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Journal articles on the topic 'Panic disorder and agoraphobia'

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Published: 4 June 2021

Last updated: 10 February 2022

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1

HAYWARD, C., J. D. KILLEN, and C. B. TAYLOR. "The relationship between agoraphobia symptoms and panic disorder in a non-clinical sample of adolescents." Psychological Medicine 33, no. 4 (May 2003): 733–38. http://dx.doi.org/10.1017/s0033291702006955.

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Background. The purpose of this study was to evaluate the clinical correlates of agoraphobic fear and avoidance and panic disorder in a non-clinical sample of adolescents.Method. In a sample of 2365 high school students, combined data from a questionnaire and a structured clinical interview were used to classify subjects with agoraphobic fear and avoidance. Panic symptoms, major depression, childhood separation anxiety disorder, anxiety sensitivity and negative affectivity were also assessed.Results. Fifteen subjects met study criteria for agoraphobic fear and avoidance in the past year. Only three (20%) of those with agoraphobia symptoms reported histories of panic attacks and there was no overlap between those with agoraphobic fear and avoidance and the 12 subjects who met DSM-III-R criteria for panic disorder. However, subjects with agoraphobia symptoms and those with panic disorder reported similar levels of anxiety sensitivity and negative affectivity. Childhood separation anxiety disorder was more common among those with agoraphobic fear and avoidance compared to those without.Conclusion. Agoraphobic avoidance is rare in non-clinical samples of adolescents and usually not associated with panic attacks. However, adolescents with agoraphobia symptoms and those with panic disorder have similar clinical correlates consistent with a panic/agoraphobia spectrum model.

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Mokhber, N., and F. Savadkoohi. "The effects of olanzapine in treatment of panic disorder with and without agoraphobia." European Psychiatry 26, S2 (March 2011): 165. http://dx.doi.org/10.1016/s0924-9338(11)71876-4.

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BackgroundIn this study, we have evaluated the effects of Olanzapine in treatment of panic disorder with and without agoraphobia.Method and materialsPatients whit resistant panic disorder (resistant to tow SSRI agents) who came to psychiatric clinic of Ibn-e-Sina and Ghaem Hospitals-Mashhad during 2004–2005 were enrolled in this study. Low dose Olanzapine (2.5 milligram per day) was administered initially. ALL cases were evaluated by different psychiatric tests such as agoraphobic cognitions questionnaire panic attack and anticipatory anxiety scale, Hamilton depression test and general functional assessment.ResultsIn this study, 30 patients were divided into two groups of panic disorder with agoraphobia (13 cases) and panic disorder without agrophobia (17 cases). Comparing these two groups, all indexes were improved significantly by time but The frequency of panic attacks in the last week minor panic attack duration of panic attacks agoraphobic cognition scale and Hamilton depression indexes were Improved significantly especially in those cases with panic disorder and agoraphobia Although the therapeutic response according to anxiety score, total panic attacks Hamilton depression test and general functional assessment was not showed any Difference.ConclusionOlanzapine augmentation has acceptable effects in the treatment of drug resistant panic disorder with agoraphobia and therapeutic effects were more significant among patients with panic disorder without agoraphobia.

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3

Argyle, Nick, Carol Solyom, and Leslie Solyom. "The Structure of Phobias in Panic Disorder." British Journal of Psychiatry 159, no. 3 (September 1991): 378–82. http://dx.doi.org/10.1192/bjp.159.3.378.

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Fear and avoidance of individual phobic situations were measured in 1168 patients with panic disorder suffering current attacks. Correlation and principal-components analyses give components of agoraphobia, illness phobia, and social phobia in panic disorder. Agoraphobia does not stand out so clearly as illness phobia and social phobia as a separate factor; ‘fear of open spaces' shows some separation from other agoraphobic situations. Frequency of panic attacks and changes associated with their remission have no special relationship to agoraphobia. Closer attention to social and illness phobia may be fruitful in discerning the evolution of panic disorder.

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4

Marchand, André, and Michel Wapler. "L'effet des troubles de la personnalité sur la réponse au traitement béhavioural-cognitif du trouble panique avec agoraphobie." Canadian Journal of Psychiatry 38, no. 3 (April 1993): 163–66. http://dx.doi.org/10.1177/070674379303800302.

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This study measures the effect of personality disorders on the efficacy of treatment of agoraphobia. Forty-one patients suffering from panic disorder with agoraphobia are evaluated for the presence of a personality disorder (according to DSM-III-R criteria) before the onset of treatment. The treatment consists in 14 sessions of behavioural cognitive therapy. Various measures of agoraphobic avoidance are obtained before (pre-test) and after the end of treatment (post-test, three month follow-up). Effect of treatment reaches statistical and clinical significance for all patients. Grouping of patients according to presence or absence of personality disorder shows no significant difference between the groups before or after treatment on scores of agoraphobia. A subgroup of patients with dependent personality disorder does not differ on measures of agoraphobic avoidance from patients without personality disorders or with other personality disorders. The discussion points out methodological limitations, differences in our study from other studies regarding the effect of personality on the treatment outcome of panic disorder with agoraphobia, as well as possibilities for future studies.

