone) in this review. The majority of studies were of moderate to low quality due to inconsistency, imprecision and unclear risk of selection and performance bias.We found low-quality evidence that revealed a benefit for antidepressants as a group in comparison with placebo in terms of efficacy measured as failure to respond (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.66 to 0.79; participants = 6500; studies = 30). The magnitude of effect corresponds to a number needed to treat for an additional beneficial outcome (NNTB) of 7 (95% CI 6 to 9): that means seven people would need to be treated with antidepressants in order for one to benefit. We observed the same finding when classes of antidepressants were compared with placebo.Moderate-quality evidence suggested a benefit for antidepressants compared to placebo when looking at number of dropouts due to any cause (RR 0.88, 95% CI 0.81 to 0.97; participants = 7850; studies = 30). The magnitude of effect corresponds to a NNTB of 27 (95% CI 17 to 105); treating 27 people will result in one person fewer dropping out. Considering antidepressant classes, TCAs showed a benefit over placebo, while for SSRIs and serotonin-norepinephrine reuptake inhibitor (SNRIs) we observed no difference.When looking at dropouts due to adverse effects, which can be considered as a measure of tolerability, we found moderate-quality evidence showing that antidepressants as a whole are less well tolerated than placebo. In particular, TCAs and SSRIs produced more dropouts due to adverse effects in comparison with placebo, while the confidence interval for SNRI, noradrenergic reuptake inhibitors (NRI) and other antidepressants were wide and included the possibility of no difference.

AUTHORS' CONCLUSIONS:

The identified studies comprehensively address the objectives of the present review.Based on these results, antidepressants may be more effective than placebo in treating panic disorder. Efficacy can be quantified as a NNTB of 7, implying that seven people need to be treated with antidepressants in order for one to benefit. Antidepressants may also have benefit in comparison with placebo in terms of number of dropouts, but a less favourable profile in terms of dropout due to adverse effects. However, the tolerability profile varied between different classes of antidepressants.The choice of whether antidepressants should be prescribed in clinical practice cannot be made on the basis of this review.Limitations in results include funding of some studies by pharmaceutical companies, and only assessing short-term outcomes.Data from the present review will be included in a network meta-analysis of psychopharmacological treatment in panic disorder, which will hopefully provide further useful information on this issue.

PMID:
29620793
DOI:
10.1002/14651858.CD010676.pub2
[Indexed for MEDLINE]
Icon for Wiley
8.
J Affect Disord. 2018 Jul;234:290-296. doi: 10.1016/j.jad.2018.02.060. Epub 2018 Mar 8.

Interplay between COMT Val158Met, childhood adversities and sex in predicting panic pathology: Findings from a general population sample.

Author information

1
Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany. Electronic address: eva.asselmann@tu-dresden.de.
2
Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
3
Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
4
Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
5
Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany.
6
Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, University Medicine, Greifswald, Germany.
7
Department of Physiological and Clinical Psychology, University of Greifswald, Greifswald Germany.

Abstract

BACKGROUND:

The single nucleotide polymorphism rs4680 of the catechol-O-methyltransferase (COMT) gene has been implicated to be involved in the etiopathogenesis of panic. However, it remains unresolved whether rs4680 modifies the risk-association between early life stress and subsequent development of panic pathology.

METHODS:

The genotype of rs4680 was determined for n = 2242 adults with European ancestry from the Study of Health in Pomerania (SHIP, a regional longitudinal cohort study from northeastern Germany). Lifetime fearful spells, panic attacks and panic disorder were assessed according to DSM-IV in 2007-2010 (when participants were aged 29-89) using the Munich Composite International Diagnostic Interview (DIA-X/M-CIDI). Childhood adversities were assessed with the Childhood Trauma Questionnaire (CTQ).

RESULTS:

Logistic regressions with interaction terms (adjusted for sex and age) revealed that rs4680 interacted with total childhood adversity, emotional abuse and physical abuse in predicting panic disorder: Respective childhood adversities predicted panic disorder in carriers of the Val/Met or Met/Met genotype, but not Val/Val genotype. Moreover, a 3-way interaction was found between rs4680, emotional abuse and sex in predicting panic attacks: Emotional abuse predicted panic attacks among male carriers of the Val/Val genotype and female carriers of the Val/Met or Met/Met genotype, but not among male carriers of the Val/Met or Met/Met genotype or female carriers of the Val/Val genotype.

