Comparative Phenomenology of Ataques de Nervios,Panic Attacks,and Panic Disorder

This article examines a clinicalsample of 66 Dominican and Puerto Ricansubjects who reported ataques de nerviosand also psychiatric disorder, and disentanglesthe phenomenological experiences of ataquede nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed thesymptomatic phenomenology of ataqueepisodes from the local perspective as well asin terms of key panic features, such asrecurrence, rapid peaking of symptoms, and lackof provocation. Independent diagnosticassessments of panic attacks and disorder werealso used to establish the phenomenologicaloverlap between ataque and panic. Ourfindings indicate that 36 percent ofataques de nervios fulfill criteria for panicattacks and between 17 percent and 33 percentfor panic disorder, depending on the overlapmethod used. The main features distinguishingataques that fulfill panic criteria fromataques that do not include whether theepisodes were provoked by an upsetting event inthe person's life and the rapidity of crescendoof the actual attack. A key finding is thatataques often share individualphenomenological features with panic episodes,but that these features usually do not ``runtogether' during the ataque experience.This confirms previous findings thatataque is a more inclusive construct thanpanic disorder. The importance of thesefindings for the clinical diagnosis andtreatment of persons with ataques isdiscussed.     

Dizziness and Panic in China: Associated Sensations of Zang Fu Organ Disequilibrium

In China, distress is commonlyexperienced as dizziness that can develop intoacute episodes resembling Western panicattacks. These distressing sensations occur ina unique cultural context with a distinctiveset of associated symptoms, beliefs andpurported etiologies. The experience ofillness is informed by traditional Chinesemedicine (TCM), an indigenous theory thatelaborates a system of organ functioning calledzang fu. Depending on the implicatedzang fu organ disequilibrium, dizzinessand panic present with a specific constellationof associated physical and mental symptoms. This paper presents a clinical survey ofpsychiatric disorders that demonstratesdizziness to be characteristic of Chineseanxiety states, most particularly panic. Threespecific cases of dizziness-focused panicascribed to different states of zang fudisequilibrium are described. In a typicalpattern, initial dizziness and associatedsymptoms intensify until they generalize intopanic attacks. The degree of dizziness andpanic corresponds to the state ofdisequilibrium of the zang fu organsystem as well as instability of the social,interpersonal and environmental context of thepatient. This paper elucidates the dynamicinterpretants of dizziness in the Chinesecontext to contribute to a medical anthropologyof this sensation.     

The Weight of Cognitions in Panic: The Link between Misinterpretations and Panic Attacks

In cognitive theory it is hypothesized that panic attacks are provoked by catastrophic misinterpretations of bodily sensations. The aim of the present study was to investigate the ability of associated word pairs referring to catastrophic thinking (e.g. palpitations-heart attack) in producing panic attacks. Patients with PD (n = 20), patients with mixed anxiety disorders (n = 20), and a healthy control group (n = 30) participated in the present study. To enhance ecological validity we first conducted a stimulus validation experiment. Subsequently, nine suitable panic and neutral word pairs were presented in block to the participants. Anxiety levels were assessed before and after the presentation. PD patients were more anxious when reading these word pairs, compared to neutral word pairs. However, none of the participants experienced a panic attack upon reading the word pairs. From the present results it seems that catastrophic thinking is rather related to the anticipatory anxiety for panic attacks, but not necessarily with the occurrence of the panic attacks themselves.     

