ABSTRACT
OBJECTIVE: The relationship between three positive symptoms of schizophrenia-hallucinations, delusions and thought disorder-and childhood physical and sexual abuse among psychiatric inpatients was investigated. METHODS: From the records of 100 consecutive admissions to an acute psychiatric inpatient unit in a New Zealand general hospital, the records of the 22 patients in which a history of either physical or sexual childhood abuse was mentioned were examined for data on the frequency and content of hallucinations, delusions, and thought disorder. RESULTS: Seventeen of the 22 patients exhibited one or more of the three symptoms. Half of the symptoms for which content was recorded appeared to be related to the abuse. An analysis of the relationships between types of abuse and specific symptoms suggested that hallucinations may be more common than delusions or thought disorder among patients who have been sexually abused, particularly among those who have experienced incest, and that delusions may be more related to having been physically abused. CONCLUSIONS: The study findings confirmed previous findings of a high frequency of auditory hallucinations, particularly command hallucinations to kill oneself, and paranoid ideation among inpatients with a history of abuse. The hypothesis that the hallucinations of abuse survivors are "pseudohallucinations" was not supported.
Subject(s)
Child Abuse/psychology , Delusions/psychology , Hallucinations/psychology , Patient Admission , Schizophrenia/diagnosis , Schizophrenic Psychology , Thinking , Adult , Child , Child Abuse/diagnosis , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/psychology , Delusions/diagnosis , Female , Hallucinations/diagnosis , Hospitals, General , Humans , Incest/psychology , Male , Middle Aged , New Zealand , Psychiatric Department, Hospital , Psychiatric Status Rating ScalesABSTRACT
Skin conductance level (SCL) was measured in 63 subjects with panic disorder, 21 of whom had major depression. Some evidence was found for low SCL being associated with depression, as has been recorded in depression without panic. The standard deviation of SCL was high and it is suggested that the etiology of depression in panic is different from primary depression, at least for some patients. High SCL was not associated with severity of illness. Recordings made in the usual small, isolated, sound-attenuated environment were compared with those made in a larger room with an investigator present for 10 patients and 10 normal controls. Lower SCLs were found in the larger room.
Subject(s)
Depressive Disorder/physiopathology , Galvanic Skin Response/physiology , Panic Disorder/physiopathology , Adult , Depressive Disorder/complications , Depressive Disorder/diagnosis , Diagnosis, Differential , Female , Humans , Male , Panic Disorder/complications , Panic Disorder/diagnosis , Phobic Disorders/complications , Phobic Disorders/diagnosis , Phobic Disorders/physiopathology , Psychiatric Status Rating Scales , Severity of Illness IndexABSTRACT
Fear and avoidance of individual phobic situations were measured in 1168 patients with panic disorder suffering current attacks. Correlation and principal-components analyses give components of agoraphobia, illness phobia, and social phobia in panic disorder. Agoraphobia does not stand out so clearly as illness phobia and social phobia as a separate factor; 'fear of open spaces' shows some separation from other agoraphobic situations. Frequency of panic attacks and changes associated with their remission have no special relationship to agoraphobia. Closer attention to social and illness phobia may be fruitful in discerning the evolution of panic disorder.
Subject(s)
Alprazolam/therapeutic use , Imipramine/therapeutic use , Panic Disorder/drug therapy , Panic Disorder/psychology , Phobic Disorders/drug therapy , Phobic Disorders/psychology , Adult , Agoraphobia/diagnosis , Agoraphobia/drug therapy , Agoraphobia/psychology , Double-Blind Method , Female , Humans , Male , Middle Aged , Panic Disorder/diagnosis , Personality Tests/statistics & numerical data , Phobic Disorders/diagnosis , PsychometricsABSTRACT
Patients with panic disorder (N = 1168) were enrolled in a multicenter, 8-week, double-blind clinical trial of imipramine, alprazolam, and placebo to analyze whether the effectiveness of these agents is dependent on the depressive/dysphoric symptomatology which often coexists in panic disorder patients. In addition to analyses performed on the whole sample of patients, the authors conducted analyses on a subsample (N = 312) defined by multiple criteria to ensure the absence of depression and dysphoria. In both the overall sample and the nondepressed subsample, the clinical response to imipramine or alprazolam was found to be independent of the presence of depression or dysphoria. In panic disorder patients for whom pharmacotherapy is being considered as treatment, the absence of depression is apparently not a contraindication.