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Cox, Brian J., Richard P. Swinson, and Brian F. Shaw. "Value of the Fear Questionnaire in Differentiating Agoraphobia and Social Phobia." British Journal of Psychiatry 159, no. 6 (December 1991): 842–45. http://dx.doi.org/10.1192/bjp.159.6.842.

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The present study examined responses on the Fear Questionnaire (FQ) of 68 patients suffering panic disorder with agoraphobia, 50 social phobics, 75 subjects with ‘non-clinical’ panic attacks, and 188 non-panicking controls. The FQ agoraphobia and social subscales had satisfactory internal consistency and were accurate (82%) in correctly differentiating the patients. In general, the patient and control groups differed as expected. The highest level of social fear was reported by social phobics and the highest level of agoraphobic fear was reported by patients with panic disorder and agoraphobia. Five items from these two subscales significantly differentiated social phobia from panic disorder with agoraphobia. The results support the reliability and validity of the FQ.

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6

GOISMAN, ROBERT M., MEREDITH G. WARSHAW, LINDA G. PETERSON, MALCOLM P. ROGERS, PAUL CUNEO, MOLLY F. HUNT, JENNIFER M. TOMLIN-ALBANESE, et al. "Panic, Agoraphobia, and Panic Disorder with Agoraphobia." Journal of Nervous and Mental Disease 182, no. 2 (February 1994): 72–79. http://dx.doi.org/10.1097/00005053-199402000-00002.

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7

Latas, Milan, Mihajlo Mitrovic, and Vladan Starcevic. "Gender differences in psychopathologic features of agoraphobia with panic disorder." Vojnosanitetski pregled 63, no. 6 (2006): 569–74. http://dx.doi.org/10.2298/vsp0606569l.

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Background/Aim. To examine gender differences in the major psychopathologic features in agoraphobia with panic disorder. Method. The study was conducted as a clinical study. The sample consisted of 119 patients, 32 men (26.9%) and 87 women (73.1%) with the basic diagnosis of agoraphobia with panic disorder. All the patients were evaluated with the clinical instruments suitable for the assessment of various clinical features associated with agoraphobia with panic disorder - questionnaires (the Hopkins Symptom Checklist 90, the Panic Appraisal Inventory, the Fear Questionnaire, the Beck Anxiety Inventory, and the Beck Depression Inventory), and the clinical rating scale (the Panic and Agoraphobia Scale). After the data collection, the sample was divided into two groups by the gender. Then the groups were compared. Results. There were no differences between the genders in the global psychopathologic features (the age at the onset of a disorder, duration of a disorder, severity and frequency of panic attacks, intensity of general psychiatric symptoms, intensity of general anxiety and depression). The women, however, reported a subjective perception of a more severe agoraphobic avoidance and males were significantly more likely than the females to anticipate the serious somatic consequences of panic attacks and worry about somatic health. Conclusion. There were a few gender specific psychopathologic features in patients with agoraphobia with panic disorder, so further studies would be necessary to come to a more precise conclusion.

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8

Wittmann, A., F. Schlagenhauf, A. Guhn, U. Lueken, C. Gaehlsdorf, M. Stoy, F. Bermpohl, et al. "Anticipating agoraphobic situations: the neural correlates of panic disorder with agoraphobia." Psychological Medicine 44, no. 11 (January 7, 2014): 2385–96. http://dx.doi.org/10.1017/s0033291713003085.

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BackgroundPanic disorder with agoraphobia is characterized by panic attacks and anxiety in situations where escape might be difficult. However, neuroimaging studies specifically focusing on agoraphobia are rare. Here we used functional magnetic resonance imaging (fMRI) with disorder-specific stimuli to investigate the neural substrates of agoraphobia.MethodWe compared the neural activations of 72 patients suffering from panic disorder with agoraphobia with 72 matched healthy control subjects in a 3-T fMRI study. To isolate agoraphobia-specific alterations we tested the effects of the anticipation and perception of an agoraphobia-specific stimulus set. During fMRI, 48 agoraphobia-specific and 48 neutral pictures were randomly presented with and without anticipatory stimulus indicating the content of the subsequent pictures (Westphal paradigm).ResultsDuring the anticipation of agoraphobia-specific pictures, stronger activations were found in the bilateral ventral striatum and left insula in patients compared with controls. There were no group differences during the perception phase of agoraphobia-specific pictures.ConclusionsThis study revealed stronger region-specific activations in patients suffering from panic disorder with agoraphobia in anticipation of agoraphobia-specific stimuli. Patients seem to process these stimuli more intensively based on individual salience. Hyperactivation of the ventral striatum and insula when anticipating agoraphobia-specific situations might be a central neurofunctional correlate of agoraphobia. Knowledge about the neural correlates of anticipatory and perceptual processes regarding agoraphobic situations will help to optimize and evaluate treatments, such as exposure therapy, in patients with panic disorder and agoraphobia.