LIMITATIONS:

Genotype data were derived by imputation. Childhood adversities and panic were assessed retrospectively.

CONCLUSIONS:

Especially (female) carriers of the Val/Met or Met/Met genotype of rs4680 might profit from targeted early interventions to prevent the onset of panic after childhood adversities.

KEYWORDS:

Childhood adversity; Epidemiology; Gene x environment interaction; Psychopathology; Trauma; rs4680

PMID:
29574383
DOI:
10.1016/j.jad.2018.02.060
[Indexed for MEDLINE]
Icon for Elsevier Science
9.
Span J Psychol. 2018 Mar 25;21:E5. doi: 10.1017/sjp.2018.6.

Psychometric Properties of the Spanish Version of the Panic Disorder Severity Scale.

Author information

1
Private practice A Coruña(Spain).
2
Private practice Zaragoza(Spain).
3
Hospital Universitario Parc Taulí(Spain).
4
Hospital del Mar(Spain).
5
Universitat Autónoma de Barcelona(Spain).

Abstract

The Panic Disorder Severity Scale (PDSS) is a well-established measure of panic symptoms but few data exist on this instrument in non north-American samples. Our main goal was to assess the psychometric properties (internal consistency, test re-test reliability, inter-rater reliability, convergent and divergent validity) and the factor structure of the Spanish version. Ninety-four patients with a main diagnosis of panic disorder were assessed with the Spanish version of PDSS, the Anxiety Sensitivity Index-3 (ASI-3), the Panic and Agoraphobia Scale (PAS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) the PDSS self-rating form and the Clinical Global Impression-Severity scale (CGI). The Spanish PDSS showed acceptable internal consistency (α = .74), excellent test-retest (total score and items 1-6: α > .58, p .90) and medium to large convergent validity (r = .68, 95% CI [.54, .79], p < .01; r = .80, 95% CI [.70, .87], p < .01; r = .48, 95% CI [.28, .67], p < .01; BAI, PAS and ASI-3 total scores respectively). Data on divergent validity (BDI-II total score: r = .52, 95% CI [.34, .67], p < .01) suggest some need for refinement of the PDSS. The confirmatory factor analysis suggested a two-factor modified model for the scale (nested χ2 = 14.01, df = 12, p < .001). The Spanish PDSS has similar psychometric properties as the previous versions and is a useful instrument to assess panic symptoms in clinical settings in Spanish-speaking populations.

KEYWORDS:

Panic Disorder Severity Scale; assessment; panic disorder; psychometric properties

PMID:
29573755
DOI:
10.1017/sjp.2018.6
[Indexed for MEDLINE]
Icon for Cambridge University Press
10.
PLoS One. 2018 Mar 20;13(3):e0194493. doi: 10.1371/journal.pone.0194493. eCollection 2018.

Catastrophic misinterpretation of bodily sensations and external events in panic disorder, other anxiety disorders, and healthy subjects: A systematic review and meta-analysis.

Author information

1
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.

Abstract

The catastrophic misinterpretation model of panic disorder (PD) predicts that the catastrophic misinterpretation of bodily sensations is a distinctive characteristic of PD. Existing research on this prediction has produced mixed findings. This paper presents a systematic review and meta-analysis of studies comparing the strength of catastrophic misinterpretation of bodily sensations and external events in patients with PD, patients with other anxiety disorders, and healthy controls. Following a systematic screening, seven studies were included in the meta-analysis. For the catastrophic misinterpretation of bodily sensations, analyses showed medium to large effects between patients with PD and healthy controls and between patients with PD and patients with other anxiety disorders. For the catastrophic misinterpretation of external events, analyses showed medium to large effects between patients with PD and healthy controls and a small negative effect between patients with PD and patients with other anxiety disorders. The findings support the assumption that the catastrophic misinterpretation of bodily sensations is a distinctive characteristic of panic disorder and thus lend support to the catastrophic misinterpretation model of PD.

