• 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.

• Journal of Oriental Neuropsychiatry
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• v.26 no.1
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• pp.1-10
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• 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.

• Korean Journal of Biological Psychiatry
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• v.16 no.1
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• pp.37-45
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• 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.

• 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.

• Journal of Oriental Neuropsychiatry
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• v.26 no.3
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• pp.293-306
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• 2015

Objectives: The purpose of this study is to identify predictors of clinical efficacy of oriental medical treatment for patients with panic disorder. Methods: We analyzed medical records of 41 patients who were diagnosed with panic disorder through DSM-IV or ICD-10 by 2 oriental medical neuro-psychiatrists. We performed frequency analysis of demographic characteristics in patients with panic disorder, and assessed the correlation between the psychological scales by Pearson correlation. Repeated measures ANOVA were used to compare the psychological scales during the treatment; and Single regression analysis was used to analyze the factors that have correlation to improvement of panic disorder by oriental medical treatment. Psychological scales used in the study were STAI-X-1/2, STAXI-S/T, BDI2, BAI, BSQ, PAS, ASI, LOT-R, SWLS, LSES and LSMS. Results: Patients' demographic characteristics indicated that there were twice more female than male patients; furthermore, there was a high ratio of patients in their 20s and 30s, with the highest percentage of onset-age in the 20s and average duration of panic disorder from 1~5 years. More than half of the total patient cohort comprised of those who had panic disorder with agoraphobia and major depressive disorder; in addition, major accompanied symptoms were dyspepsia, chest discomfort and headache. After treatment, most scores of psychological scales were significantly reduced, and correlation between the psychological scales was significant. Furthermore, we identified some factors that were significantly correlated to improvement of panic disorder by oriental medical treatment. Conclusions: In conclusion, treatment of panic disorder with oriental medicine was clinically efficient and improved the quality of life.

• Anxiety and mood
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• v.11 no.2
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• pp.129-135
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• 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.

• Anxiety and mood
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• v.3 no.2
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• pp.110-115
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• 2007

Objective : The authors examined the treatment response and remission rates in patients with panic disorder after short-term pharmacotherapy in an effort to determine the factors that can be used to predict remission in Korean patients with panic disorder. Methods : Sixty-one patients with panic disorder were recruited for participation in this study. The psychological symptoms of the patients were measured using the HAMA, HAMD, STAIS, STAIT, ASI and API at baseline and after 3 months of pharmacotherapy. Results : Patients with panic disorder showed significantly lower scores on all psychological measures after 3 months of pharmacotherapy with paroxetine. The remission rate was 44.3%, and the response rate was 54.1%. The remitters showed significantly lower HAMD, HAMA, STAIS, STAIT, and ASI scores than the non-remitters. Linear regression analysis revealed that the baseline HAMA, HAMD, and ASI scores could be used to predict the remission rate after controlling for age, sex and agoraphobia. Conclusion : Compared with previous reports, our study showed a similar remission rate in Korean patients with panic disorder. Lower baseline levels of anxiety, depression, and anxiety sensitivity were found to be predictors of treatment remission in panic disorder.

• Journal of Oriental Neuropsychiatry
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• v.26 no.2
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• pp.161-170
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• 2015

Objectives: This study was performed to review the research trends in the treatment of panic disorder in traditional Chinese medicine (TCM). Methods: We searched articles in the China National Knowledge Infrastructure (CNKI) from 2004 to 2014. Search key words were '惊恐' and 'panic disorder', and we selected eight studies except for non-clinical, unrelated studies, tests on animals. Results: We finally selected eight articles, and the results were as follows. CCMD-3 was most frequently used as a diagnostic criterion and HAMA was mostly used for outcome measurement. In TCM there are various ways, such as herbal medicine, acupuncture and psychotherapy, to treat panic disorder. Most of the studies showed effective results. Most of the treatment group reported that they had less side effects than the control group. However, the quality of these clinical studies was low. Conclusions: In TCM, research on panic disorder was being conducted more actively than in Korean medicine. According to this study, it seems that in TCM, the treatment of panic disorder might be more effective and have some advantages. Therefore, with this study, we hope to activate more clinical research on the treatment of panic disorder in Korean medicine.

• Anxiety and mood
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• v.2 no.2
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• pp.101-107
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• 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.

• Anxiety and mood
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• v.8 no.1
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• pp.9-15
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• 2012

Objectives : The purpose of this study was to assess the health-related quality of life (HRQoL) for patients with panic disorder using EQ-5D and EQ-VAS, and to examine the relationship between health-related quality of life and clinical outcomes following treatment. Methods : 29 patients with panic disorder were recruited from the Seoul Metropolitan area and 20 patients were followed up after two months of outpatient treatment. The Panic Disorder Severity Scale (PDSS) was used to assess the severity of the panic disorder and the changes in symptoms. HRQoL was assessed with EQ-5D and EQ-VAS at baseline and at two months of treatment. Results : All enrolled panic disorder patients showed significantly impairment of HRQoL in view of the subscales of EQ-5D, EQ-VAS index scores. The severity of PDSS was correlated the HRQoL in the panic patients. After treatment, the EQ-5D, EQ-VAS index scores showed significant improvement. Conclusion : Panic disorder patients suffer from lower HRQoL as well as from symptoms of the disorder. They showed clinical improvement and a restored HRQoL with treatment. These outcomes suggest using the EQ-5D, EQ-VAS such as the HRQoL in the assessment of patients with panic disorder is essential.