• Title/Summary/Keyword: Paranoid

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The Clinical Study On Posttraumatic Stress Disorder Patients due to a Serise of Traffic Accidents;SCL-90-R (교통사고 후 외상성 스트레스 장애 후유증 환자에 대한 고찰;SCL-90-R 중심으로)

  • Ko, Kyoung-Mo;Choi, Sung-Hun;Kim, Jae-Su;Park, Seo-Young;Lee, Yun-Kyu;Lee, Yoon-Kyoung;Lee, Kyung-Min;Lee, Bong-Hyo;Lim, Seong-Chul;Choi, Hong-Sik;Lee, Eun-Kyung;Jung, Tae-Young;Seo, Jung-Chul
    • Journal of Acupuncture Research
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    • v.24 no.6
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    • pp.63-68
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    • 2007
  • Objectives : The purpose of this study was designed to estimate the effects of Oriental medical treatment on posttraumatic stress disorder patient due to a series of traffic accidents by using SCL-90-R. Methods : We studied 20 patients who were admitted to Daegu Haany University Oriental Hospital from October2006 to May 2007. Results : 4 symptoms of SCL-90-R, somatization, obsessive-compulsive, depression and anxiety were significantly different when comparing after-treatment with before-treatment. But, 5 symptoms of SCL-90-R, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation and psychoticism showed no difference between after-treatment with, before-treatment measurements. The total impact or SCL-90-R was significant comparing after-treatment with before-treatment measurements. Conclusions : We concluded that there was a significant effectof Oriental medical treatment on posttraumatic stress disorder patients caused by a seriesof traffic accident. However, the findings of this study need to be confirmed in more patients with further studies.

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A STUDY ON MENTAL HEALTH STATE OF HIGH SCHOOL STUDENTS (고등학생의 정신건강 상태에 관한 연구 -SCL-90을 이용, 서울시 인문계 1 . 3학년을 중심으로-)

  • 김은주
    • Korean Journal of Health Education and Promotion
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    • v.5 no.2
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    • pp.110-141
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    • 1988
  • This study was conducted to find out the mental health state of high school students. First-year students and third-year students af liberal high schools is Seoul were subject to this study. Questionnaire of Symptom Checklist-90 and various factors was adopted for the survey. A total of 916 questionnaires was sellected for the analysis, and the results are obtained as follows; 1) The characteristics in responses to mental health scale showed that obsessive-compulsive scale score was the highest, followed by interpersonal-sensitivity, depression, hostility, and anxiety. The subject group of the students showed higher scores in nine symptom dimensions except somatization than other normal group. 2) Girl-students showed higher scores than boy-students in somatization, depression, and anxiety, whereas the opposite was true in hostility. 3) Third-year students got high scores, in somatization, anxiety and Depression. 4) Parental marriage state of the repondents showed significant differences in nine symptom dimensions of mental health. Scores of the students with parents was the lowest, followed by those of students with only mother, only father and the rest(no parents, divorced, sepaerated, step-parent) in increasing order. 5) Smoking students showed high score in obsessive-compulsive, depression, hostility, paranoid ideation, and psychoticism. Especially in hostility, they got much higher score. 6) Students with poor record at school got higher scores in every symptom dimension than those with good record at school, especially in obsessive-compulsive and depression scale. 7) Parents' attitude toward student showed significant effect on every scale. Students under over-expectation or indifference from parents were in bad mental health state. 8) Students who have advisor proved to be in better mental health state than those who never consult their personal problems with others. 9) He who has family history got higher scores in some scales. 10) Respondents who looked upon what they have learned in high school as being rather an obstacle to sound social life got high scores in all the symptom dimensions and next came those of the students who answered that there were a lot of unnecessary things in their learning. 11) Those for whom it would not quite necessary to enter college if there were little formal schooling discrimination in society got high scores in obsessive-compulsive, interpersonal sensitivity, depression, hostility, and in psychoticism, especially higher in obsessive-compulsive scale. 12) Mental health state of the students who are influenced by the social surroundings, mass media, and the home environments showed high score in 8 symptom dimensions. 13) Abnormal response frequency of this sample is as follows; 24.0% of boys, 23.8% of girls, 22.5% of the first-year students, and 26.9% of the third-year students. There were significant difference among the grades. 14) The factors of distinctive correlation between the dimensions of SCL-90 and 16 factors were the father's negative attitude and depression, negative responses on teaching contents and anxiety, and smoking and hostility. In conclusion, mental health state of liberal highschool students on the whole showed worse than other normal groups. It had close terms with relation with their parents, schoolwork, smoking, teaching contents, the social surrounding, mass media, and the home environments. Thus I believe there need not only mental health education of students, training of teachers, counceling of parents, but also changes in teaching contents, and the improvement of educational system and the social surroundings under the national support.