PMID:
29558505
PMCID:
PMC5860765
DOI:
10.1371/journal.pone.0194493
[Indexed for MEDLINE]
Free PMC Article
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11.
Psychother Psychosom. 2018;87(3):187-189. doi: 10.1159/000487599. Epub 2018 Mar 13.

Pretreatment Cardiac Vagal Tone Predicts Dropout from and Residual Symptoms after Exposure Therapy in Patients with Panic Disorder and Agoraphobia.

Author information

1
Department of Psychology, University of Greifswald, Greifswald, Germany.
2
Department of Psychology, Ohio State University, Columbus, Ohio, USA.
3
Department of Psychology, University of Cologne, Cologne, Germany.
4
Department of Psychology, University of Basel, Basel, Switzerland.
5
Christoph-Dornier Foundation for Clinical Psychology, Bremen, Germany.
6
Department of Psychology, University of Hamburg, Hamburg, Germany.
7
Department of Psychology, University of Würzburg, Würzburg, Germany.
8
Department of Psychology, Humboldt University of Berlin, Berlin, Germany.
9
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
10
Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
11
Department of Psychiatry, University of Münster, Münster, Germany.
12
Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany.
13
Department of Psychology, Technische Universität Dresden, Dresden, Germany.
PMID:
29533952
DOI:
10.1159/000487599
[Indexed for MEDLINE]
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12.
J Affect Disord. 2018 Jul;234:38-44. doi: 10.1016/j.jad.2018.02.038. Epub 2018 Feb 17.

Anxiety disorders and figural fluency: A measure of executive function.

Author information

1
VIRENZE-RIAGG Maastricht, METggz Maastricht, Regional Institute for Mental Health Care in Outpatients, Maastricht, The Netherlands; Maastricht University Medical Center, School for Mental Health and Neuroscience (MHeNS) / Alzheimer Centre Limburg and Department of Psychiatry and Psychology / MUMC, Maastricht, The Netherlands. Electronic address: bgulpers.uop@gmail.com.
2
University of Groningen, University Medical Center Groningen, Center for Psychiatry & Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands.
3
Maastricht University Medical Center, School for Mental Health and Neuroscience (MHeNS) / Alzheimer Centre Limburg and Department of Psychiatry and Psychology / MUMC, Maastricht, The Netherlands.

Abstract

BACKGROUND:

Anxiety possibly interferes with executive functioning, although most studies rely on anxiety symptoms or lack control for comorbid depression. The objective of the present study is to examine the association between executive functioning and (individual) anxiety disorders with ak,ld without controlling for depression.

METHOD:

Generalized anxiety disorder (GAD), panic disorder with and without agoraphobia, agoraphobia, social phobia, as well as depressive disorder according to DSM-IV criteria were assessed with the Mini International Neuropsychiatric Interview in 82,360 community-dwelling people participating in the Lifelines cohort. Figural fluency as a measure of executive functioning was assessed with the Ruff Figural Fluency Test (RFTT). Linear regression analyses with the RFFT score as the dependent variable and psychiatric diagnosis as independent variables (dummies) were performed, adjusted for potential confounders. Multivariate results are presented with and without adjustment for depression.

RESULTS:

Presence of any anxiety disorder was associated with worse performance on the RFFT (B = - 0.78, SE = 0.32, p = .015), independent of depression. No dose-response relationship with the number of anxiety disorders was found. Only agoraphobia and generalized anxiety disorder were significantly associated with the RFFT score in the multivariate models. Agoraphobia remained significant when further adjusted for depressive disorder (B = - 1.14, SE = 0.41, p < .01), while GAD did not (B = 0.013, SE = 0.431, p = .975).

LIMITATIONS:

Executive function was tested by only one measure, namely figural fluency.

CONCLUSION:

Agoraphobia is associated with worse executive functioning. Treatment of agoraphobia could be influenced by the executive dysfunction which clinicians should be aware of when regular treatment fails.

