• Korean Journal of Psychosomatic Medicine
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• v.29 no.1
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• pp.26-33
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• 2021

Objectives : This study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack. Methods : A retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher's exact test was used. Collected data was analyzed using R 4.03. Results : Cardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (𝛘²=4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (𝛘²=8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%. Conclusions : The most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.

• Anxiety and mood
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• v.19 no.2
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• pp.69-76
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• 2023

Objective : This study aimed to find out whether the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales are useful in distinguishing social anxiety disorder, panic disorder, and major depressive disorder. Methods : The study sample included 118 patients: 33 with social anxiety disorder, 53 with major depressive disorder, and 32 with panic disorder. Participants were classified according to the diagnosis indicated on their medical records. MMPI-2-RF scores were derived from MMPI-2 protocols. Results : The results of multivariate analysis of variance showed that the elevated scales were consistent with the diagnostic and clinical characteristics of each diafnostic group. Logistic regression analyses identified several scales that were useful in differentiating the diagnostic groups. The higher Cognitive Complaints (COG) scale significantly differentiated major depressive disorder from the other groups. The higher Self-Doubt (SFD) scale and Somatic Complaints (RC1) scale were useful in differentiating social anxiety disorder and panic disorder respectively. The lower Cynicism (RC3) scale was also useful in differentiating social anxiety disorder. Other scales that were useful in distinguishing between pairs of groups were also identified. Conclusion : The results of this study suggest that the MMPI-2-RF scales can be useful for discriminating anxiety disorders.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.6
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• pp.302-308
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• 2006

Purpose: Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regnioal cerebral blood flow (rCBF) after CBT in patients with panic disorder. Materials and Methods: Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial $^{99m}Tc-ECD$ brain perfusion SPECT images were acquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. Results: Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced ($14.9{\pm}3.9\;vs.\;7.0{\pm}1.8$, p<0.05; $30.3{\pm}8.5\;vs.\;21.6{\pm}3.4$, p<0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. Conclusion: These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder.

• Korean Journal of Psychosomatic Medicine
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• v.6 no.2
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• pp.147-154
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• 1998

Objective : This study was designed to find the characteristics of MMPI that could influence the outcome of cognitive behavioral therapy(CBT) for panic disorder. Methods : 34 patients who met DSM-IV criteria for panic disorder with or without agoraphobia had completed 11 weekly sessions of cognitive behavioral therapy. All the patients were assessed with MMPI before the initiation of treatment. Five self-report measures including Beck Depression Inventory(BDI), Spielberger State-Trait Anxiety Inventory(STAI), Agoraphobic Cognition Questionnarie(ACQ), Body Sensation Questionnaire(BSQ), and Daily Anxiety Selfrating (0 - 8 scales) were also assessed as a pre- and post-treatment assessment. After the completion of treatment, patients were classified by the High End-State(HES) functioning group and the Low End-State(LES) functioning group for the data analysis. Results : 1) The LES group showed significantly higher scores in Hypochondriasis Scale(HS), Depression Scale(D), Hysterical Scale(Hy), Obsessive Scale(Pt), Schizophrenia Scale(Sc) and Validity Scale(F) of MMPI than the HES group. However, these differences gave impressions that the LES group had more severe symptoms rather than that they could be the factors influencing the outcome of CBT. 2) Though, the severity of symptoms of the LES group in the 5 measures of pre-assessment was basically higher than that of the HES group. The fact that both group showed the similar improvement between pre- and post-assessment supported the above interpretation. Conclusion : In regarding the above results, MMPI was not a proper tool that could provide the factors influencing the outcome of CBT. In the future study, the authors need to use a different tool that can find the personality characteristics more directly.

• Korean Journal of Psychosomatic Medicine
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• v.11 no.2
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• pp.205-213
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• 2003

Objectives: The authors intended to evaluate long-term outcome of group cognitive behavioral therapy(GCBT) for panic disorder and examined the variables to predict high end-state functioning in 12 months follow-up. Methods: 236 patients meeting DSM-IV criteria for panic disorder were assessed by STAI, ASI, BDI, BSQ, PBQ, ACQ at pre & post treatment, and were asked about the frequency of panic attacks during recent one month. We executed stepwise discriminant analysis on the clinical variables at pre treatment assessment to find the variables for discriminating between high end-state function(HES) and low end-state function(LES). Results: After GCBT, 82.6% of panic patients maintained high end-state functioning at 12 months follow-up. The results of discriminant analysis showed that BDI and BSQ at pre treatment assessment were significant variables to predict end-state functioning at 12 months follow-up. The hit ratio of discriminant analysis was 69.2%. Conclusion: These results suggest that the therapeutic effect of GCBT can be maintained through 12 months. Especially, it is likely that patients who were less depressed and who had less experienced the fear of physical symptoms at pre-treatment can maintain HES.

