Clinical implications of agoraphobia in patients with panic disorder

Shin, Jin Young; Park, Doo‐Heum; Ryu, Seung‐Ho; Ha, Jee Hyun; Kim, Seol Min; Jeon, Hong Jun

doi:10.1097/md.0000000000021414

Cited by 9 publications

(7 citation statements)

References 38 publications

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“…PD patients with comorbid agoraphobia were more likely to emerge serious anxiety symptom and avoidance behavior, and agoraphobia was considered to result from recurrent panic attacks ( 54 ). A recent study also showed that patients with PDA (panic disorder with agoraphobia) had severer anxiety symptom and higher anxiety trait than those with PD alone ( 55 ). PDA patients were reported greater self-criticism and fatalism ( 56 ) and higher severity of fear of bodily sensation ( 57 ) than those with PD alone.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Among BDNF Val66Met Polymorphism, Plasma BDNF Level, and Trait Anxiety in Chinese Patients With Panic Disorder

et al. 2022

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BackgroundBrain-derived neurotrophic factor (BDNF) is a candidate for susceptibility locus of Panic disorder (PD). However, the findings about the role of the BDNF Val66Met variant in PD were not consistent. Till now, the relationship between BDNF Val66Met polymorphism and anxiety-related traits in PD patients has been rarely explored. This study aimed to explore the relationship among BDNF Val66Met polymorphism, plasma BDNF level and anxiety-related trait in Chinese PD patients.MethodThis multi-center study included 116 PD patients and 99 health controls. We detected single-nucleotide polymorphism (SNP) of BDNF rs6265 (Val66Met) and BDNF plasma level in the two groups. In addition, PD patients were administered the State-Trait Anxiety Inventory (STAI), Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and Hamilton Anxiety Rating Scale (HAMA-14). Quantitative comparison of the differences of BDNF concentration among subjects with different genotypes and association between BDNF Val66Met genotype and trait anxiety were performed.ResultsThere were no significant differences in the genotype frequency (p = 0.79) or allele frequency (p = 0.88) between PD patients and health controls. BDNF plasma levels of PD patients were significantly lower than those in control group (p = 0.003). BDNF plasma levels of the Met/Met genotype were significantly lower than those of Val/Met genotype in PD patients (p = 0.033). PD patients carried Met/Met genotype showed significantly higher scores in STAI trait compared to those carried Val/Val genotype (p = 0.045) and Val/Met genotype (p = 0.018). STAI trait scores of PD patients with agoraphobia were significantly higher than those of patients without agoraphobia (p < 0.05). The ANCOVA showed that the dependent variable STAI trait score was significantly affected by factor “genotype” (Val/Val, Val/Met, Met/Met, p = 0.029), and covariate “agoraphobia” (p = 0.008). In this model, 11.5% of the variance of the STAI trait score was explained by the BDNF genotype. Contrast analysis showed STAI trait scores of Met/Met subjects were significantly higher than those of Val/Met (p = 0.018) and Val/Val individuals (p = 0.045).ConclusionWe found that anxiety trait was associated with the BDNF polymorphism in PD patients. BDNF Met/Met genotype may decrease plasma BDNF level and increase trait anxiety in panic disorder.

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Section: Discussionmentioning

confidence: 99%

The Relationship Among BDNF Val66Met Polymorphism, Plasma BDNF Level, and Trait Anxiety in Chinese Patients With Panic Disorder

et al. 2022

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“…This finding is consistent with prior studies, which demonstrated that clinical characteristics worsen when agoraphobia and PD are comorbid. 6 40 However, some points should be considered when interpreting KSCL95 findings: because KSCL95 comprehensively evaluates various psychiatric symptoms through a single self-report questionnaire (multidimensional instrument), it is necessary to exercise caution in determining which specific features show a significant group difference. 41 Further studies using individual scales for each feature are needed to validate the current findings.…”

Section: Discussionmentioning

confidence: 99%

“…1 More than half of diagnosed PD cases are accompanied by agoraphobia 2 3 : a fear of open or crowded situations, such as public transportation, due to the possibility of experiencing panic-like symptoms with no options for receiving help or escaping. 1 Compared with patients with PD alone, patients with PD and comorbid agoraphobia show an extended illness duration, 4 more frequent comorbidities, 5 more severe panic attacks, and higher levels of emotional symptoms, including depression, 6 indicating that PD with comorbid agoraphobia has a more severe clinical presentation than PD alone.…”

