• ETRI Journal
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• v.45 no.1
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• pp.105-118
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• 2023

We tested the feasibility of automated discrimination of patients with panic disorder (PD) from healthy controls (HCs) based on multimodal physiological responses using machine learning. Electrocardiogram (ECG), electrodermal activity (EDA), respiration (RESP), and peripheral temperature (PT) of the participants were measured during three experimental phases: rest, stress, and recovery. Eleven physiological features were extracted from each phase and used as input data. Logistic regression (LoR), k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), and multilayer perceptron (MLP) algorithms were implemented with nested cross-validation. Linear regression analysis showed that ECG and PT features obtained in the stress and recovery phases were significant predictors of PD. We achieved the highest accuracy (75.61%) with MLP using all 33 features. With the exception of MLP, applying the significant predictors led to a higher accuracy than using 24 ECG features. These results suggest that combining multimodal physiological signals measured during various states of autonomic arousal has the potential to differentiate patients with PD from HCs.

• 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.

• Korean Journal of Psychosomatic Medicine
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• v.28 no.1
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• pp.53-62
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• 2020

Objectives : This study investigated lifetime experiences of trauma, treatment retention, and psychiatric symptoms among outpatients with panic disorder after initiation of pharmacotherapy. Our research hypothesis was that panic patients with childhood trauma would display more severe symptoms and less treatment retention compared to those without such history. Methods : A total of 135 first-visit outpatients with DSM-IV panic disorder were approached during the period from March 2012 to August 2016. Fifty-three patients (39%) either refused or returned incomplete questionnaires, leading to a final sample size of 82. Participants completed the Trauma History Screen, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. Results : The number of lifetime trauma was significantly correlated with treatment retention (rho=-0.269, p=0.015). Among subtypes of trauma, only childhood physical abuse was significantly correlated with treatment retention (rho=-0.298, p=0.007). Conclusions : Our results indicated that psychological trauma, particularly of an interpersonal nature from childhood, can affect pharmacotherapy treatment retention in panic disorder. This may be mediated by poor patient-doctor relationships originating from trust issues among childhood trauma survivors or lack of perceived improvement due to the more severe symptoms and unfavorable course experienced by those with childhood trauma. Further studies are needed to explore the reasons for poor treatment adherence in this population.

• Journal of Oriental Neuropsychiatry
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• v.21 no.4
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• pp.207-218
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• 2010

Objectives : This case report presents a 33-year-old male patient who complained chest pain and anxiety. diagnosed with panic disorder with agoraphobia improved by Herbal Extracts. SRP(Stress Reduction Program) and Acupuncture treatment. Methods : In early treatment period. we evaluated his general psychological state through interview and self-questionnaires(STAI, SCL-90-R, STAXI, BDI) for treatment planing. And then we had prescribed herbal extracts for 20 weeks with applying SRP and acupuncture treatment. After 20 weeks we assessed his psychological symptoms with same evaluation tools. Results : After 20 weeks. We found that patient's somatic and psychological symptoms(anxiety, depression, anger) were alleviated. Frequency and severity of panic attacks were reduced also. Conclusions : Herbal extracts. especially Gyejigayonggolmoryo-tang(桂枝加龍骨牡蠣湯) and Jakyakgamcho-tang(芍藥甘草湯), may be useful therapeutic tool for control of panic attack symptoms and anxiety.

• Korean Journal of Biological Psychiatry
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• v.26 no.2
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• pp.65-70
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• 2019

Objectives The objective of this study is to investigate differences in clinical characteristics between female panic disorder (PD) patients with abortion history (PD+A) and without abortion history (PD-A). Methods We examined data from 341 female patients diagnosed with PD. We divided the patients with PD into PD+A (82 patients) and PD-A (259 patients) to compare demographic and clinical characteristics. The following instruments were applied : stress coping strategies, NEO-neuroticism, the Anxiety Sensitivity Index-Revised (ASI-R), the Albany Panic and Phobia Questionnaire (APPQ), the Beck Depression Inventory, the Beck Anxiety Inventory (BAI) and the Sheehan Disability Scale. Results Compared to the PD-A, the PD+A group showed no significant difference in coping strategies. However, significantly higher scores in neuroticism, the ASI-R, the APPQ and the BAI were observed. In terms of health-related disability, the PD+A group did not show significant difference. Conclusions Our results suggest that the PD+A group may differ from the PD-A group in trait markers such as neuroticism and anxiety sensitivity, and abortion history may be associated with panic-related symptom severity. Our study suggests that further consideration is needed on such clinical characteristics in PD patients with abortion history.