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Vos, S. P. F., M. J. H. Huibers, L. Diels, and A. Arntz. "A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia." Psychological Medicine 42, no. 12 (April 30, 2012): 2661–72. http://dx.doi.org/10.1017/s0033291712000876.

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BackgroundInterpersonal psychotherapy (IPT) seems to be as effective as cognitive behavioral therapy (CBT) in the treatment of major depression. Because the onset of panic attacks is often related to increased interpersonal life stress, IPT has the potential to also treat panic disorder. To date, a preliminary open trial yielded promising results but there have been no randomized controlled trials directly comparing CBT and IPT for panic disorder.MethodThis study aimed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia. Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were randomized. Primary outcomes were panic attack frequency and an idiosyncratic behavioral test. Secondary outcomes were panic and agoraphobia severity, panic-related cognitions, interpersonal functioning and general psychopathology. Measures were taken at 0, 3 and 4 months (baseline, end of treatment and follow-up).ResultsIntention-to-treat (ITT) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia. Per-protocol analyses emphasized the differences between treatments and yielded larger effect sizes. Reductions in the secondary outcomes were equal for both treatments, except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations, all of which decreased more in CBT.ConclusionsCBT is the preferred treatment for panic disorder with agoraphobia compared to IPT. Mechanisms of change should be investigated further, along with long-term outcomes.

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Pollard, C. Alec, and Gerald L. Cox. "Social-Evaluative Anxiety in Panic Disorder and Agoraphobia." Psychological Reports 62, no. 1 (February 1988): 323–26. http://dx.doi.org/10.2466/pr0.1988.62.1.323.

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18 agoraphobics with panic attacks had significantly higher scores on the Willoughby Personality Schedule, a measure of social-evaluative anxiety, than 18 matched patients with panic disorder. Results are compatible with the position that hypersensitivity to criticism is associated with and may contribute to the development of agoraphobia following panic attacks, but further research is needed.

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11

Richards, Jeffrey C., Vanessa Richardson, and Ciaran Pier. "The Relative Contributions of Negative Cognitions and Self-efficacy to Severity of Panic Attacks in Panic Disorder." Behaviour Change 19, no. 2 (June 1, 2002): 102–11. http://dx.doi.org/10.1375/bech.19.2.102.

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AbstractThe aim of this study was to determine the degree to which fearful and catastrophic cognitions, and self-efficacy for managing panic predicted various panic attack characteristics in panic disorder. The cognitive variables consisted of anxiety sensitivity, the frequency of fearful agoraphobic cognitions and measures of catastrophic misinterpretation of symptoms. The panic parameters were number and severity of panic symptoms, distress associated with panic attacks, worry about future panics, duration of panic disorder, and life interference due to panic disorder. These variables were measured in 40 people with panic disorder, 31 of whom also had significant agoraphobia. The frequency of fearful agoraphobic cognitions was the strongest predictor of panic attack symptomatology, predicting number of symptoms, symptom severity and degree of anticipatory fear of panic. Catastrophic misinterpretation of symptoms and anxiety sensitivity did not independently predict any panic parameters. Only self-efficacy for managing the rapid build-up of panic symptoms was specifically related to panic severity. The results therefore suggest that cognitive behaviour therapy for panic symptoms in panic disorder should reduce fearful cognitions rather than focus on panic coping strategies. The results offer little support for the contribution of the expectancy or catastrophic misinterpretation theories to the maintenance of panic disorder.

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12

FAVA, G. A., C. RAFANELLI, S. GRANDI, S. CONTI, C. RUINI, L. MANGELLI, and P. BELLUARDO. "Long-term outcome of panic disorder with agoraphobia treated by exposure." Psychological Medicine 31, no. 5 (July 2001): 891–98. http://dx.doi.org/10.1017/s0033291701003592.

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Background. There is a paucity of long-term outcome studies of panic disorder that exceed a 2-year follow-up. The aim of the study was to evaluate the long-term follow-up of patients with panic disorder with agoraphobia treated according to a standardized protocol.Methods. A consecutive series of 200 patients satisfying the DSM-IV criteria for panic disorder with agoraphobia was treated in an out-patient clinic with behavioural methods based on exposure homework. One hundred and thirty-six patients became panic free after 12 sessions of psychotherapy and 132 were available for follow-up. A 2- to 14-year (median = 8 years) follow-up was performed. Survival analysis was employed to characterize the clinical course of patients.Results. Thirty-one of the 132 patients (23%) had a relapse of panic disorder at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 93·1 after 2 years, 82·4 after 5 years, 78·8 after 7 years and 62·1 after 10 years. Such probabilities increased with younger age, and in the absence of a personality disorder, of high pre-treatment levels of depressed mood, of residual agoraphobic avoidance after exposure, and of concurrent use of benzodiazepines and antidepressant drugs.Conclusions. The findings suggest that exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

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13

Başoglu, Metin, Isaac M. Marks, Cengiz Kiliç, Richard P. Swinson, Homa Noshirvani, Klaus Kuch, and Geraldine O'Sullivan. "Relationship of Panic, Anticipatory Anxiety, Agoraphobia and Global Improvement in Panic Disorder with Agoraphobia Treated with Alprazolam and Exposure." British Journal of Psychiatry 164, no. 5 (May 1994): 647–52. http://dx.doi.org/10.1192/bjp.164.5.647.