KEYWORDS:

Agoraphobia; Anxiety disorders; Cognition; Generalized anxiety disorder; Panic disorder; Social phobia

PMID:
29522942
DOI:
10.1016/j.jad.2018.02.038
[Indexed for MEDLINE]
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13.
Am J Clin Hypn. 2018 Apr;60(4):367-377. doi: 10.1080/00029157.2017.1326372.

Integrating Hypnosis with Other Therapies for Treating Specific Phobias: A Case Series.

Author information

1
a Private Practice , New York , New York , USA.

Abstract

There is a high prevalence of anxiety disorders including specific phobias and panic disorder in the United States and Europe. A variety of therapeutic modalities including pharmacotherapy, cognitive behavioral therapy, systematic desensitization, hypnosis, in vivo exposure, and virtual reality exposure therapy have been applied. No one modality has been entirely successful. There has been only a limited attempt to combine psychological therapies in the treatment of specific phobias and panic disorder and what has been done has been primarily with systematic desensitization or cognitive behavioral therapy along with hypnotherapy. I present two cases of multiple specific phobias that were successfully treated with hypnotherapy combined with virtual reality exposure therapy or in vivo exposure therapy. The rationale for this integrative therapy and the neurobiological constructs are considered.

KEYWORDS:

acrophobia; hypnosis; integrative psychotherapy; panic disorder; social phobia; specific phobia; vestibular-positional disorder; virtual reality exposure therapy

PMID:
29485374
DOI:
10.1080/00029157.2017.1326372
[Indexed for MEDLINE]
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14.
PLoS One. 2018 Feb 21;13(2):e0193338. doi: 10.1371/journal.pone.0193338. eCollection 2018.

Early intervention for subthreshold panic disorder in the Netherlands: A model-based economic evaluation from a societal perspective.

Author information

1
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
2
Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Utrecht, The Netherlands.
3
Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands.
4
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.

Abstract

BACKGROUND:

Panic disorder (PD) is associated with impaired functioning and reduced quality of life. In the Netherlands, almost 2% of the population experiences clinically relevant panic symptoms without meeting the diagnostic criteria for PD, which is referred to as subthreshold PD (STHPD). Evidence suggests that subthreshold mental disorders may have a similar impact on quality of life and functioning in comparison with full-blown mental disorders, which draws attention to the need for interventions for STHPD. These interventions are currently not systematically provided in clinical practice. This study aims to investigate the population cost-effectiveness of adding a CBT-based early intervention for adults with STHPD to the existing health care for people with PD in the Netherlands.

METHODS:

A health-economic Markov model was constructed in order to compare quality adjusted life-years (QALYs) and societal costs of adding an early intervention to usual care for PD. The model compares usual care with an alternative program in which usual care is supplemented with a CBT-based early intervention. Input parameters for the model were derived from national sources and published literature where possible, and based on expert opinion otherwise. Probabilistic and deterministic sensitivity analyses were conducted to evaluate the uncertainty of the model input parameters.

RESULTS:

On average, the added CBT-based early intervention was dominant in comparison with usual care, meaning that the early intervention yielded more QALYs at lower costs. At a willingness-to-pay threshold of €20,000 per QALY, the cost-effectiveness probability of the added early intervention was 98%. Sensitivity analyses showed that the results were robust.

CONCLUSIONS:

This study showed that offering an early intervention in addition to usual care for PD is potentially cost-effective, but it should be further investigated to what extent trial results can be extrapolated to the level of the population before such interventions are implemented on a large scale.

PMID:
29466470
PMCID:
PMC5821393
DOI:
10.1371/journal.pone.0193338
[Indexed for MEDLINE]
Free PMC Article
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15.
J Clin Neurosci. 2018 Apr;50:131-132. doi: 10.1016/j.jocn.2018.01.055. Epub 2018 Feb 21.

Novel SGCE mutation in a patient with myoclonus-dystonia syndrome - Diagnostic delay of more than 40 years.