Panic Disorder in African-Americans: Symptomatology and Isolated Sleep Paralysis

While attention has been paid to thestudy of panic disorder (PD) with or withoutagoraphobia among Caucasians, surprisinglylittle empirical research within the UnitedStates has looked at the phenomenology of PDamong minority groups. In this paper wepresent data we have collected and review otherresearch on the phenomenology, social supports,and coping behavior among African-Americanswith panic disorder. Our studies indicate that,in comparison to Caucasians, African-Americanswith PD reported more intense fears of dying orgoing crazy, as well as higher levels ofnumbing and tingling in their extremities. African-Americans reported higher rates ofcomorbid post traumatic disorder and moredepression. African-Americans also usedsomewhat different coping strategies (such asreligiosity and counting one's blessings), lessself-blame, and were somewhat more dissatisfiedwith social supports. The incidence ofisolated sleep paralysis was, as per previousreports, higher in African-Americans. Thesefindings, results of other research, and theimplications for assessment and treatment arediscussed within a semantic network analysis of panic (Hinton and Hinton 2002, thisissue).     

Orthostatic panic as a key Vietnamese reaction to traumatic events: the case of September 11, 2001

This article discusses a culturally specific response to traumatic events: orthostatic panic attacks among Vietnamese refugees. We compared the rate and severity of orthostatic panic as well as the rates and severity of associated flashbacks a month before and a month after September 11, 2001. After that date, the rate and severity of orthostatic panic greatly increased, as did the rate and severity of associated flashbacks. The central role of orthostatic panic as a response to traumatic events is illustrated through a patient's vignette. An explanation of why September 11 so profoundly influenced this population is adduced, including an explanation of why it resulted in considerable worsening of orthostatic panic.     

Panic Disorder,Somatization, and the New Cross-cultural Psychiatry: The Seven Bodies of a Medical Anthropology of Panic

This article aims to adduce aframework that will allow for thecross-cultural study of panic disorder. Theauthors take sensation as the key unit ofanalysis, aiming to contribute to a medicalanthropology of sensation. The seven analyticperspectives that are suggested in the articleare the following: the full spectrum of panicattack sensations (the sensation body), thebiological generation of panic sensations (thebiological body), sensation as invoking anethnophysiology (the ethnophysiological body),sensation as metaphor (the metaphoric body),sensation as invoking the landscape (thelandscape body), sensation as invokingcatastrophic cognitions (the catastrophiccognitions body), and sensation as invokingmemory (the memory-associational body).     

Childhood Internalizing and Externalizing Problems Predict the Onset of Clinical Panic Attacks over Adolescence: The TRAILS Study

Background

Panic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence.

Method

This study is part of the TRacking Adolescents’ Individual Lives Survey (TRAILS), a Dutch longitudinal population cohort study (N = 1,584). Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR) and the parent-report Child Behavior Checklist (CBCL) at baseline (age 10–12). At age 18–20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI). We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10–20 years, using survival analysis in univariate and multivariate models.

Results

There were N = 314 (19.8%) cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2%) who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05), and YSR Thought Problems (HR 1.15, p<.05) and Social Problems (HR 1.26, p<.01) predicted panic attack onset.

Conclusion

Risk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence.     

Weekly and Holiday-Related Patterns of Panic Attacks in Panic Disorder: A Population-Based Study

Background

While chronobiological studies have reported seasonal variation in panic attacks (PA) episodes, information on the timing of PA by week-days may enable better understanding of the triggers of PA episodes and thereby provide pointers for suitable interventional approaches to minimize PA attacks. This study investigated weekly variation in potential PA admissions including associations with holidays using a population-based longitudinal, administrative claims-based dataset in an Asian population.

Methods

This study used ambulatory care data from the “Longitudinal Health Insurance Database 2000. We identified 993 patients with panic disorder (PD), and they had 4228 emergency room (ER) admissions for potential PA in a 3-year period between 1 January 2009 and 31 December 2011. One-way analysis of variance (ANOVA) was used to examine associations between the potential PA admissions and holidays/weekend days/work-days of the week.

Results

The daily mean number of potential PA admissions was 3.96 (standard deviation 2.05). One-way ANOVA showed significant differences in potential PA admissions by holiday and day of the week (p<0.001). Daily frequencies showed a trough on Wednesday-Thursday, followed by a sharp increase on Saturday and a peak on Sunday. Potential PA admissions were higher than the daily mean for the sample patients by 29.4% and 22.1%, respectively on Sundays and holidays. Furthermore, the weekly variations were similar for females and males, although females always had higher potential PA admissions on both weekdays and holidays than the males.