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In a controlled trial of alprazolam and exposure in 154 patients with panic disorder with agoraphobia, relations between panic, anticipatory anxiety, and phobic avoidance were examined. The three symptoms were independent of one another at baseline and improved largely independently during treatment; only early improvement in avoidance predicted global improvement after treatment. Global improvement was more related to reduction of avoidance than a decrease in panics. Panic was not a valuable outcome measure in panic disorder with agoraphobia.

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Baldwin, DS. "Depression and panic: Comorbidity." European Psychiatry 13, S2 (1998): 65s—70s. http://dx.doi.org/10.1016/s0924-9338(98)80016-3.

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SummaryPanic disorder is a common condition. Epidemiological studies throughout the world consistently indicate that the lifetime prevalence of panic disorder (with or without agoraphobia) is between 1.5% and 3.5%. Panic disorder shows substantial comorbidity with other forms of mental illness. Major depressive disorder occurs in 50 to 65% of individuals with panic disorder and there is considerable cross-sectional and longitudinal comorbidity with recurrent brief depression and dysthymia. Phobic anxiety disorders, most notably social phobia and generalised anxiety disorder, commonly occur with panic disorder, especially in individuals with more severe agoraphobia. Approximately 35 to 50% of individuals with panic disorder in community settings also have agoraphobia. Panic disorder also shows significant comorbidity with physical illness. Compared with individuals without or with some other psychiatric diagnosis, patients with panic disorder have an increased risk of suffering from multiple medically unexplained symptoms and are associated with high use of medical services and increased mortality from both cardiovascular and cerebrovascular disease.

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Latas, Milan, Vladan Starcevic, and Goran Trajkovic. "Relationship of psychiatric comorbidity and treatment of panic disorder and agoraphobia." Srpski arhiv za celokupno lekarstvo 134, no. 7-8 (2006): 267–72. http://dx.doi.org/10.2298/sarh0608267l.

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Introduction. Besides numerous studies that examined various aspects of comorbidity in patients with panic disorder and agoraphobia and numerous studies that examined efficacy of different treatment modalities in these patients, there was no study that examined relationship of overall psychiatric comorbidity and treatment of patients with panic disorder and agoraphobia. Objective. The objective of the study was to establish the effect of psychiatric comorbidity on treatment efficiency of patients with panic disorder and agoraphobia. Method. The sample of the study consisted of 119 patients with primary diagnosis of panic disorder and agoraphobia. The therapy of patients was based on the use of individual integrative model of treatment, which incorporated psycho-pharmaceuticals (benzodiazepines and antidepressants) and cognitive- behavior therapy. Symptom severity was estimated by Panic and Agoraphobia Scale before and after the completion of treatment. Patients with comorbidity and patients without any comorbidity were compared by MANOVA and ANOVA with repeated measures. Results. The results of the study showed that 91% of patients met diagnostic criteria of comorbid psychiatric disorder and these patients had more severe clinical picture than patients without any comorbid disorder before the treatment. The results also showed that, after the completion of treatment, there was a significant reduction of all analyzed symptoms, that the effects of treatment were significantly better in patients with psychiatric comorbidity and that comorbid psychiatric disorders had no negative effect on the main goals of the treatment. Conclusion. Based on these results, it may be concluded that: in patients with panic disorder and agoraphobia and comorbid psychiatric disorders, the pharmacotherapy must be based on simultaneous use of antidepressants and benzodiazepines, while standard cognitive-behavior therapy of patients with panic disorder and agoraphobia must be modified in case of the existing comorbid psychiatric disorders.

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Başoǧlu, Metin, Isaac M. Marks, and Seda Şengün. "A Prospective Study of Panic and Anxiety in Agoraphobia with Panic Disorder." British Journal of Psychiatry 160, no. 1 (January 1992): 57–64. http://dx.doi.org/10.1192/bjp.160.1.57.

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The features of panic and anxiety in the natural environment were studied by prospective self-monitoring in 39 patients with chronic agoraphobia and panic disorder. Panics overlapped greatly with anxiety episodes but were more intense. Panics occurred more often in public places than did anxiety episodes, but had otherwise similar symptom profile, time of occurrence, and antecedents. Most panics surged out of a pre-existing plateau of tonic anxiety which lasted most of the day. Spontaneous panics were less frequent than situational panics and occurred more often at home but were otherwise similar. These findings do not support the sharp distinction between panic and anxiety in DSM–III–R, not its emphasis on spontaneous panic in classifying anxiety disorders. Thoughts of dying and ‘going crazy’/losing control accompanied only a minority of panic/anxiety episodes and seemed to be a product of intense panic rather than a cause.

