• 생물정신의학
• /
• 제16권1호
• /
• pp.37-45
• /
• 2009

Objectives : It is reported that panic disorder is frequently comorbid with other psychiatric illnesses. The aim of this study was to investigate differences of psychiatric comorbidity according to age of onset of panic disorder. Methods : Three hundred-two patients participated in the study. All the patients were evaluated by clinical instruments for the assessment the presence of other comorbid psychiatric disorders and various clinical features; Korean version of Mini International Neuropsychiatric Interview, Self-report questionnaires(Beck Anxiety Inventory, Beck Depression Inventory, Anxiety Sensitivity Index and State-Trait Anxiety Inventory) and clinical rating scale (Hamilton Anxiety Scale, Hamilton Depression Scale and Global Assessment of Functional score). Chi-square test was used to determine the difference between early onset and late onset panic disorder. Results : Forty percent of panic patients were found to have at least one comorbid psychiatric diagnosis. There were no differences among the groups divided by number of comorbidity in sex, agoraphobia comorbidity, duration of panic disorder, except onset age of panic disorder. Early onset group had more comorbidy with social phobia, agoraphobia, PTSD. We also found that Early onset panic disorder patients were more likely to experience derealization, nausea, parethesia than late onset panic disorder patients. Conclusion : The results of our study are in keeping with previous data from other parts of the world. Our finding suggest that earier onset of panic disorder related to more psychiatric comorbidity.

• 대한불안의학회지
• /
• 제2권2호
• /
• pp.101-107
• /
• 2006

Object : Since autonomic nerve system dysfunction was known as the mechanism of panic disorder, many researchers used heart rate variability (HRV) as means of measuring autonomic nerve function of patients with panic disorder. We aimed to examine the effect of paroxetine medication for 3 months on symptom improvement and change of heart rate variability of the patients with panic disorder. Methods : The subjects were patients with panic disorder who visited the psychiatric outpatient clinic of Samsung Medical Center in Seoul. We included panic disorder patients who were aged from 20 to 50 and in normal BMI range (from 18 to 30) to minimize the effect of age and weight on HRV data. We excluded the patients with EKG abnormalities, hypertension or other major psychiatric disorders. They took 20-40 mg paroxetine medication a day for 3 months. Alprazolam was used only during the first month to control the acute panic symptoms and was tapered off after that. We measured the acute panic inventory (API), Hamilton rating scale for anxiety and depression (HAM-A & HAM-D), Spielberger state-trait anxiety inventory (STAIS, STAIT), and Beck depression inventory (BDI) in order to assess clinical improvement of the patients. And we measured time and frequency domain HRV in the resting, standing and cognitive stress states to assess the change of HRV. All measurements were done before and after paroxetine treatment. Result : After paroxetine medication, patients showed significant improvement in all psychiatric scales. In time domain of HRV, standard deviations of all R-R intervals (SDNN) were significantly increased in all states. In frequency domain of HRV, the ratio of high frequency to total power (HF/TP) in the standing state was significantly increased. Conclusion : After 3 months paroxetine medication, panic disorder patients showed significant clinical improvement and change in HRV data such as SDNN in all states and HF/TP ratio in the standing state. This result suggests that paroxetine medication is effective for the improvement of autonomic nerve system dysfunction in panic disorder patients.

• 대한불안의학회지
• /
• 제10권1호
• /
• pp.17-23
• /
• 2014

Objective : Panic disorders are frequently accompanied by major depressive disorder (MDD). There is insufficient information about which clinical factors in panic disorder are associated with comorbid MDD. The aim of this study is to identify clinical factors related with comorbid MDD in patients with panic disorder. Methods : Two experienced psychiatrists diagnosed panic disorder based on DSM-IV criteria. This diagnosis in the 275 subjects was confirmed again by Mini-International Neuropsychiatric Interview (MINI). Lifetime comorbid psychiatric diagnoses were examined by MINI. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Panic Disorder Severity Scale (PDSS) were used to assess the severity of depressive, anxiety and panic symptoms. Results : The result of MINI showed that 95 patients (34%) with panic disorder satisfied the diagnosis of MDD. Multivariate logistic regression model showed that comorbid generalized anxiety disorder (GAD) and the symptom of "fear of losing control or going crazy" were associated with MDD in patients with panic disorder. In female patients, the "chills or hot flushes" symptom was also associated with comorbid MDD. Conclusion : These results showed that coexisting GAD and certain symptoms of panic are associated with comorbid MDD.

