Panic Attack as a Marker of Core Psychopathological Processes

Abstract

Objective: The goal of this study is to test the hypothesis that panic attacks are a marker of core psychopathological processes across mental disorders and that there are distinct syndromal patterns of psychopathology associated with specific subtypes of panic attack that can be distinguished by age and associated fear at onset. Methods: Data were drawn from the National Comorbidity Survey, a community-based household sample (n = 8,098) representative of the United States adult population. Four panic subtypes were identified based on findings from clinical studies and on our hypothesis. Multivariate logistic regression models were used to identify sociodemographic characteristics, panic symptoms and mental disorder correlates of each subtype. Results: Results of multivariate logistic regression analyses identified distinct sociodemographic characteristics, panic symptoms, psychiatric comorbidity, suicidal behavior and use of services associated with early-onset and late-onset panic with and without fear/anticipatory anxiety at the first attack. Conclusions: These findings provide support for the hypothesis that panic attacks are a marker of core underlying psychopathological processes and introduce new, preliminary evidence to support the possible existence of different panic subtypes in the general population. While these results need replication, these findings suggest that the specific type of comorbidity among those with panic attacks can be predicted to a large degree by the age and associated fear/anticipatory anxiety at the onset of the panic attacks.

Assessing Risk for Imminent Suicide

“…Furthermore, other studies 10,[15][16][17] report an acute, high-intensity, negative affect state that seems to serve as a trigger for SA. In agreement with this hypothesis, other reports have linked increased risk for suicide with affectively intense panic attacks, [18][19][20] and our recent national database studies 21,22 suggest that panic attacks may serve as a mediator for transition from SI to SA in depressed patients.…”

Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V

“…Several studies, albeit mostly epidemiological or community samples, have shown that PAs may serve as a risk marker for a wide range of psychiatric disorders, [41][42][43] multimorbidity, and more severe disease status. [44] Moreover, individuals with PAs (prevalence of uncued PAs unknown) report higher levels of trait anxiety, state anxiety, and depression compared to individuals who have never experienced PAs.…”

Prevalência e características do espectro bipolar em amostra populacional definida da cidade de São Paulo

“…Não se obteve nesta amostra nenhum sujeito com diagnóstico de anorexia nervosa e transtorno de estresse pós-traumático. Também se investigou a presença de ataques de pânico isoladamente, cuja presença vem sendo investigada em estudos populacionais (Goodwin, Hamilton, 2001Goodwin, Hoven, 2002) …”

“…A prevalência dos ataques de pânico nos 4 grupos bipolares aponta para o aumento do risco no espectro bipolar, não exclusivamente no TAB tipo I, onde foram sistematicamente investigados na literatura recente (Goodwin, Hamilton, 2001Goodwin, Hoven, 2002;Frank et al, 2002). Em amostras clínicas, em torno de 50 % dos BP I apresentaram sintomas do espectro do pânico, que estiveram associados a maior gravidade e recorrência da depressão bipolar e aumento das tentativas de suicídio .…”

“…Em amostras clínicas, em torno de 50 % dos BP I apresentaram sintomas do espectro do pânico, que estiveram associados a maior gravidade e recorrência da depressão bipolar e aumento das tentativas de suicídio . Em estudos epidemiológicos, tanto no NCS (Goodwin, Hamilton, 2001;Goodwin, Hoven, 2002), como no estudo do ECA (Goodwin, Hamilton, 2002) (Goodwin, Hamilton, 2002). No ECA-SP os bipolares tipo II tiveram mais comorbidades ansiosas em geral, mas a agorafobia só foi significativamente maior nos grupos subsindrômicos.…”