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Rogers, Malcolm P., Kerrin White, Meredith G. Warshaw, Kimberly A. Yonkers, Fernando Rodriguez-Villa, Grace Chang, and Martin B. Keller. "Prevalence of Medical Illness in Patients with Anxiety Disorders." International Journal of Psychiatry in Medicine 24, no. 1 (March 1994): 83–96. http://dx.doi.org/10.2190/txm9-evx8-q4wt-g03j.

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Objective: This investigation examines the prevalence and characteristics of medical illness in 711 patients enrolled in the Harvard/Brown Anxiety Disorders Research Program (HARP), a multi-center, longitudinal study of anxiety disorders. Method: Elligible subjects were those with present or past index anxiety disorders: panic disorder without agoraphobia, panic disorder with agoraphobia, agoraphobia without panic disorder, social phobia, or generalized anxiety disorder. They were assessed by trained raters using structured diagnostic interviews and the Medical History Form II. Results: Patients with panic disorder and co-morbid major depressive disorder had significantly higher rates of reported medical illness than anxiety disorder patients without depression. When the rates of medical illness for all subjects were compared with those from the Rand Health Insurance Experiment, we found the prevalence of several medical problems to be disproportionately increased. Conclusions: Although our results are preliminary, it appears that patients with panic disorder have more reported medical problems than the public at large, in particular, more ulcer disease, angina, and thyroid disease. Somatic complaints in patients with panic disorder, therefore, need to be carefully considered.

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18

Crowe, Raymond R., and Russel Noyes. "Panic disorder and agoraphobia." Disease-a-Month 32, no. 7 (July 1986): 389–444. http://dx.doi.org/10.1016/s0011-5029(86)80010-4.

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Klein, Donald F. "Panic disorder with agoraphobia." British Journal of Psychiatry 163, no. 6 (December 1993): 835–36. http://dx.doi.org/10.1192/bjp.163.6.835a.

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Schmidt, Norman B., Aaron M. Norr, and Kristina J. Korte. "Panic Disorder and Agoraphobia." Research on Social Work Practice 24, no. 1 (January 27, 2013): 57–66. http://dx.doi.org/10.1177/1049731512474490.

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21

Ferentz, Kevin Scott. "Panic disorder and agoraphobia." Postgraduate Medicine 88, no. 2 (August 1990): 185–92. http://dx.doi.org/10.1080/00325481.1990.11704708.

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Wesner, Robert. "Panic Disorder and Agoraphobia." Primary Care: Clinics in Office Practice 14, no. 4 (December 1987): 649–56. http://dx.doi.org/10.1016/s0095-4543(21)01035-6.

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Berle, David, Vladan Starcevic, Denise Milicevic, Anthony Hannan, and Karen Moses. "Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?" Behavioural and Cognitive Psychotherapy 38, no. 3 (March 26, 2010): 275–89. http://dx.doi.org/10.1017/s135246581000007x.

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Background: There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. Aims: We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. Method: The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Results: Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. Conclusions: These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

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Bienvenu, O. Joseph, Chiadi U. Onyike, Murray B. Stein, Li-Shiun Chen, Jack Samuels, Gerald Nestadt, and William W. Eaton. "Agoraphobia in adults: Incidence and longitudinal relationship with panic." British Journal of Psychiatry 188, no. 5 (May 2006): 432–38. http://dx.doi.org/10.1192/bjp.bp.105.010827.

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BackgroundTheories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data.AimsTo determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort.MethodA sample of 1920 adults in east Baltimore were assessed in 1981 -1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS). Psychiatristdiagnoses were made in a subset of the sample at follow-up (n=816).ResultsForty-one new cases of DIS/DSM–III–R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM-III panic disorder predicted first incidence of agoraphobia (OR=12, 95% CI 3.2-45), as did younger age, female gender and other phobias. Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI 1.8-8.4). Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3–180; agoraphobia before panic OR=16, 95% CI 3.2–78).ConclusionsThe implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM–IV appears incorrect.

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Teggi, R., D. Caldirola, B. Colombo, G. Perna, G. Comi, L. Bellodi, and M. Bussi. "Dizziness, migrainous vertigo and psychiatric disorders." Journal of Laryngology & Otology 124, no. 3 (December 3, 2009): 285–90. http://dx.doi.org/10.1017/s0022215109991976.

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AbstractObjectives:This study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.Study design:Retrospective study.Setting:Out-patients in a university hospital.Materials and methods:Fifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.Results:Dizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).Conclusions:Our data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.

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Ito, L. M., L. A. De Araujo, V. L. C. Tess, T. P. De Barros-Neto, F. R. Asbahr, and I. Marks. "Self-exposure therapy for panic disorder with agoraphobia." British Journal of Psychiatry 178, no. 4 (April 2001): 331–36. http://dx.doi.org/10.1192/bjp.178.4.331.