• 심성연구
• /
• 제37권1호
• /
• pp.1-30
• /
• 2022

이 글은 음악을 하는 20대 초반 청년들에게 발생한 공황발작의 의미를 분석 심리학적으로 이해해보고자 하는 시도이다. 공황발작은 주로 20대에 발생한다고 알려진 불안신경증의 일종으로 다양한 자율신경계 증상에 동반되는 극심한 공포와 두려움이 특징이다. 공황발작과 감정기복, 자살사고나 자해행동이 동반된 세 사례에서 공황발작이 나타났던 상황을 살펴보고, 각 사례에서 공황발작의 심리적 의미를 살펴보았다. 첫 번째 사례의 공황발작은 무의식적인 상태로 남아 있고자 하는 이에게 의식성을 가지고 생각하거나 사고하게끔 한다. 두 번째 사례에서 미래를 향한 삶으로의 전진을 망설이며 갈등하는 이에게 내면의 문을 열어 자신의 깊은 마음과 접촉할 수 있게 하여 갈등을 초월할 가능성을 열어주기도 한다. 세 번째 사례에서는 무의식의 실현되고자 하는 본능과 충동을 공황발작으로 경험하고, 그 충동을 의식적으로 실현해간다. 각각 다른 의미가 있는 것처럼 보이는 그들의 공황발작은 청년기 이전 시기의 의식 수준으로부터 새로워질 것을 촉구하는 무의식의 강력한 접근일 것이다.

• 동의신경정신과학회지
• /
• 제26권1호
• /
• pp.1-10
• /
• 2015

Objectives: The purpose of this study was to evaluate the effect of breath-counting meditation on anxiety disorder patients with panic attack. Methods: Two anxiety disorder patients with panic attack were treated with Breath-counting Meditation, acupunctures, and herb-medications. The patients have been predicted for anxiety disorder with panic attack through Dignosis and Statistical Manual (DSM-IV), Panic Disorder Severity Scale (PDSS), BDI (Beck Depression Inventory), and BAI (Beck Anxiety Inventory) on their 1st and 6th treatments. Results: After the treatments, both the physical and psychological symptoms have decreased. Conclusions: This study suggests that the breath-counting meditation is an effective way for treating patients who are suffering from anxiety disorder with panic attack.

• 정신신체의학
• /
• 제4권2호
• /
• pp.245-253
• /
• 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.

• 대한상한금궤의학회지
• /
• 제6권1호
• /
• pp.55-62
• /
• 2014

Objective : This case report show the effect of Yonggyechulgam-tang on Panic disorder. Methods : The patient was diagnosed Panic disorder based on DSM-5. According to Shanghanlun six meridian patterns diagnostic system, the patient treated with Yonggyechulgam-tang for 4 months. The level of panic disorder was evaluated by VAS and BAI. Results : After the treatment, VAS and BAI decreased $10{\rightarrow}2$, $42{\rightarrow}4$ each. Conclusions : Yonggyechulgam-tang improved the symptoms of Panic disorder on this study. Although Yonggyechulgam-tang is not an usual treatment for Panic disorder, we could prescribe the medicine due to Shanghanlun six meridian patterns diagnostic system.

• 수면정신생리
• /
• 제4권1호
• /
• pp.49-56
• /
• 1997

Nocturnal panic involves sudden awakening from sleep in a state of panic characterized by various somatic sensation of sympathetic arousal and intense fear. Many(18-71%) of the spontaneous panic attacks tend to occur from a sleeping state unrelated to the situational and cognitive context. Nocturnal panickers experienced daytime panics and general somatic sensation more frequently than other panickers. Despite frequent distressing symptoms, these patients tend to exhibit little social or occupational impairment and minimal agoraphobia and have a high lifetime incidence of major depression and a good response to tricyclic antidepressants. Sleep panic attacks arise from non-REM sleep, late stage 2 or early stage 3. The pathophysiology and the similarity of nocturnal panic to sleep apnea, dream-induced anxiety attacks, night terrors, sleep paralysis, and temporal lobe epilepsy are discussed.

• 대한불안의학회지
• /
• 제4권1호
• /
• pp.49-54
• /
• 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.

• 대한불안의학회지
• /
• 제11권2호
• /
• pp.129-135
• /
• 2015

Objective : Brain-derived neurotrophic factor (BDNF) is implicated in the pathophysiology of several neuropsychiatric disorders. However, there are few studies on BDNF of panic disorder. In this study, we investigated plasma BDNF levels in patients with panic disorder, and evaluated whether there are associations between clinical characteristics of panic disorder and plasma BDNF levels. Methods : We included 110 patients with panic disorder and 110 health controls in the current study. Plasma BDNF levels were measured by the enzyme-linked immunosorbent assay (ELISA). Plasma BDNF level differences were evaluated according to the clinical characteristics, such as duration of illness, recent stressful life event, agoraphobia, and insomnia. Results : The mean plasma BDNF levels of patients with panic disorder were significantly lower, as compared with those of controls (192.50 pg/mL vs. 693.75 pg/mL, t=8.838, p<0.001). The mean plasma BDNF levels of patients who had recent stressful life events were significantly higher, as compared with those who did not ($269.79{\pm}358.96pg/mL$ vs. $136.94{\pm}187.06pg/mL$, t=-2.525, p=0.013). Conclusion : These results suggested that BDNF plays a potential role in the pathophysiology of panic disorder.