Panic Disorder

Abstract

We compared three groups of patients with panic disorder, generalised anxiety disorder and major depressive episode with a control group. Methods of comparison included a clinical profile of the patients, assessed by the Arabic version of the Present State Examination (PSE), a psychological battery of tests measuring personality traits and depressive and anxiety states, and the dexamethasone suppression test (DST) as a biological marker. Our data showed that psychological assessment and DST did not significantly differentiate between the three disorders. Despite a symptom overlap between the disorders, however, some symptoms were associated significantly more often with one disorder than another. Patients with panic disorder differed from patients with major depressive episode in showing more situational, avoidance and free floating anxiety, and more anxious foreboding. They showed less self-negligence, ideas of guilt, early awakening and social withdrawal. Compared with patients with generalised anxiety disorder, patients with panic disorder showed more loss of interest and muscle tension and less anxious foreboding, restlessness, inefficient thinking, social withdrawal and delayed sleep. Our conclusion is that the clinical course and the symptom profile of panic disorder justifies its existence as an independent diagnostic category.

Peripheral Biomarkers in DSM-5 Anxiety Disorders: An Updated Overview

“…Lastly, different studies investigated the HPA axis modifications (suppression and response to treatment) as possible biomarkers. In this light, non-suppression in the dexamethasone suppression test emerged to be comparable to what was observed in MDD outpatients, though with limited value in differentiating between GAD and other ADs [142,[157][158][159][160]. Cognitive-behavioral therapy (CBT) [150], escitalopram [151], and treatments refocusing GAD patients' attention [152] were found to be followed by reduced cortisol levels compared to the HCs.…”

“…Plasma ACTH concentration ↑ vs. HCs [140] Plasma cortisol level =vs. HCs [140,141] ↑ vs. HCs [142] Salivary cortisol levels =vs. HCs [107,143] ↑ vs. HCs and positively correlated with symptoms [144] Hair cortisol levels ↓ vs. HCs [145,146] sAA/cortisol ratio ↑ vs. HCs [147] Salivary cortisol awakening response ↑ in GAD with comorbid MDD vs. HCs [148] ↓ vs. HCs in adults (>65 years) with long-lasting ADs [149] Plasma DHEAS levels =vs.…”

“…In males, ↓ decline rate of post-stress cortisol increases vs. HCs [143] In females, ↑ post-stress cortisol secretion and ↓ recuperation capacity correlated with clinical severity [143] Plasma cortisol levels (following CBT, escitalopram, and treatments refocusing patients' attention) ↓ vs. HCs [150][151][152] Plasma cortisol levels (after treatment with buspirone, alprazolam, or diazepam) =pre vs. post treatment [153][154][155][156] sAA/cortisol ratio (after mental arithmetic challenge) ↓ vs. HCs [147] HPA axis modifications (after dexamethasone suppression test) =vs. MDD [142,[157][158][159][160] Panic disorders with or without agoraphobia…”

Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition

“…Non-suppression in the DST in GAD patients (up to 27%) is comparable to that of MDD outpatients, but seems to have little value in distinguishing between GAD and other disorders, including PDA, MDD and agoraphobia (Avery et al 1985; Schweizer et al 1986; Tiller et al 1988; Okasha et al 1994; Schittecatte et al 1995).…”