Subject(s)
Alprazolam/therapeutic use , Anxiety Disorders/drug therapy , Depressive Disorder/epidemiology , Imipramine/therapeutic use , Panic , Adult , Anxiety Disorders/complications , Anxiety Disorders/epidemiology , Comorbidity , Depressive Disorder/complications , Depressive Disorder/drug therapy , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Outcome and Process Assessment, Health Care/statistics & numerical data , PlacebosABSTRACT
Patients who meet DSM-III-R criteria for a diagnosis of panic disorder often show a complex mixture of psychopathological symptoms, including panic attacks (spontaneous and situational), anxiety (anticipatory and generalized), phobias (fear and avoidance), depression/dysphoria, and social and occupational disability. Various theories about the pathogenesis of these symptoms have been advanced that focus on a given symptom (e.g., panic, phobia) being primary in these disorders, with concurrent symptoms seen as epiphenomena or as secondary and reactive to a core symptom. This study, conducted on a large sample of panic disorder patients (N = 1,168), examines the temporal sequential pattern of symptom improvement in these patients, and explores how these relationships relate to various pathogenic theories. Our multiple analyses, when considered together, tend not to support any pathogenic theory that views a given symptom as being central to the overall disorder; our findings have obvious implications for theoreticians and clinicians interested in the study and treatment of panic and anxiety disorders.
Subject(s)
Anxiety Disorders/diagnosis , Panic , Adult , Alprazolam/therapeutic use , Anxiety Disorders/drug therapy , Anxiety Disorders/psychology , Double-Blind Method , Female , Humans , Imipramine/therapeutic use , Male , Outcome and Process Assessment, Health Care , Placebos , Psychiatric Status Rating Scales , Remission Induction , Severity of Illness IndexABSTRACT
The Panic-Associated Symptom Scale (PASS) is presented as a new measurement of the severity of the core symptoms of panic disorder. This first description addresses the rationale for its design and its scoring, score distributions, test-retest reliability, correlations within the PASS and with other scales, principal component structure, and response to drug therapy. Data are presented from a large study group of patients with panic disorder (n = 1168). Problems in measuring panic disorder are discussed.
Subject(s)
Anxiety Disorders/diagnosis , Panic , Phobic Disorders/diagnosis , Psychiatric Status Rating Scales , Adult , Anxiety Disorders/psychology , Arousal , Female , Humans , Male , Phobic Disorders/psychology , PsychometricsABSTRACT
In order to establish the clinical validity of currently used ways of subtyping panic disorder the predictive power of associated current avoidance behaviour and (secondary) major depression for the response to active treatment (alprazolam, imipramine) was tested. The analysis was based on the data from the Cross-National-Collaborative-Panic-Study. Limited support for validity evidenced by predicting drug response was found for grading panic disorder by the severity of avoidance behaviour; patients with panic attacks and agoraphobia are more responsive to imipramine (compared with alprazolam) when using the reduction of the total number of panic attacks (or of spontaneous panic attacks) as the outcome criterion; patients without any avoidance behaviour did better with alprazolam (compared with imipramine).
Subject(s)
Agoraphobia/classification , Alprazolam/therapeutic use , Anxiety Disorders/classification , Depressive Disorder/classification , Imipramine/therapeutic use , Panic , Adult , Agoraphobia/drug therapy , Agoraphobia/psychology , Anxiety Disorders/drug therapy , Anxiety Disorders/psychology , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Double-Blind Method , Female , Humans , Male , Panic/drug effects , Prognosis , Psychiatric Status Rating Scales , Social EnvironmentABSTRACT
The impact of the avoidance behaviour on the psychopharmacological treatment of panic disorder was explored in the Cross National Collaborative Panic Study (n = 1134 patients); in this double blind randomized trial alprazolam, imipramine and placebo were compared during an 8-week treatment period. Patients with extensive avoidance behaviour (agoraphobia) had the most profit from the active drugs. Counter expectancy these specific drug effects were most pronounced in avoidance behaviour. Active drugs (in particular imipramine) were especially more effective than placebo if the patients presented with associated avoidance behaviour. The results suggest that agoraphobia defines more a particular type of anxiety disorder overlapping with panic disorder than merely a severe state of panic disorder.
Subject(s)
Agoraphobia/drug therapy , Agoraphobia/psychology , Alprazolam/therapeutic use , Arousal/drug effects , Fear/drug effects , Imipramine/therapeutic use , Panic Disorder/drug therapy , Panic Disorder/psychology , Social Behavior , Adult , Double-Blind Method , Female , Humans , Male , Panic/drug effects , Personality TestsABSTRACT
Of 20 patients attending a clinic for maintenance therapy of schizophrenia, seven had regular panic attacks, and these were often associated with agoraphobia and social phobia. Similar fears and avoidance in other cases were associated with paranoid ideas and negative symptoms. The relationship of panic to psychotic symptoms varied greatly. In two patients neuroleptics were associated with an increase in panic attacks.
Subject(s)
Agoraphobia/psychology , Anxiety Disorders/psychology , Panic , Schizophrenia/diagnosis , Schizophrenic Psychology , Adult , Chronic Disease , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Schizophrenia/rehabilitationABSTRACT
Avoidance behaviour and secondary major depression are both frequent in clinical samples of patients with panic disorder. Their status is unclear: indicators of severity of panic disorder or indicators of separate psychiatric disorders. Among the data of the Cross-National Collaborative Panic Study (n = 1,168) we found that especially avoidance behaviour defines more severe states of panic disorder (earlier age at onset, higher frequency of panic attacks and higher level of psychopathology); co-occurrence of major depression is less clearly associated with more severe panic disorder. The results are compatible with the DSM-III-R concepts of comorbidity of panic disorder and major depression and of subtyping panic disorder by avoidance behaviour.