Section: Introductionmentioning

confidence: 99%

Altered Low Frequency Heart Rate Variability Associated with Agoraphobia in Panic Disorder: A Retrospective Study

Kim,

Park

et al. 2023

Yonsei Med J

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Purpose This study aimed to compare the clinical features of panic disorder (PD) with comorbid agoraphobia to those of PD alone. We focused on autonomic nervous system (ANS) alterations reflected in heart rate variability (HRV) and executive function deficits reflected in the Stroop test. Materials and Methods We retrospectively compared psychometric features, Stroop test results, and resting-state HRV across three groups: a subclinical group with anxiety attack history, a PD group without agoraphobia, and a PD group with agoraphobia. The subclinical group included 10 male and 34 female, the PD without agoraphobia group included 17 male and 19 female, and the PD with agoraphobia group included 11 male and 18 female. Results The PD with agoraphobia group had higher Symptom Checklist–95 scores than the other groups. Both PD groups had longer reaction times in the Stroop test than the subclinical group. There were no significant differences in HRV parameters between the PD groups with and without agoraphobia. Compared with the subclinical group, the PD with agoraphobia group showed significantly lower values of the natural logarithm of low-frequency HRV. Conclusion Our results do not support that executive function deficits and ANS alterations are more pronounced with comorbid agoraphobia among PD groups. However, PD with agoraphobia patients showed more complex and severe clinical symptoms in their self-reports. Compared with the subclinical group, PD patients with agoraphobia showed specific features in the natural logarithm of low-frequency HRV. Our findings suggest that agoraphobia comorbidity should be considered when evaluating or treating patients with PD.

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“…Agoraphobia, which can be diagnosed alone but is typically accompanied by panic disorder, is a clinical condition associated with poor prognosis in the treatment of panic disorder. 48 Comorbid bipolar disorder is also regarded as a poor prognostic factor for the treatment of panic disorder. 49 In the three cases above, two patients (cases 1 and 3) had suffered panic disorder with agoraphobia for a long period of time, and none of the patients responded to two or three consecutive trials of pharmacotherapy, including quetiapine combined with valproate (cases 1 and 2) and quetiapine combined with lithium (case 3).…”

Section: Discussionmentioning

confidence: 99%

Valproate Adjuvant Cognitive Behavioral Therapy in Panic Disorder Patients With Comorbid Bipolar Disorder: Case Series and Review of the Literature

Choi

2022

Psychiatry Investig

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Anxiety disorders are the most common comorbid psychiatric disorders in patients with bipolar disorder. Managing anxiety symptoms in comorbid conditions is challenging and has received little research interest. The findings from preclinical research on fear conditioning, an animal model of anxiety disorder, have suggested that memory reconsolidation updating (exposure-based therapy) combined with valproate might facilitate the amelioration of fear memories. Here, three cases of successful amelioration of agoraphobia and panic symptoms through valproate adjuvant therapy for cognitive behavioral therapy in patients who failed to respond to two to three consecutive standard pharmacotherapy trials over several years are described. To the best of the author’s knowledge, this is the first attempt to combine CBT with valproate in patients with panic disorder, agoraphobia, and comorbid bipolar disorder. Additionally, the background preclinical research on this combination therapy based on the reconsolidation-updating mechanism, the inhibition of histone deacetylase 2, and critical period reopening, off-label use of valproate in panic disorder, plasticity-augmented psychotherapy, and how to combine valproate with CBT is discussed.

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Clinical implications of agoraphobia in patients with panic disorder

Cited by 9 publications

References 38 publications

The Relationship Among BDNF Val66Met Polymorphism, Plasma BDNF Level, and Trait Anxiety in Chinese Patients With Panic Disorder

The Relationship Among BDNF Val66Met Polymorphism, Plasma BDNF Level, and Trait Anxiety in Chinese Patients With Panic Disorder

Altered Low Frequency Heart Rate Variability Associated with Agoraphobia in Panic Disorder: A Retrospective Study

Valproate Adjuvant Cognitive Behavioral Therapy in Panic Disorder Patients With Comorbid Bipolar Disorder: Case Series and Review of the Literature

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