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BackgroundExposure to external phobic cues is an effective therapy for panic/agoraphobia but the value of exposure to interoceptive cues is unclear.AimsRandomised controlled comparison in panic/agoraphobia of the effects of (a) external, (b) interoceptive or (c) combined external and interoceptive self-exposure to (d) control subjects.MethodEighty out-patients were randomised to a control group or to one of three forms of self-exposure treatment (external, interoceptive, or combined). Each treatment included seven sessions over 10 weeks and daily self-exposure homework. Assessments were at pre- and post-treatment and up to 1 year post-entry. Assessors remained blind during treatment.ResultsThe three self-exposure groups improved significantly and similarly at post-treatment and up to 1-year follow-up, and significantly more than did the control subjects. Rates of improvement on main outcome measures averaged 60% at post-treatment and 77% at follow-up.ConclusionsThe three methods of self-exposure were equally effective in reducing panic and agoraphobic symptoms in the short- and long-term.

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Hoffart, Asle, Ann Hackmann, and Harold Sexton. "Interpersonal Fears among Patients with Panic Disorder with Agoraphobia." Behavioural and Cognitive Psychotherapy 34, no. 3 (May 2, 2006): 359–63. http://dx.doi.org/10.1017/s1352465806002980.

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To study the role of catastrophic interpersonal cognitions in panic disorder with or without agoraphobia, a questionnaire listing such items – the Interpersonal Panic Fear Questionnaire (IPFQ) – was constructed and administered to English and Norwegian samples. The results of the factor analysis indicated a three-factor structure of interpersonal fears: fear of negative evaluation, fear of being trapped and separated from safe persons and places, and fear of being neglected. The corresponding three IPFQ scales had satisfactory internal consistency and sensitivity to change following therapeutic intervention, discriminated well between diagnostic groups, and correlated moderately with measures of other dimensions of panic disorder and agoraphobia. The construct validity of the interpersonal fears was further supported by mostly significant relationships between the IPFQ scales and a measure of agoraphobic avoidance, when the contribution of intrapersonal (physical, loss of control) fears was controlled.

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Pavlichenko, A. "Clinical staging in panic disorder and agoraphobia." European Psychiatry 33, S1 (March 2016): S326. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1127.

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There is an increasing literature about the implementation of the staging model in many mental disorders. According to this approach, there are four stages of a psychiatric disorder: prodromal stage, acute manifestations, residual phase, chronic. In this study, we empirically investigate whether additional clinical variables such as clinical manifestations and comorbid disorders may be useful to modify the staging model to panic disorder (PD).We distinguished inpatient sample (n = 79) with a diagnosis of “panic disorder” according to the DSM-IV criteria. We propose that the inclusion of prodromal stage of PD does not make clinical sense since the different unspecific neurotic symptoms may proceed to a variety of anxiety and depressive disorders. First stage was characterized by the situationally predisposed panic attacks (PA) with both somatic and cognitive symptoms. Comorbid disorders included somatoform disorders and generalized anxiety disorder (GAD). During second stage individuals experienced agoraphobic avoidance until traveling in public transport. On the other hand, spontaneous PA were accompanied by the only somatic but not cognitive symptoms. The most common patterns of comorbidity were GAD and alcohol misuse. Third stage was associated with the absence or limited symptom attacks and chronic agoraphobia. Major depression and obsessive-compulsive disorder might be an integral part of the clinical manifestations. This study supports that the staging model in PD might be updated by the detailed description of clinical manifestations and comorbid disorders at each stage that may help the practitioners to choose the best strategy for the treatment of a particular patient.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Tweed, J. Lindsey, Victor J. Schoenbach, Linda K. George, and Dan G. Blazer. "The Effects of Childhood Parental Death and Divorce on Six-Month History of Anxiety Disorders." British Journal of Psychiatry 154, no. 6 (June 1989): 823–28. http://dx.doi.org/10.1192/bjp.154.6.823.

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Duke Epidemiologic Catchment Area (ECA) data were used to examine the relationships between: (a) early childhood maternal death, paternal death, and parental separation/divorce, and (b) six-month DIS/DSM-III diagnoses of agoraphobia with and without panic attacks, simple phobia, social phobia, panic disorder, generalised anxiety disorder, and obsessive-compulsive disorder. Associations were found between: (a) maternal death and agoraphobia with panic attacks, and (b) parental separation/divorce and agoraphobia with panic attacks and panic disorder. The associations could not be explained by the effects of potentially confounding socio-demographic factors.

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Berle, David, Vladan Starcevic, Anthony Hannan, Denise Milicevic, Claire Lamplugh, and Pauline Fenech. "Cognitive factors in panic disorder, agoraphobic avoidance and agoraphobia." Behaviour Research and Therapy 46, no. 2 (February 2008): 282–91. http://dx.doi.org/10.1016/j.brat.2007.12.002.