Conclusions

We found that potential PA admissions among persons with PD varied systematically by day of the week, with a significant peak on weekends and holidays.     

An evolutionary perspective on panic disorder and agoraphobia

Panic, when viewed ethologically, is not pathological in itself; it is rather an adaptation that evolved to facilitate escape in dangerous situations. Patients with panic disorder have panic with normal form, but the attacks occur in the absence of real danger. The agoraphobia syndrome can be understood as a related adaptation that is expected after repeated panic attacks. These hypotheses account for many aspects of panic and agoraphobia that are difficult for proximate theories to explain, and they suggest new research questions and strategies.     

Predictors and Moderators of Internet- and Group-Based Cognitive Behaviour Therapy for Panic Disorder

Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient settings. This study investigated a selection of outcome predictors and moderators of ICBT for panic disorder based on data from a randomised controlled trial where therapist-guided ICBT was compared with group CBT (GCBT) for panic disorder. Participants (N = 104) received 10 weeks of ICBT or GCBT and were assessed before and after treatment, and after six months. Multiple regression analyses were used to test for significant predictors of treatment outcome. Predictors of positive treatment response for both modalities were having low levels of symptom severity and work impairment. In addition, anxiety sensitivity was found to have a small negative relationship with treatment outcome, suggesting that anxiety sensitivity may slightly enhance treatment response. Treatment modality had a moderating effect on the relationship between domestic impairment and outcome and on the relationship between initial age of onset of panic symptoms and treatment outcome, favouring ICBT for patients having had an early onset of PD symptoms and for patients having a high domestic functional impairment. These results suggest that both ICBT and GCBT are effective treatment modalities for PD and that it is possible to predict a significant proportion of the long-term outcome variance based on clinical variables.     

Cholecystokinin and panic disorder--three unsettled questions

The serendipitously discovered panicogenic effect of the cholecystokinin fragment, the C-terminal tetrapeptide amide (CCK-4), has suggested that the widespread network of CCK neurons and corresponding CCK-B receptors in the brain are in some way involved in pathogenesis panic disorders in man. Two decades of research have now established that exogenous CCK-4 in a reproducible, dose-dependent and sensitive manner indeed evokes panic attacks in both healthy subjects and at even lower doses in anxiety patients. But several questions about the molecular mechanisms by which endogenous CCK peptides may precipitate panic attacks remain to be answered. This review focuses on three immediate questions. (1) Does endogenous CCK-4 exist? (2) Is the panicogenic effect mediated only through CCK-B receptors? (3) Are measurements of CCK peptides in cerebrospinal fluid of use in elucidating the pathogenesis and/or diagnosis? This review concludes that the answers to these questions may further the understanding of panic disorder substantially, and hence contribute to improved diagnosis and therapy of the disease.     

CCK-4-Induced Calcium Mobilization in T Cells Is Enhanced in Panic Disorder

Abstract: We investigated the effects of brain cholecystokinin (CCK) receptors on the intracellular calcium concentration and protein kinase C in human T cells. CCK-4 produced a transient increase in calcium in the absence of extracellular calcium. CCK-B agonists stimulated calcium mobilization in a dose-dependent manner in T cells. CCK-B antagonists suppressed CCK-4-induced calcium mobilization more potently than CCK-A antagonist. The recovery of desensitization of the CCK-4-induced response was delayed by a phosphoserine/phosphothreonine phosphatase inhibitor, calyculin A. The responsiveness to CCK-4 was also reduced by phorbol 12,13-dibutyrate (PDBu), and this effect of PDBu was abolished completely by preincubation with staurosporine. CCK-4-induced calcium mobilization was too small to attribute the desensitization to the protein kinase C transduction pathway. T cells from patients with untreated panic disorder exhibited significantly higher cholecystokinin-4-induced calcium mobilization than those from healthy controls or patients with treated panic disorder. These results suggest that cholecystokinin-B receptor function in T cells of patients with panic disorder is enhanced. Cholecystokinin-4-induced calcium mobilization in T cells may be state dependent and useful as a biological marker of panic disorder.     