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Correlation between The Parents' Character of Orthodontic Patients and Patients Cooperation (치과 교정 환자 부모의 인성(SCL-90-R)과 환자 협조도의 상관관계)

  • Kim, Jong-Oh;Chung, Dong-Hwa;Lee, Jin-Woo;Cha, Kyung-Suk
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.4
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    • pp.415-422
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    • 2011
  • The study on correlation between the parents' character of orthodontic patients and patients cooperation. Although dentists have excellent skill and technique, patients' cooperation is always demanded. Patients' poor cooperation results in poor treatment result. Cooperation between psycho-social state of parents and patient's cooperation was studied. The parent's psychosocial state is evaluated with scl-90-r. The cooperation is measured by appointment time compliance, appliance taking rate, breakage of appliance, and fee paying. Parents' psychosocial contents are somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic-anxiety, paranoid ideation, psychoticism, and additional item. Statistics was done by SPSS WINDOW version 12.0 program. The result showed no correlation between patients' cooperation and their parents' psychosocial state. There is no correlation between father's psychosocial state and patients' cooperation except psychoticism. There is no correlation between mother's psychosocial state and patients' cooperation. However, there was correlation among cooperation variables: appointment time compliance, appliance taking rate, breakage of appliance, cost paying. Appliance taking rate and cost paying showed positive correlation. Our findings suggest that patients' cooperation does not followed their parents' pychosocial state. Other combined factors should be considered like pychosocial state of patient and doctor-patient relationship.

Psychopathological Profile of Women with Breast Cancer Based on the Symptom Checklist-90-R

  • Pan, Xiong-Fei;Fei, Man-Dong;Zhang, Kenneth Y.;Fan, Zhen-Lie;Fu, Feng-Huan;Fan, Jin-Hu
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6579-6584
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    • 2013
  • Background: With effective early treatments, many breast cancer patients suffer from psychological distress due to adverse effects and lifelong physical disfigurement. Our study aimed to evaluate the psychopathological profile of breast cancer patients in comparison with healthy women and explored demographic correlates. Method: We consecutively enrolled breast cancer patients who came to the hospital for follow-up or rehabilitation care after primary treatment, and healthy female relatives or friends of inpatients in the Cancer Institute of Chinese Academy of Medical Sciences between August 30, 2010 and January 1, 2012. Psychopathological profile was assessed based on the Symptom Checklist-90-R (SCL-90-R) for patients and controls. We compared demographics such as age, ethnicity, education, marriage, and occupation, and incorporated these data plus cancer status for the association with the general SCL-90-R index and scores for 9 major symptom dimensions in multiple regression analysis. Results: We surveyed a total of 291 female breast cancer patients and 531 healthy women. The average age was $55.1{\pm}6.40$ years for breast cancer patients and $43.1{\pm}12.8$ for healthy controls (P<0.01). The mean survival was 5.20 years for cancer patients (range, 0.60-9.90 years). There were statistically significant differences in education, marriage, and occupation between the two groups (P<0.01). General index ($1.45{\pm}0.45$ versus $1.32{\pm}0.37$) and 8 dimension scores (excluding anxiety) on SCL-90-R were significantly higher in patients (P<0.05). Multiple regression analysis showed that the breast cancer status was positively correlated with general SCL-90-R index and 6 dimension scores (excluding the anxiety, phobic anxiety and paranoid ideation dimensions) (P<0.05). Regression coefficients ranged from 0.10 (depression) to 0.19 (somatization). Higher interpersonal sensitivity was noticed in single women compared to married women. Conclusions: Chinese patients with breast cancer demonstrate greater psychopathology compared to healthy controls. The breast cancer status is an independent contributing factor to the general psychopathological profile. Breast cancer patients should be given particular counseling and care to alleviate their psychological distress.