• Anxiety and mood
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• v.4 no.1
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• pp.49-54
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• 2008

Objective : This article is a part of the Korean Medication Algorithm Project for Panic Disorder, which aims to build consensus regarding the diagnosis, treatment response and achievement of clinical remission for patients with panic disorder in Korea. Methods : The questionnaire used in this article had parts : 1) diagnosis, 2) treatment response, and 3) remission for patients with panic disorder. The questionnaire was completed by each of 54 Korean psychiatrists who had much experience in treating patients with panic disorder. We classified the experts' opinions into 3 categories (first-line, second-line, and third-line) using the ${\chi}^2$-test. Results : Five factors were considered in this research : panic attack, anticipatory anxiety, phobic avoidance, severity of illness, and psychosocial disability. Most reviewers agreed that the presence of a panic attack was the most important factor in the diagnosis of patients with panic disorder. Phobic avoidance was included in the first-line category, whereas the severity of illness and psychosocial disability were included in the second-line category. Most reviewers also agreed that the presence of a panic attack was the most important factor in determining the appropriate treatment response, and it was included in the first-line category along with several other items. To determine remission status, the patients' scores on tests pertaining to the severity of panic attack, anticipatory anxiety, phobic avoidance, severity of illness and psychosocial disability should be less than 3.0-3.3 on a 9-point Likert scale. Conclusion : We suggest useful information for making a diagnosisof panic disorder, determining the appropriate treatment response and identifying remission in panic disorder patients on the basis of the results of a nationwide survey of experts in Korea.

• Anxiety and mood
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• v.8 no.2
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• pp.146-152
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• 2012

Objective : Individuals with anxiety disorders experience a wide range of time to seeking treatment (TST) as well as various comorbid mental disorders. The present study examined the TST in social anxiety disorder (SAD) and panic disorder. This study aimed to find out the influence of comorbid mental disorder on TST of anxiety disorder through the comparison of SAD and panic disorder. Methods : This study included 311 SAD and 378 panic disorder patients at the initial visit of psychiatric clinic. Contribution of clinical (number of comorbidity, comorbid type and onset age) and demographic (current age) factors to TST were investigated by multivariate analysis. Results : The median length of TST was 14.03 years in SAD and 2.26 years in panic disorder. In social anxiety disorder, fewer comorbidity, younger onset age, and older age were factors associated with delayed TST. In panic disorder, only younger onset age was associated with delayed TST. In both disorders, comorbid depressive disorder was associated with shorter TST. Conclusion : Our data provided the differences in illness behavior needing help based on comorbid mental disorders between SAD and panic disorder. In addition to comorbid disorder, factors affecting TST of anxiety disorder requires future investigation.

• Korean Journal of Psychosomatic Medicine
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• v.4 no.2
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• pp.245-253
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• 1996

In spite of its prominent effects on reduction of panic attacks and preveniton of relapse, cognitive-behavioral therapy(CBT) for panic disorder is seldomly utilized and studied in this country. for the past year, authors have modified CBT program for panic disorder that was based on PCT(panic control program) designed by Dr. Barlow and Dr. Craske. Our program is composed of informational component, somatic management skills, cognitive restructuring, interoceptive exposure and in vivo exposure. One patient has significantly improved by this program and satisfied with the treatment result. The aim of this article is to present our experience of treating a panic patient with CBT.

• Anxiety and mood
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• v.2 no.1
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• pp.17-21
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• 2006

SSRIs have been considered as the first line of treatment for patients with panic disorder since 1990s along with cognitive behavioral treatments. High potency benzodiazepines (e.g. alprazolam, clonazepam) have had advantages in anti-panic effects. However, these drugs have limitations of treating panic disorder because of their dependency, tolerance and withdrawal. Serotonin and noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine were introduced as antidepressants since 1990s. Recently, it is confirmed that SNRIs have the remarkable anti-panic effects although some concerns about its cost, tolerance, withdrawal, side effects such as dry mouth, constipation, and hypertension have emerged. In this regard, further study is required to confirm the efficacy of long term treatment of panic disorder. Despite these concerns, venla-faxine extended-release is an effective treatment in patients with panic disorder.

• 건강소식
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• v.28 no.7 s.308
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• pp.6-9
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• 2004