Alpha-delta sleep in a patient with nocturnal panic attacks

Sleep and Biological Rhythms - We report here on our finding of an alpha-delta sleep in a 40-year-old-female patient suffering from panic attacks, including nocturnal panic attacks, who complained...     

Maternal panic disorder and congenital abnormalities: a population-based case-control study

BACKGROUND: Maternal panic disorder in pregnancy is the most common manifestation of anxiety disorders in Hungary. The association between panic disorder during pregnancy and structural birth defects, i.e., congenital abnormalities, was studied. METHODS: The prevalence of maternal panic disorder in cases with different congenital abnormalities was compared to that of matched controls in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. RESULTS: Of 22,843 cases with congenital abnormalities, 210 (0.9%) had mothers with panic disorder during pregnancy compared to 187 (0.5%) of 38,151 controls (adjusted prevalence odds ratio [POR] 1.6; 95% CI, 1.3-2.0). Specific groups of congenital abnormalities were also assessed versus controls. Cases with isolated cleft lip with or without cleft palate (CL/P) (adjusted POR, 3.4; 95% CI, 1.3-9.0) and multiple congenital abnormalities (adjusted POR, 3.0; 95% CI, 1.2-7.2) were more likely to have had mothers with panic disorder during the study pregnancy. Notably, among mothers with panic disorders, the associations were found only in offspring of untreated mothers. CONCLUSIONS: A higher rate of isolated CL/P and multiple congenital abnormalities may be caused by the direct biological effect of panic disorder or by the interaction of maternal panic disorder and lifestyle factors. Antipanic drug treatment seems to have a protective effect for isolated CL/P and multiple congenital abnormalities. Birth Defects Research (Part A), 2006.     

Electroencephalogram abnormalities in panic disorder patients: a study of symptom characteristics and pathology

Background  

Since the 1980s, a high EEG abnormality rate has been reported for patients with panic disorder. However, how the EEG abnormalities of panic disorder patients are related to the clinical features and pathology of these patients has yet to be clarified. In this study we investigated whether or not EEG abnormalities are related to the 13 symptoms in the DSM-IV criteria for a diagnosis of panic attacks.     

A controlled study of Tourette syndrome. III. Phobias and panic attacks.

Comparison was made of the frequency of phobias and panic attacks in normal controls and in patients with Tourette syndrome (TS), attention-deficit disorder (ADD), and ADD secondary to a TS gene. For phobias the most significant difference between controls and TS patients was with respect to fear of public transportation (P = .002), followed by fear of being alone (P = .009), fear of being in a crowd (P = .01), fear of being in water (P = .025), fear of animals (P = .04), fear of public speaking (P = .05), and other fears (P = .05). Only 8.5% of controls had more than three simple phobias and none had more than five, whereas 26% of TS patients had more than three (P = .008) and some had as many as 13. As opposed to 19% of TS patients, none of the controls had phobias that interfered with their life (P = .001). Among female TS patients 55.1% had 3-13 phobias, compared with 8.7% of the female controls (P less than .0005). There was no correlation between the ADD score and the number of phobias (r = -.010) and little correlation with the total number of tics (r = .14). Panic attacks were present in 8.3% of the controls and 33% of the TS patients (P = .0008). This frequency increased to 55.2% (P less than .0005) for grade 3 (severe) TS patients. None of the controls, 15.9% of all TS patients (P = .002), and 31% of grade 3 TS patients (P less than .0005) had more than three panic attacks in 1 wk. Total panic-symptom score (12 possible symptoms) was significantly greater than that in the controls in all grades of TS. The presence or absence of ADD had little effect on the total panic-symptom score, but the presence of ADD resulted in a significantly lower average age at onset of panic attacks (8.8 years) compared with those TS patients without ADD (15.4 years) (P = .03). These observations indicate that phobias and panic attacks are a significant part of the symptomatology of TS and provide the first clear indication that phobias and panic attacks can be due to the presence of a major gene.     