Author information

1
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Movement Disorders Section, Campus Virchow Klinikum and Campus Mitte, Department of Neurology, Charitéplatz 1, 10119 Berlin, Germany. Electronic address: dorothee.kuebler@charite.de.
2
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Movement Disorders Section, Campus Virchow Klinikum and Campus Mitte, Department of Neurology, Charitéplatz 1, 10119 Berlin, Germany.
3
Institute of Neurogenetics, University of Lübeck, Maria-Goeppert-Straße 1, 23562 Lübeck, Germany.

Abstract

We present a case of myoclonus-dystonia syndrome illustrated by three videos in which we found a novel SGCE mutation. As the patient described here was suffering from predominant psychiatric comorbidities it took more than 40 years from the first manifestation of the disease until the diagnosis. Having detected the genetically proven cause for his motor and non-motor symptoms was an enormous relief to our patient. We want to share this instructive case in order to prompt neurologists and psychiatrists to look closely at both movement disorders and neuropsychiatric signs in order to diagnose and treat patients to the latest standard.

KEYWORDS:

DYT11; Myoclonus dystonia; Novel mutation; Psychiatric symptoms; SGCE gene

PMID:
29429788
DOI:
10.1016/j.jocn.2018.01.055
[Indexed for MEDLINE]
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16.
BMC Gastroenterol. 2018 Jan 27;18(1):21. doi: 10.1186/s12876-018-0749-3.

Epidemiology of gastrointestinal symptoms in young and middle-aged Swiss adults: prevalences and comorbidities in a longitudinal population cohort over 28 years.

Author information

1
Research Department, Rehabilitation Clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland. avramidmar@gmail.com.
2
Research Department, Rehabilitation Clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland.
3
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
4
Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of São Paulo, São Paulo, Brazil.
5
Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
6
Department of Psychiatry und Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Abstract

BACKGROUND:

Although subacute and chronic gastrointestinal symptoms are very common in primary care, epidemiological date are sparse. The aim of the study was to examine and quantify the prevalence of subacute and chronic gastrointestinal symptoms and their associations with somatic and mental disorders in the general population.

METHODS:

Data were collected prospectively between 1981 (age m = 22, f = 23) and 2008 (age 49/50) from the Zurich Cohort Study (n = 292 men, 299 women), a representative general population survey. The participants were assessed using a semi-structured interview, the "Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology" (SPIKE). Prevalence rates were computed to be representative of the general population aged 22-50. Associations were quantified by odds ratios (ORs) and their 99% confidence intervals (CI).

RESULTS:

The prevalences of intestinal and of gastric symptoms were significantly higher among women in all categories examined. For example, any gastric symptoms: f. 26.4% vs m.15.2%; any intestinal symptoms: 27.6% vs 14.6%; nausea/vomitus: 19.1% vs 4.5%; constipation: 15.8% vs 6.5% (all p < 0.001). Strong associations (all p < 0.0001) were found between fatigue (1 month) and chronic stomach (OR = 9.96, 99%-CI: 5.53-17.94) and chronic intestinal symptoms (OR = 9.02, 99%-CI: 4.92-16.54). Panic attacks were associated with subacute intestinal symptoms (OR = 4.00, 99%-CI: 2.43-6.59). Anxiety was more strongly associated with subacute intestinal symptoms (OR = 3.37, 99%-CI: 2.23-5.08) than with subacute stomach symptoms (OR = 1.85, 1.20-2.86). Bipolar disorders were associated with subacute stomach symptoms (OR = 1.83, 1.18-2.17) and unipolar depression with subacute intestinal symptoms (OR = 2.05, 1.34-3.15).

CONCLUSIONS:

Remarkably high prevalence rates of gastric and intestinal complaints were observed in women (over 1/4; men 1/7). Fatigue/neurasthenia was the strongest co-factor in both conditions. Various syndromes related to anxiety, phobia, and panic disorders showed further significant associations. The integration of psychiatric and/or psychological treatment could help address the functional part of gastric and intestinal syndromes.