Effects of Maum Meditation Training on Mental Health according to the Length of the Training Period (마음수련명상의 지속기간에 따른 정신건강의 효과)

  • Lee, In-Soo;Oh, Jin-Hwan;Kwon, In-Sook
    • The Journal of the Korea Contents Association
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    • v.13 no.1
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    • pp.342-353
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    • 2013
  • The purpose of this study was to investigate the effects of short-term Maum Meditation and to compare effects according to the length of the training period on mental health of teachers. In this research, 2 types of design were used which were one-group pre-posttest design and descriptive study. In short-term Maum Meditation group, 2 times of surveys were carried out, 75 teachers in the faculty training filled out the structured questionnaire. In Long-term Maum Meditation group, 101 teachers who were attending Maum Meditation above one-year filled out the structured questionnaire. The data were analyzed by SPSS WIN 14.0 program. The results showed that there was a significant difference in mental health including 9 subscales for short-term Maum Meditation group. Also, in long-term Maum Meditation group, there were significant differences in mental health excepting paranoid ideation. It was founded that Maum Meditation is the way for the mental health promotion in short-term and long-term period. So it is necessary to develop program according to training period for not only clinical application but also to strengthen coping ability for stress.

The Lived Experience of Children of Alcohol Dependent Fathers (알코올중독 아버지와 사는 자녀의 경험에 관한 연구)

  • Kim Myung Ah
    • 한국보건간호학회:학술대회논문집
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    • 2002.10a
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    • pp.224-227
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    • 2002
  • Alcoholism affects not only the individuals who depend on it, but also their families. Children who have an alcohol dependent parent have various problems and need help, but little attention has been given to them. Many references report only negative characteristics of these children. In order to help the children of alcohol dependent parents, health professionals need more information. A wholistic understanding and analysis of these children is needed as a basis for the development of suitable programs of help them. A phenomenological methodology was used to identify the experience of children whose fathers were addicted to alcohol. The findings portray the essence of the lived experience of children of alcohol dependent fathers. Nine adolescents participated in in-depth inverviews and observation with the researcher, done between October and December 2001. The data were recorded on audio tape and transcribed. Sampling was continued until the data were theorectically saturated. The Colaizzi's method was used for data analysis. The results of this study are as follows. Three themes and twenty six meanings were identified. The first theme is Living Alone: living abusively as partner to an alcohol dependent father, living dangerously like an explosive fury, living as an object that ha no self, living with rejection of fatherly being, living with felt responsibility but having no power to help mother who suffers patiently with pain and abuse, living along with no shoulder to lean on, and living with the prejudice of sex discrimination. The second theme is Paradoxical Coping in Life. The meanings are obsessive behavior as a way to control father's behavior, always on the defensive due to anxiety and tension, being afraid of life alone due to paranoid thoughts, contradictory expectation about father's drinking behavior due to life with chronic tension, stress becoming familiar and life being boring and tendious without stimulation, life that is fake and filled with misinterpretations about reality, affection sought from others due to loneliness, compensatory life within peer group, negative expectation about the future due to negative experiences, controling others to protect ego, denial of real emotion to protect self from hurt, life of regretting self, and strong need for approval from others. The third theme is sustaining life. The meanings are ambivalence between revenge on father and pity, struggle for desirable self against fear of gather-like image, understanding father through self reflection, hope to find fatherly being through father's recovery, being able to stand through emotional control and cognitive restructuring, nurturing the seed of hope for the future while in a situation of desperation. The contribution of this study is to give a wholistic understanding of the empirical reality of children of alcohol dependent parents and to develop substantive theory in nursing knowledge. In nursing practice, the results of this study can provide a foundation for the development of programs for children of alcohol dependent parents.