Evacuation of Pedestrians with Two Motion Modes for Panic System

In this paper, we have captured an underlying mechanism of emergence of collective panic in pedestrian evacuations by using a modification of the lattice-gas model. We classify the motion of pedestrians into two modes according to their moods. One is gentle (mode I), the other is flustered (mode II). First, to research the cause for crowd, we fix the motion modes of pedestrians and increase the proportion of pedestrians with motion mode II (ρ_II). The simulation results show that the pedestrians with motion mode II are lack of evacuation efficiency and cause more casualties. Further, we use the SIS (susceptible-infective-susceptible) model to describe the spreading of the panic mood. The system can be in the high-mix state when the infection probability λ is greater than a fuzzy threshold. In addition, the distances S from wounded people to the exit are researched, the number of wounded people gets maximum at the internal S = 5 ∼ 10, which is independent of ρ_II and λ. This research can help us to understand and prevent the emergence of collective panic and reduce wounds in the real evacuation.     

The Neuroanatomical Basis of Panic Disorder and Social Phobia in Schizophrenia: A Voxel Based Morphometric Study

ObjectiveIt is known that there is a high prevalence of certain anxiety disorders among schizophrenic patients, especially panic disorder and social phobia. However, the neural underpinnings of the comorbidity of such anxiety disorders and schizophrenia remain unclear. Our study aims to determine the neuroanatomical basis of the co-occurrence of schizophrenia with panic disorder and social phobia.MethodsVoxel-based morphometry was used in order to examine brain structure and to measure between-group differences, comparing magnetic resonance images of 20 anxious patients, 20 schizophrenic patients, 20 schizophrenic patients with comorbid anxiety, and 20 healthy control subjects.ResultsCompared to the schizophrenic patients, we observed smaller grey-matter volume (GMV) decreases in the dorsolateral prefrontal cortex and precentral gyrus in the schizophrenic-anxiety group. Additionally, the schizophrenic group showed significantly reduced GMV in the dorsolateral prefrontal cortex, precentral gyrus, orbitofrontal cortex, temporal gyrus and angular/inferior parietal gyrus when compared to the control group.ConclusionsOur findings suggest that the comorbidity of schizophrenia with panic disorder and social phobia might be characterized by specific neuroanatomical and clinical alterations that may be related to maladaptive emotion regulation related to anxiety. Even thought our findings need to be replicated, our study suggests that the identification of neural abnormalities involved in anxiety, schizophrenia and schizophrenia-anxiety may lead to an improved diagnosis and management of these conditions.     

Panic escape polyethism in worker and soldier Coptotermes formosanus (Isoptera: Rhinotermitidae)

Termites were the first animal to form societies. Two hundred million years of evolution provide for a multitude of innate social behaviors that can be experimentally dissected. These fine‐tuned patterns of behavior are especially interesting when observing group decision making in the panic mode. In this study, we examined behavioral patterns of termites under panic conditions to gain insight into how an escape flow self‐organizes. One hundred worker and 10 soldier Coptotermes formosanus were released into agar plates. After a disturbance was created most workers followed each other and ran along the wall of dishes, thus forming a unidirectional escape flow, whereas soldiers showed a significantly higher frequency of moving to the center of the arena or on periphery of the escape flow as compared to workers. Agonistic behavior was usually observed as soldiers moved to center or periphery. This is the first report on the behavioral repertoire of termites when panicked, with details on the behavioral polymorphism of workers and soldiers during an escape.