• Journal of Oriental Neuropsychiatry
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• v.16 no.1
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• pp.159-169
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• 2005

Anxiety is essentially a normal emotion with great adaptive significance like pain. to ease human suffering, treatment is sought to quell pain and anxiety only when they are excessive or when they interfere with performance or general health. In oriental medicine, anxiety has been also known as a important factor which is cause of body and mind disease. We obtained some points after studying of bibliographic research about anxiety and anxiety disorder like follows: 1. The signification of anxiety is similar to fear affection(恐情) and anxious feelings are fearful, long for solitary life and afraid of captivity. 2. Mechanism of anxiety disorder is related with kidney(腎) as well as heart(心), liver(肝), gall bladder(膽) and stomach(胃). 3. The prescription of fear affection is tonifying of kidney(益腎) and fixing of kidney's pure substance(固精) that is based on deficiency of kidney(賢氣不足) 4. A representative disorder about anxiety and phobia are Keongke(驚悸) and Cheongchung(정충). 5. Keongke(驚悸) and Cheongchung(정충) may be understood as phobias(恐佈症), general anxiety disorder(凡不安障碍) and panic disorder(恐慌障碍).

• Korean Journal of Biological Psychiatry
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• v.2 no.1
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• pp.107-114
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• 1995

This study was to investigate the anatomical evidence of anxiety. MRI was used to study 11 patients with panic disorder and 15 patients with complex partial seizure, and 21 controls. The regions of interest in the MRI were measured with computer-assisted planimetry using the AutoCad and digitizer. The following results were obtained ; 1) The mean age was 49.7(12.4) years in patients with panic disorder and 30.1(7.5) years in patients with complex partial seizure. 2) There were na signi ficant differences between 3 groups in the values of cerebral area, temporal lobe, caudate nucleus, hippocampus, parahippocampus, amygdala, third ventricle and VBR. The right parahippocampal region which attracted most attention in neurobiological studies regarding anxiety, tended to be larger in both study groups compared to the control group, but with no statistical significance. 3) There was lett-right reversal of temporal lobes in both study groups. And these are mainly due to asymmetrical increase in area of the temporal lobe on right side. These results suggest that temporal lobe, especially right temporal, is the anatomical correspondence of anxiety and functional activation of temporo-limbic system may be accompanied by the structural change of temporal lobe.

• Sleep Medicine and Psychophysiology
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• v.8 no.1
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• pp.52-58
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• 2001

Objectives: An Increased level of psychophysiologic arousal and diminished physiologic flexibility would be observed in patients with panic disorder compared with a normal control group. We investigated the differences of psychophysiologic response between patients with panic disorder and normal control to examine this hypothesis. Methods: Ten Korean patients with panic disorder who met the diagnostic criteria of DSM-IV were compared with 10 normal healthy subjects. In psychological assessment, levels of anxiety and depression were evaluated by State-Trait Anxiety Inventory, Beck's Depression Inventory and Hamilton Rating Scale For Anxiety and Depression. Heart rate, respiration rate, electrodermal response, and electromyographic activity were measured by biofeedback system (J & J I-330 model) to determine psychophysiologic responses on autonomic nervous system. Stressful tasks included mental arithmetic, video game, hyperventilation, and talking about a stressful event. Psychophysiologic responses were measured according to the following procedures : baseline(3 min)-mental arithmetic (3 min)-rest (3 min)-video game (3 min)-rest (3 min)-hyperventilation (3 min)-rest (3 min)-talking about a stressful event (3 min). Results: The baseline level of anxiety and depression, electrodermal response (p=.017), electromyographic activity (p=.047) and heart rate (p=.049) of patients with panic disorder were significantly higher than those of the normal subject group. In electrodermal response, patient group had significantly higher startle response than the control group during hyperventilation (p=.001). Startle and recovery responses of heart rate in the patient group were significantly lower than responses in the control group during mental arithmetic (p=.007, p=.002). In electrodermal response of the patient group, startle response was significantly higher than recovery response during mental arithmetic (p=.000) and video game task (p=.021). Recovery response was significantly higher than startle response in respiratory response during hyperventilation. Conclusion: The results showed that patients with panic disorder had higher autonomic arousal than the control group, but the physiologic flexibility was variable. We suggest that it is helpful for treatment of panic disorder to decrease the level of autonomic arousal and to recover the physiologic flexibility in certain stressful event.

• Korean Journal of Psychosomatic Medicine
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• v.31 no.1
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• pp.19-24
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• 2023

Objectives : Biofeedback is a useful non-pharmacological treatment for panic disorder (PD), but no studies have identified physiological markers related to the treatment response. This study investigated predictors of the treatment response for biofeedback in patients with PD. Methods : A retrospective study based on the electronic medical records of 372 adult patients with PD was performed. Patients received biofeedback treatment at least once, and physiological markers including heart rate, heart rate variability, respiratory rate, skin conductance, skin temperature, and electromyography were collected before the treatment began. The patients were classified as responders or non-responders based on the change in Clinical Global Impression-Severity (CGI-S) score. Results : The response rate to biofeedback treatment was 30.4%. Multivariable logistic regression analysis revealed that a higher CGI-S score at baseline and fewer benzodiazepine prescriptions were associated with a better response to biofeedback treatment. According to subgroup analyses, the baseline CGI-S score, dose of benzodiazepines, and skin conductance are candidate predictors of the response to biofeedback treatment in men, while only baseline disease severity was associated with the treatment response in women. Conclusions : The present results suggest that skin conductance may be target marker and predictor for biofeedback in male patients with PD.

• 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.