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Personality Trait in Panic Disorder Patient and Its Clinical Significance (공황장애 환자의 성격특성과 임상적 의의)

  • Chae, Young-Lae;Lee, Chung-Tai;Kim, Bo-Yeon;Lee, Sung-Pil;Hong, Seung-Chul;Kim, Chong-Woo;Keh, Yoon-Jung
    • Korean Journal of Psychosomatic Medicine
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    • v.3 no.2
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    • pp.139-146
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    • 1995
  • Forty patients meeting DSM-III-H criteria for panic disorder and 51 normal controls were assessed with the Personality Diagnostic Questionnaire-Revised(PDQ-R), a self-rating scale designed to assess Axis II personality disorders and traits. Results replicated previous findings of a preponderance of dependent, avoidant, and histrionic features. But our result showed other features such as paranoid, schizotypal, borderline, and antisocial traits also. Patients were divided into two groups according to the severity of their personality traits(high or low). These groups were compared in various panic symptomatology and SCL-90-R. None of the specific symptom dimensions in panic disorder, i.e. panic, anxiety, agoraphobia, social impairment, or chronicity was different between groups. Rather, high personality trait groups were found to have significantly more symptomatology in SCR-90-R than low personality groups. Result indicated that patients exhibiting a greater number of personality traits were also significantly more symptomatic. The results suggested a possible link beteween panic disorder and personality disorder. And, general factors such as depression, social or interpersonal sensitivity might provide a much better explanation of personality disorders in panic patients.

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The Influence of Estrogen on Dopamine Metabolites in Schizophrenia (정신분열병에서 도파민 대사물에 대한 에스트로겐의 영향)

  • Cheon, Jin-Sook;Lee, Jang-Hyun;Oh, Byoung-Hoon
    • Korean Journal of Biological Psychiatry
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    • v.6 no.2
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    • pp.209-218
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    • 1999
  • Objectives : The aims of this study were to discriminate the clinical differences, to measure the estrogen and homovanillic acid levels, to evaluate a correlation between estrogen and homovanillic acid, and to identify an association of cognitive deficit with estrogen and homovanillic acid among male and female schizophrenics. Methods : In addition to the structured interviews, the plasma estrogen levels by radioimmunoassay and the homovanillic acid levels by HPLC were measured in 20 male and 21 female schizophrenics as well as 10 healthy male and 9 female controls. Results : 1) The plasma estrogen levels were higher in females than males, and significantly higher in female schizophenics than female controls. The homovanillic acid levels were higher in female schizophrenics than female controls, and were lower in male schizophrenics than male controls. 2) The onset age seemed to be earlier in male schizophrenics, and the frequency of admission, duration of antipsychotic drug administration, dosage of antipsychotics and duration of illnesses were more in males. The estrogen and homovanillic acid levels were significantly higher in female schizophrenics. 3) The estrogen levels had a significant positive correlation with sex, age and onset age, while the homovanillic acid levels did with sex. However, estrogen were not correlated with homovanillic acid levels. 4) The estrogen and homovanillic acid levels were not significantly different between male and female schizophrenics with cognitive deficits. In the schizophrenic patients without cognitive deficits, the estrogen levels were significantly higher in females, while there were no significant sex differences in homovanillic acid. 5) In the male and female schizophrenics predominantly with negative symptoms, there were no significant differences in estrogen and homovanillic acid levels. In those predominantly with positive symptoms, the estrogen levels were significantly higher in females, while there were no sex differences in homovanillic acid levels. 6) In schizophrenics with undifferentiated subtype, the estrogen and homovanillic acid levels were significantly higher in females. In those with paranoid or disorganized subtypes, the estrogen levels were significantly higher in females, while there were no sex differences in the homovanillic acid levels. 7) The mean values of PANSS-negative, PANSS-total, PANSS-CF, MMSE-K and estrogen levels were significantly higher in male schizophrenics with cognitive deficits. The mean values of illness duration, CGI, PANSS-positive, PANSS-negative, PANSS-total, PANSS-CF and MMSE-K were significantly higher in female schizophrenics with cognitive deficits. 8) The variables which showed significant correlation with cognitive deficits were PANSS-negative, PANSS-total, PANSS-CF, MMSE-K and estrogen levels in male schizophrenics. The variables which showed significant correlation with cognitive deficits were subtypes, onset age, illness durataion, CGI, PANSS-positive, PANSS-negative, PANSS-total, PANMSS-CF and MMSE-K in female schizophrenics. The estrogen levels were significantly correlated with admission frequencies, history of antipsychotic administration, duration of antipsychotic administration and cognitive deficits in male schizophrenics, while age were not correlated with in females. The homovanillic acid levels had a significant correlation with subtypes and onset age in male schizophrenics, while there were no correlation among variables in females. Conclusions : Although the plasma concentrations of estrogen and homovanillic acid in female schizophrenics were significantly higher than males, we could not find an association between them. Furthermore, the various factors affecting on the cognitive deficits, estrogen and homovanillic acid levels seemed to be somewhat different according to sex.