KEYWORDS:

Associations; Epidemiology; Functional; Gastrointestinal; General population survey; Odds ratios; Prevalence

PMID:
29374473
PMCID:
PMC5787318
DOI:
10.1186/s12876-018-0749-3
[Indexed for MEDLINE]
Free PMC Article
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17.
Expert Opin Drug Saf. 2018 Mar;17(3):315-324. doi: 10.1080/14740338.2018.1429403. Epub 2018 Jan 22.

Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines.

Author information

1
a Laboratory of Panic & Respiration, Institute of Psychiatry , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.

Abstract

Panic disorder (PD) is a prevalent and disabling anxiety disorder that can be treated effectively. Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are among the most frequently prescribed drugs for PD. In this article, the authors review the current evidence on efficacy, adverse events, and limitations of these two treatment options. Areas covered: MEDLINE/Pubmed and Web of Science databases were searched for open or placebo-controlled trials on SSRIs and/or benzodiazepines in PD treatment. Expert opinion: The literature search yielded 4,957 articles related to the theme. Of these, 24 articles were included in this review. Despite their usefulness in PD, SSRIs are associated with a delay of several weeks in onset of therapeutic effect and have the potential to exacerbate anxiety and panic early in the treatment course. Benzodiazepines present rapid onset of action, but can cause tolerance and dependence. Despite strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD, few trials have performed head-to-head comparisons of these two drug classes. Future studies on the pharmacological treatment of PD should make direct comparisons of risks, benefits, and limitations of each group. This could help improve the evidence-based pharmacotherapy of PD.

KEYWORDS:

Citalopram; adverse events; alprazolam; clonazepam; escitalopram; fluoxetine; fluvoxamine; paroxetine; sertraline

PMID:
29357714
DOI:
10.1080/14740338.2018.1429403
[Indexed for MEDLINE]
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18.
J Affect Disord. 2018 Apr 1;230:7-14. doi: 10.1016/j.jad.2017.12.096. Epub 2018 Jan 3.

Pre-disaster PTSD as a moderator of the relationship between natural disaster and suicidal ideation over time.

Author information

1
University of Pennsylvania, Department of Psychiatry, United States.
2
Harvard University, T.H. Chan School of Public Health, United States; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States.
3
Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States.
4
Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile.
5
Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile. Electronic address: bvicent@udec.cl.

Abstract

BACKGROUND:

Natural disasters are associated with a variety of negative health consequences, including enhanced suicide risk. Factors that moderate the relationship between disaster exposure and enhanced suicide risk are unknown. The aim of the current study was to determine whether pre-disaster PTSD moderates the association between change over time in thoughts of death, suicidal ideation (SI), suicide plans, and suicide attempts (SA) from pre- to post-disaster.

METHODS:

Participants (n = 2832) were recruited from Chile as part of the larger PREDICT study and completed a measure of lifetime PTSD and panic disorder at baseline and a lifetime death/suicide measure at baseline in 2003 and again 6, 12, and 24 months later (i.e. "pre-disaster"). One year following a major earthquake and tsunami in 2010 (i.e., "post-disaster"), participants completed another death/suicide measure.

RESULTS:

Both those with and without pre-disaster PTSD experienced significant increases in SI from pre- to post-disaster. However, pre-disaster PTSD was associated with significantly accelerated increases in thoughts of death and SI from pre-to post-disaster. At nearly all time-points, pre-disaster PTSD was associated with higher thoughts of death and SI, suicide planning, and SA. In contrast, panic disorder did not moderate the association between time and changes in SI.

LIMITATIONS:

There was a long time-gap between pre-disaster and post-disaster, with limited data about what occurred during this time.

CONCLUSION:

Pre-disaster PTSD is an important predictor of increased SI following a natural disaster, and groups with pre-disaster PTSD should be prioritized for receipt of mental health resources following a natural disaster.

KEYWORDS:

Chile; Natural disaster; Posttraumatic stress disorder; Suicide

PMID:
29355729
DOI:
10.1016/j.jad.2017.12.096
[Indexed for MEDLINE]
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19.
BMC Res Notes. 2018 Jan 12;11(1):23. doi: 10.1186/s13104-018-3130-2.