Subject(s)
Agoraphobia/psychology , Depressive Disorder/psychology , Fear , Panic , Adult , Agoraphobia/diagnosis , Americas , Depressive Disorder/diagnosis , Double-Blind Method , Europe , Humans , Multicenter Studies as Topic , Randomized Controlled Trials as TopicABSTRACT
Phenomenological data are presented for panic attacks and non-panic anxiety in 159 patients. Anxiety episodes of sudden onset tend to have greater severity, more symptoms, and shorter duration and some distinctive cognitive features. This cluster of features emerged from the analysis as characteristic of the panic attack. There were no differences between situational and spontaneous attacks nor are attacks occurring in depressed patients different from those in-patients who suffered from anxiety disorders. The ideas characteristic of normal anxiety are directed towards ordeals in the future. It is the immediacy of the anxious cognitions of imminent death, collapse or becoming insane that are characteristic of panic attacks. A definition of panic attacks is suggested.
Subject(s)
Anxiety Disorders/diagnosis , Fear , Panic , Adolescent , Adult , Aged , Anxiety Disorders/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Phobic Disorders/diagnosis , Phobic Disorders/psychology , Psychiatric Status Rating ScalesABSTRACT
This paper examines the nosological and aetiological relationships of panic disorder to the anxiety states and depression. The phenomenology is detailed from an unbiased sample of 90 cases selected, on the basis of meeting positive criteria for panic disorder, from 3 series of consecutive cases. Panic attacks were found to be only quantitatively distinct from non-panic anxiety. Truly spontaneous attacks, not preceded by anxiety-provoking cognitions, were uncommon. No unique association with agoraphobia was seen, other anxiety states and depression being common. Social phobia and generalized anxiety often preceded the development of panic disorder, as did some cases of agoraphobia. Depression was usually non-specific and secondary when only DSM-III MDE criteria were used. Significant neurotic traits were found, particularly anxiety, dependency and poor sexual adjustment. Panic disorder has multiple causal factors only one of which is a genetic tendency for panic attacks. While important therapeutically, panic attacks should not be given the primary place in diagnosis.
Subject(s)
Anxiety Disorders/diagnosis , Fear , Panic , Adult , Aged , Agoraphobia/diagnosis , Agoraphobia/psychology , Anxiety Disorders/psychology , Arousal , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neurotic Disorders/diagnosis , Personality Inventory , Phobic Disorders/diagnosis , Psychiatric Status Rating ScalesSubject(s)
Behavior Therapy/methods , Cognition , Fear , Panic , Adolescent , Adult , Aged , Anxiety Disorders/psychology , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Phobic Disorders/psychologyABSTRACT
This paper reviews anxiety, panic, and phobic disorders as they were described in landmark works, along with more recent epidemiologic studies of the disorders. The author discusses clinical syndromes of anxiety as outlined in the DSM-III: agoraphobia, social phobia, generalized anxiety disorder, panic disorder, simple phobic states, and obsessive-compulsive disorder, relating them to Phobic Anxiety-Depersonalization Syndrome and to earlier descriptions by Westphal and Benedict. The paper addresses the problem of delineating anxiety and phobic states from depressive disorders, with regard to diagnosis and treatment outcome. Various etiological bases of agoraphobia, panic, and anxiety disorders are suggested: heredity, life events and circumstances, family background and developmental history, the premorbid personality, and some psychological aspects. Several questions are explored on the relationships of agoraphobia, anxiety and panic attacks. For example, is agoraphobia a new disease or one stage in the development of severe chronic anxiety? Are the phobias of agoraphobia acquired by conditioning or learning? Are "panics" spontaneous or physiological? Are panic attacks the first event in the primary cause of agoraphobia? For future work the authors propose a reassessment of the prevalence of agoraphobia and related disorders, a more careful definition of the agoraphobic disorders, and thorough clinical investigation of the various treatment modalities in well-defined populations. The past twenty years' achievements in behavioural and pharmacological treatments for agoraphobia are briefly recapitulated.
Subject(s)
Agoraphobia/etiology , Anxiety Disorders/etiology , Fear , Panic , Phobic Disorders/etiology , Agoraphobia/therapy , Depersonalization/psychology , Depressive Disorder/diagnosis , Humans , Life Change EventsSubject(s)
Anxiety Disorders/therapy , Adolescent , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/etiology , Behavior Therapy , Child , Humans , Psychotherapy , Relaxation TherapyABSTRACT
The main supporters of 62 patients admitted to a psychogeriatric ward were interviewed to determine the number and nature of problems and how well these problems were tolerated. The problems affecting the supporters' personal and social life were common but well tolerated. The behavioural problems of the patient were multiple and less well tolerated. The age and sex of the patient or supporter were not significant but supporters who lived alone with the patient had a higher tolerance than those in larger households. The results are compared with Sanford's study of geriatric admissions. The implications of the study point to the need for earlier intervention.