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The Effects of d-Amphetamine on the Brain 5-HT, 5-HIAA, MAO and the Behavior of Rat (d-Amphetamine이 백서뇌의 5-HT, 5-HIAA, MAO 및 행동에 미치는 영향에 관한 연구)

  • Suh, Yoo-Hun;Woo, Jong-In;Park, Chan-Woong
    • The Korean Journal of Pharmacology
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    • v.17 no.2
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    • pp.47-62
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    • 1981
  • d-amphetamine이 사람에서 paranoid schizophrenia와 아주 유사한 model psychosis를 일으키며 또한 사람과 실험동물에서 실제 정신분열증에서 뚜렷이 관찰되는 behavioral perservation을 일으킬 수 있음이 관찰되었다. 이에 많은 학자들은 이러한 양상의 행동변화가 정신분열증의 원인 추구에 중요한 의미를 주는 뇌변화를 반영할지도 모른다는 생각에 많은 연구를 거듭하여 왔다. 지금까지는 주로 catecholamine기전에 대하여 집중적 연구가 수행되어져 왔으나 최근에는 d-amphetamine의 약리기전의 일부는 5-HT기전이 차지하고 있으며, 여러 행동변화에는 catecholaimin 보다 5-HT 가 더 중요하게 관계하고 있다는 주장이 나오고 있다. 또한 d-amphetamine은 시험관내에서 MAO 특히 신경전달물질 분해요소인 A type를 가역적으로 억제할 수 있음이 보고되어 많은 흥미를 끌어왔으나 생체내에서의 억제여부는 직접적으로 확인이 되고 있지 않다. 그러나 최근에 Braestrup(1977)과 El Hait(1978)등은 간접적인 방법으로 생체내에서도 억제시킬 수 있음을 보고하고 있다. 이에 저자는 d-amphetamine에 의해 야기되는 행동변화와 그 밑바탕을 이루는 생화학적 기전에 5-HT가 차지하는 역할을 알아보기 위해서 다음의 실험을 시행하였다. 첫째, d-amphetamine의 급성, 만성 투여가 5-HT의 5-HIAA 로의 turnover와 MAO활성도에 어떤 영향을 미치며, 더 나아가서 이 양자사이에 어느 정도 상관관계가 있는지를 알아보기 위해서 d-amphetamine을 투여한 후 시간 경과에 따라서 뇌내 5-HT, 5-HIAA, 5-HT turnover rate와 MAO 활성도를 측정하였다. 둘째, d-amphetamine, 5-HT 합성을 증가시키는 약물과 합성을 억제시키는 약물을 투여하고, 위의 생화학적 실험과 행동관찰을 병합 실시하여 비교분석하였다. 그 결과는 다음과 같다. 1) d-amphetamine (6 mg/kg)을 급성투여시, 뇌내 5-HT함량이 투여 1시간 후에 최고로(대조치의 123%, p<0.001) 증가되다가 이후 감소하며, 5-HIAA 함량은 처음 15분부터 감소하기 시작하다가 30분에 최저로 떨어지며(대조치의 78%, p<0.005) 이후 증가하여 24시간째는 약간 대조치 이상으로 회복되었다. 미토콘드리아 MAO활성도는 1시간째에 최저로 떨어지다가(대조치의 89%, p<0.05)이후 회복하기 시작하여 24시간째에 약간 대조치 이상으로 회복되었다. 5-HT의 turnover rate는 MAO활성도 변화와 거의 같은 변화를 보였다. 2) 만성투여시 (하루 2번, 14일간 투여)는 5-HT 함량, 5-HIAA 함량, MAO 활성도 및 5-HT turnover rate 모두가 중등도로 감소되었다. (각각 대조치의 87%, 69%, 80%, 79%). 3) MAO 활성도와 5-HT turnover rate 사이에는 높은 상관관계가 있었다. (r=0.866, p<0.001, N=94). 4) MAO 활성도의 역동학 실험에서는 대조치에 비해 투여군에서 Km 값은 의미가 있는 증가가 있었으나 $V_{max}$값은 큰 변동이 없었다. 5) d-amphetamine을 급성 투여할때는 sleeping과 lying components는 상당한 감소를 보인 반면, locomotor activity 는 1시간까지는 상당한 증가를 보였으며 용량이 적을수록 더 큰 증가가 있었다. 반면 stereotypy는 1시간까지 용량이 증가할수록 더 큰 증가가 나타나서 locomotor activity에서 stereotypy 의 증가로 이행을 나타내었다. 만성 투여시는 locomotor activity는 점차적인 감소를 보였으나 stereotypy는 점차적인 증가가 나타나서 14일쯤에는 평형에 도달하였다. 6) PCPA 단독 투여군(400 mg/kg, 3번)에 있어서는 5-HT와 5-HIAA 함량의 상당한 감소가 나타났으나 MAO 활성도와 행동에는 큰 변화를 나타내지 않았다. PCPA전 처치군에 있어서도 5-HT와 5-HIAA 함량은 마찬가지로 상당한 감소를 나타내었으나 gnawing, sniffing과 locomotor activity는 더 증가를, stereotyped head weaving, forepaw treading과 hindlimb abduction은 상당한 감소를 나타내었다. 7) L-tryptophan(100 mg/kg)단독 투여시는 5-HT 함량은 약간 증가를 나타내었으나 5-HIAA 함량은 상당한 증가를 보였다. MAO활성도나 행동은 큰 변화없었다. L-tryptophan 전처치군에 있어서는 5-HT 함량은 더 큰 증가를 보였으나, 5-HIaa 함량은 MAO 활성도는 별 변화없었으며 stereotypedlateral head waving, forepaw treading 과 hindlimb abduction은 증가를, locomotor activity, gnawing과 sniffing components는 감소를 나타내었다. 8) d-amphetamine 단독투여, 혹은 L-tryptophan 전처치, PCPA 전처치후 측정한 5-HT 함량과 stereotyped head weaving, forepaw treading, hinilimb abduction components 사이에는 높은 상관관계가 있었다(r=0.789, p<0.001). 반면 5-HT 함량과 locomotor activity, stereotyped gnawing과 sniffing components 사이에는 약한 음성의 상관관계가 있었다. (r=0.554, p <0.005). 이상의 결과로 미루어 볼때 5-HT의 5-HIAA 로의 turnover rate 는 주로 MAO 활성도에 의해서 조절되며 5-HT 기전이 d-amphetamine에 의해서 야기된 여러 행동변화 중 상당한 부분에서 중요한 역할을 하리라고 생각된다.