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Preti, Antonio, Martina Piras, Giulia Cossu, Elisa Pintus, Mirra Pintus, Goce Kalcev, Federico Cabras, et al. "The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy." Psychiatry Investigation 18, no. 4 (April 25, 2021): 277–83. http://dx.doi.org/10.30773/pi.2020.0342.

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Objective Current nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL).Methods Community survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL.Results In the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5–2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9–24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00.Conclusion One out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.

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Skapinakis, P., G. Lewis, S. Davies, T. Brugha, M. Prince, and N. Singleton. "Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation." European Psychiatry 26, no. 6 (September 2011): 354–62. http://dx.doi.org/10.1016/j.eurpsy.2010.06.004.

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AbstractObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.

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LONDON, ROBERT T. "Treating Panic Disorder and Agoraphobia." Clinical Psychiatry News 33, no. 8 (August 2005): 22. http://dx.doi.org/10.1016/s0270-6644(05)70582-8.

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HUMBLE, M., and B. WISTEDT. "Serotonin, Panic Disorder and Agoraphobia." International Clinical Psychopharmacology 6 (June 1992): 21–40. http://dx.doi.org/10.1097/00004850-199206005-00003.

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LUNDY, MICHAEL S. "Childhood Panic Disorder With Agoraphobia." American Journal of Psychiatry 147, no. 3 (March 1990): 376—a—377. http://dx.doi.org/10.1176/ajp.147.3.376-a.

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Fišeković, Saida, and Svjetlana Loga-Zec. "Sertraline and Alprazolam in the Treatment of Panic Disorder." Bosnian Journal of Basic Medical Sciences 5, no. 2 (May 20, 2005): 78–81. http://dx.doi.org/10.17305/bjbms.2005.3292.

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A compared, 12 week, placebo controlled study, with fixed dose, outpatient study of patients diagnosed with panic disorder with and without agoraphobia according to ICD-10, was conducted to evaluate the efficacy and safety of sertraline and alprazolam. The study included 40 patients, divided in two groups. We evaluated number of ICD-10-defined panic attacks, agoraphobia and anticipatory anxiety. All patients were aged 18 year and older and were randomized to either sertraline or alprazolam. Sertraline applied in fixed doses of 20 mg/day and alprazolam in doses 1-1,5 mg/day significantly reduced the frequency of panic attacks in panic disorder patients, reduced symptoms of agoraphobia and anticipatory anxiety

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Middeldorp, Christel M., Andrew J. Birley, Danielle C. Cath, Nathan A. Gillespie, Gonneke Willemsen, Dixie J. Statham, Eco J. C. de Geus, et al. "Familial Clustering of Major Depression and Anxiety Disorders in Australian and Dutch Twins and Siblings." Twin Research and Human Genetics 8, no. 6 (December 1, 2005): 609–15. http://dx.doi.org/10.1375/twin.8.6.609.

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AbstractThe aim of this study was to investigate familial influences and their dependence on sex for panic disorder and/or agoraphobia, social phobia, generalized anxiety disorder and major depression. Data from Australian (N = 2287) and Dutch (N = 1185) twins and siblings who were selected for a linkage study and participated in clinical interviews to obtain lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnoses were used. In a liability model, tetrachoric correlations were estimated in sibling pairs and sex differences between sibling correlations were tested. For each diagnosis, the sibling correlations could be constrained to be equal across the Australian and Dutch samples. With the exception of panic disorder and/or agoraphobia, all sibling correlations were the same for brother, sister and opposite-sex sibling pairs and were around .20. For panic disorder and/or agoraphobia, the correlation was .23 in brother and sister pairs, but absent in opposite-sex sibling pairs. From these results it can be concluded that upper heritability estimates, based on twice the correlations in the sibling pairs, vary between 36% (major depression) and 50% (social phobia). Furthermore, different genetic risk factors appear to contribute to the vulnerability for panic disorder and/or agoraphobia in men and women. No other sex differences were found.

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Fava, Giovanni A., Maria Zielezny, Gianni Savron, and Silvana Grandi. "Long-Term Effects of Behavioural Treatment for Panic Disorder with Agoraphobia." British Journal of Psychiatry 166, no. 1 (January 1995): 87–92. http://dx.doi.org/10.1192/bjp.166.1.87.

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BackgroundThere are few long-term follow-up studies of panic disorder treatments, particularly when patients have been treated by behavioural methods only and have recovered.Method110 consecutive patients satisfying the DSM–III–R criteria for panic disorder with agoraphobia were treated in an out-patient clinic with behavioural methods based on exposure. After 12 sessions of psychotherapy, 81 patients became panic-free. A 2–9 year follow-up was available. Survival analysis was employed to characterise the clinical course of patients. Regular assessments by a clinical psychologist were based on the Clinical Interview for Depression.ResultsThe estimated cumulative percentage of patients remaining in remission was 96.1% for at least two years, 77.6% for at least five years, and 67.4% for at least seven years. These outcomes greatly improved in the absence of a personality disorder or residual agoraphobia after treatment.ConclusionsThe findings suggest that, even though one patient in four is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting relief for the majority of patients. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

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Bhagwagar, Hvovi. "EMDR in the Treatment of Panic Disorder With Agoraphobia: A Case Description." Journal of EMDR Practice and Research 10, no. 4 (2016): 256–74. http://dx.doi.org/10.1891/1933-3196.10.4.256.