Does cognitive behavioral therapy alter mental defeat and cognitive flexibility in patients with panic disorder?

Author information

1
Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan. nagata@medicalheart-shizu.jp.
2
Cognitive Behavioral Therapy Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
3
Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
4
Organization for Promotion of Tenure Truck, University of Miyazaki, 1-1, Gakuenkibanadai-Nishi, Miyazaki, 889-2192, Japan.
5
Inada Clinic, Osaka, 2-6-5 Johoku-cho, Takatsuki, Osaka, 569-0071, Japan.
6
Clinic Adachi, Gifu, 62 Oikecho, Gifu, Gifu, 500-8373, Japan.
7
United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
8
Department Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
9
Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.

Abstract

OBJECTIVE:

Mental defeat and cognitive flexibility have been studied as explanatory factors for depression and posttraumatic stress disorder. This study examined mental defeat and cognitive flexibility scores in patients with panic disorder (PD) before and after cognitive behavioral therapy (CBT), and compared them to those of a gender- and age-matched healthy control group.

RESULTS:

Patients with PD (n = 15) received 16 weekly individual CBT sessions, and the control group (n = 35) received no treatment. Patients completed the Mental Defeat Scale and the Cognitive Flexibility Scale before the intervention, following eight CBT sessions, and following 16 CBT sessions, while the control group did so only prior to receiving CBT (baseline). The patients' pre-CBT Mental Defeat and Cognitive Flexibility Scale scores were significantly higher on the Mental Defeat Scale and lower on the Cognitive Flexibility Scale than those of the control group participants were. In addition, the average Mental Defeat Scale scores of the patients decreased significantly, from 22.2 to 12.4, while their average Cognitive Flexibility Scale scores increased significantly, from 42.8 to 49.5. These results suggest that CBT can reduce mental defeat and increase cognitive flexibility in patients with PD Trial registration The study was registered retrospectively in the national UMIN Clinical Trials Registry on June 10, 2016 (registration ID: UMIN000022693).

KEYWORDS:

Cognitive behavioral therapy; Cognitive flexibility; Mental defeat; Panic disorder

PMID:
29329597
PMCID:
PMC5767061
DOI:
10.1186/s13104-018-3130-2
[Indexed for MEDLINE]
Free PMC Article
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20.
J Affect Disord. 2018 Mar 15;229:171-176. doi: 10.1016/j.jad.2017.12.086. Epub 2018 Jan 3.

The regional homogeneity of cingulate-precuneus regions: The putative biomarker for depression and anxiety.

Author information

1
Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan, ROC; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: stephenlai99@gmail.com.

Abstract

OBJECTIVES:

In addition to clinical interview, the modern putative biomarker to differentiate depression and anxiety would be warranted. The translational medicine characteristics of neuroimaging, such as the regional homogeneity (ReHo), is an option for depression and anxiety. Therefore we designed this study trying to identify the biomarker pattern for depression and anxiety.

METHODS:

Resting-state functional magnetic resonance imaging was acquired for 53 patients with first-episode medicine-naïve major depressive disorder (MDD), 53 first-episode medicine-naïve patients with panic disorder (PD) and 54 controls. The calculation of ReHo was performed. The ANOVA repeated measures were applied for the 3 groups to investigate the putative differences between MDD and PD (FDR corrected p < 0.05).

RESULTS:

After multiple comparisons, the major findings of ReHo were found in the bilateral anterior cingulate cortex and bilateral precuneus. MDD group had lower ReHo values than PD group in the left anterior cingulate cortex. MDD group had significant alterations of ReHo in the left anterior cingulate cortex and bilateral precuneus when compared to controls. PD group had alterations in the bilateral precuneus when compared to controls.

CONCLUSION:

The specific cingulate alterations might be a putative ReHo biomarker to differentiate MDD from PD in cingulate-precuneus background for ReHo alterations.

KEYWORDS:

Anterior cingulate cortex; Major depressive disorder; Panic disorder; Precuneus; Regional homogeneity

PMID:
29316519
DOI:
10.1016/j.jad.2017.12.086
[Indexed for MEDLINE]
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