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Personality Characteristics and Those Influences on the Outcome of Cognitive Behavioral Therapy in Patients with Panic Disorder (공황장애 환자의 성격 특성과 인지행동치료의 결과에 미치는 영향)

  • Choi, Young-Hee;Lee, Dong-Hyun;Park, Kee-Hwan;Yoon, Haye-Young;Woo, Jong-Min
    • Korean Journal of Psychosomatic Medicine
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    • v.10 no.2
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    • pp.142-153
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    • 2002
  • The authors intended to investigate personality characteristics and those influence on the outcome of cognitive behavioral therapy in patients with panic disorder. 167 patients who met DSM-IV criteria for panic disorder were assessed by the PDQ-R(Personality Disorder Questionnaire-Revision) and various self-report tools for assessing symptoms of panic disorder. The effect of therapy was measured by the changes of scores and the end state functioning before and after 12-sessions of CBT. The patients with panic disorder were more likely showed obsessive-compulsive, avoidant and paranoid personality disorder and also Cluster C. If is needed when patients were divided into two groups according to total scores of PDQ-R(high or low personality disorder groups), high personality disorder group showed many evidences for increased psychopathology at the start of treatments, this suggested the close linkage between panic disorder and personality disorder. Interestingly, there were no significant differences between both groups in scores of clinical variables and the end state functioning. In conclusion, although patients with high tendency of personality disorder had more generalized problems at the beginning of treatments, they could improve as much as the patients with low tendency of personality disorder. They can be helped by cognitive behavioral therapy for panic disorder and seem to profit as much as patients with low tendency of personality disorder. If is needed to seek other factors in poor responders for cognitive behavioral therapy.

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