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The results of preliminary research investigating the application of eye movement desensitization and reprocessing (EMDR) treatment in panic disorder and panic disorder with agoraphobia suggests that reprocessing of past traumas produces significant reduction of anxiety and consequently, remission from panic attacks and avoidance behavior. This article describes the case study of a 30-year-old working professional where EMDR treatment, used to target early childhood traumas, led to reduction in symptoms of panic disorder with agoraphobia. Panic attacks diminished after 17 sessions of EMDR treatment, which followed Leeds’s treatment model. Treatment gains were maintained 5 years after termination. The study shows the value of solid preparation work, and of addressing the current triggers and recent events, before targeting historical traumas. EMDR worked as a first-line treatment to resolving the roots of the panic attacks, suggesting that the resolution of traumatic childhood memories can make a significant difference to current symptoms of panic disorder with agoraphobia.

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Oei, Tian P. S., Peter R. Gross, and Larry Evans. "Phobic Disorders and Anxiety States: How do they Differ??" Australian & New Zealand Journal of Psychiatry 23, no. 1 (March 1989): 81–88. http://dx.doi.org/10.3109/00048678909062596.

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A review of the clinical literature to date has shown that the nature of the relationship between phobic disorders and anxiety states is still unclear. As a wide range of symptoms are shared by patients with all DSM-III anxiety disorder diagnoses, at this stage there is still a need to investigate the latent dimensions which distinguish the anxiety disorder subtypes. In the present study 176 patients with the DSM-III diagnoses of agoraphobia with panic attacks, social phobia, panic disorder and generalized anxiety disorder completed the Fear Survey Schedule, Fear Questionnaire, Hostility and Direction of Hostility Questionnaire, Maudsley Personality Inventory, and the Hamilton Anxiety and Depression Scales. Group membership was significantly predicted by a discriminant analysis which yielded a Fear Questionnaire agoraphobia function and a social phobia function. the results from discriminant analysis suggests that agoraphobia and anxiety states may be closely related. Classification errors were also determined, providing further evidence with which to refute the claim that agoraphobia has “all or none” characteristics.

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Kasper, L. Pezawas, S. "Paroxetine in panic disorder with agoraphobia." International Journal of Psychiatry in Clinical Practice 5, no. 4 (January 2001): 279–81. http://dx.doi.org/10.1080/13651500152732630.

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Lteif, Ghada N., and Matig R. Mavissakalian. "Life events and panic disorder/ agoraphobia." Comprehensive Psychiatry 36, no. 2 (March 1995): 118–22. http://dx.doi.org/10.1016/s0010-440x(95)90106-x.

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Vgontzas, Alexandros N., Joyce D. Kales, James O. Ballard, Antonio Vela-Bueno, and Tjiauw-Ling Tan. "Porphyria and Panic Disorder With Agoraphobia." Psychosomatics 34, no. 5 (September 1993): 440–43. http://dx.doi.org/10.1016/s0033-3182(93)71848-4.

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Chambless, Dianne L. "Update on panic disorder and agoraphobia." Current Opinion in Psychiatry 3, no. 6 (1990): 790–94. http://dx.doi.org/10.1097/00001504-199012000-00015.

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Chambless, Dianne L. "Update on panic disorder and agoraphobia." Current Opinion in Pediatrics 3, no. 6 (December 1990): 790–94. http://dx.doi.org/10.1097/00008480-199012000-00015.

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Hedley, Liv Margaret, and Asle Hoffart. "Agoraphobia without history of panic disorder." Clinical Psychology & Psychotherapy 8, no. 6 (2001): 436–43. http://dx.doi.org/10.1002/cpp.295.

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Swinson, Richard P., and Klaus Kuch. "Behavioural Psychotherapy of Agoraphobia/Panic Disorder." International Review of Psychiatry 1, no. 3 (January 1989): 195–205. http://dx.doi.org/10.3109/09540268909110410.

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Hoffart, Asle, Liv M. Hedley, Karol Svanøe, Tomas Formo Langkaas, and Harold Sexton. "Agoraphobia With and Without Panic Disorder." Journal of Nervous and Mental Disease 204, no. 2 (February 2016): 100–107. http://dx.doi.org/10.1097/nmd.0000000000000419.

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Lydiard, R. Bruce, and James C. Ballenger. "Antidepressants in panic disorder and agoraphobia." Journal of Affective Disorders 13, no. 2 (September 1987): 153–68. http://dx.doi.org/10.1016/0165-0327(87)90020-6.

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Sheehan, David V. "Benzodiazepines in panic disorder and agoraphobia." Journal of Affective Disorders 13, no. 2 (September 1987): 169–81. http://dx.doi.org/10.1016/0165-0327(87)90021-8.

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