Panic disorder in the families of patients with normal coronary arteries and non-fear panic disorder.

Patients with non-fear panic disorder (NFPD) meet DSM-III-R criteria for panic disorder, but do not report subjective fear or anxiety. Although apparently common in medical settings, this controversial group is in need of further diagnostic validation. This study assessed family history of panic disorder in patients with chest pain and normal coronary arteries (CP/NCA) and either NFPD, panic disorder with fear, or no panic. It was hypothesized that the two panic disorder groups would have similar, elevated rates of panic disorder in their first-degree relatives, compared to patients without panic. The results support the hypothesis; about 17% of the first-degree relatives of both NFPD and panic disorder patients were diagnosable with panic disorder according to proband interviews, whereas only 4.6% of the first-degree relatives of patients without panic were so diagnosable. These results support the diagnostic validity of NFPD in CP/NCA patients, because such patients had a family history of panic disorder similar to patients with a more classical panic disorder presentation. The lack of fear symptoms and behavior in NFPD may cause panic disorder to be overlooked as a potential cause of somatic symptoms in patients with no medical explanation for their condition.     

The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder

The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS determined by the so-called hyperventilation provocation test (a brief period of voluntary hyperventilation with recognition of symptoms). The overlap rates with HVS were: 48% for panic disorder, 83% for panic disorder with agoraphobia and 82% for generalized anxiety disorder. However, a pilot study on transcutaneous monitoring of carbon dioxide tension leads us to question the validity of the voluntary hyperventilation method that we used to determine HVS-status. It is unclear whether hyperventilation plays an important role in panic and general anxiety, as our overlap findings suggest. For patients who recognize the symptoms induced by voluntary hyperventilation, the hyperventilation provocation procedure provides a therapeutic means of exposure to feared bodily sensations.     

Culture,personality, and reactions to praise and criticism1

An empirical study was designed to investigate the effects of personality and sociocultural background on reactions to positive and negative performance feedback. Eighty college students of two sociocultural backgrounds (Mexican- and Anglo-American) were asked to work on a three-dimensional jigsaw puzzle and were then either praised or criticized, ostensibly according to their “problem-solving strategies,” but actually on the basis of random assignment to either condition. Seven dependent variables were included, representing various reactions to the feedback. Four-way analyses of variance were conducted on each dependent measure with the independent variables being type of feedback, locus of control, sex of subject, and ethnicity. In addition to consistent main effects for feedback, the results revealed that reactions to feedback, particularly criticism, are often mediated by personality and/or sociocultural factors. The findings are discussed in relation to previous literature and the need to take a sociocultural perspective in psychological research is emphasized.     

从社会文化的视角看健康与教育的阶层差异

如何缩小健康和教育的阶层差异, 促进社会公平是世界各国普遍关心的社会问题。已有的社会阶层心理研究取向中, 社会文化视角从不同阶层的文化所塑造的不同自我出发, 提出了解释社会阶层生产和再生产的文化循环理论和提升低阶层社会适应水平的差异教育方法, 这些理论观点为教育与健康的阶层差异提供了超越个体或环境任何单一因素的系统解释, 并提供了着眼于社会心理重塑的干预方案以减少健康和教育的不平等。未来社会文化视角的研究和实践工作的可能方向包括理论和干预实践的中国化, 与其他社会阶层理论和社会公正视角相结合, 以及考察社会流动与文化变迁背景的影响。     

Brain hemispheric organization, anxiety, and psychoses

Abnormalities of brain hemispheric organization have been found in a variety of psychiatric disorders. Despite the great amount of data collected and the number of theoretical models elaborated, the role of these abnormalities in the pathogenesis of these disorders remains controversial. This article briefly reviews current concepts of hemispheric functioning, discusses the role of abnormalities of brain hemispheric organization in schizophrenia and in two anxiety disorders (panic disorder and obsessive-compulsive disorder), and outlines a developmental perspective that accounts for the observed abnormalities.     

Panic and posttraumatic stress disorder: implications for culture, risk, and treatment

The articles in this special series reflect productive cross-fertilization between the fields of panic disorder and posttraumatic stress disorder. The purpose of this commentary is to elucidate the implications of this research for the broader themes of culture, risk factors, and treatment.     

Cognitive abilities, sociocultural background and academic achievement

The influence of students' sociocultural background on academic achievement is a well established fact. Research also points out that sociocultural background is related to students' cognitive abilities and these have an effect on their academic achievement. However, the mediator role of cognitive abilities on the relationship between sociocultural background and academic achievement is less well known. A structural equation model that represents these relationships was tested in a sample (N= 728) of Portuguese junior high school students. Multigroup analysis of the model showed the importance of the cognitive ability mediation effect between sociocultural background and academic achievement in the 7th and 9th grades, but not in the 8th grade. This difference may be the result of the academic transition experienced in the 7th and 9th grades in the Portuguese educational system, which requires parents' higher involvement in school.     

The reliability and validity of the panic disorder self-report: a new diagnostic screening measure of panic disorder

This study examined the Panic Disorder Self-Report (PDSR), a new self-report diagnostic measure of panic disorder based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). PDSR diagnoses were compared with structured interview diagnoses of individuals with generalized anxiety disorder, social phobia, and panic disorder and nonanxious controls. Receiver operating characteristic analyses revealed that the PDSR showed 100% specificity and 89% sensitivity. The PDSR also demonstrated retest reliability, convergent and discriminant validity, and kappa agreement of .93 with a structured interview. Finally, the PDSR demonstrated clinical validity. Students who were identified as having panic disorder using the PDSR did not have significantly different scores on the Panic Disorder Severity Scale--Self-Report form (P. R. Houck, D. A. Speigel, M. K. Shear, & P. Rucci, 2002) than a panic disordered community sample. However, both groups had significantly higher scores than students identified as not meeting criteria for panic disorder.     

A Study of Panic Attacks in University Students of Iran

This study examined the parameters of panic, fear, and avoidance among university students in Iran. Data were collected from 347 students using Farsi translations of the Panic Attack Questionnaire, Beck Depression Inventory, Taylor Manifest Anxiety Scale, State-Trait Anxiety Inventory, and Anxiety Sensitivity Index. Thirty-eight percent of participants reported panic attacks in the past year and 21.4% reported panic attacks in the past 4 weeks when prompted by a broad definition of panic. Men and those with unexpected panic reported greater panic severity whereas women with panic attacks reported greater situational fear and avoidance. Panickers who satisfied DSM-III-R panic disorder (PD) criteria reported greater lifestyle restriction and general psychopathology. The findings provide tentative support for cross-cultural similarity in panic phenomenology and the validity of DSM-III-R PD criteria among university students in Iran. The results are discussed by reference to nonclinical panic research and general themes of Iranian culture.     

Social anxiety and fear of bodily sensations in panic disorder and agoraphobia: A matched comparison

This study tests the hypothesis that social anxiety and fear of bodily sensations are associated with the development of agoraphobic avoidance behavior in panic disorder patients. Twenty patients with panic disorder were compared to 20 patients with panic disorder with agoraphobia, matched by sex and duration of disorder. The two groups did not differ on measures of fear and frequency of assertive social responses. However, the agoraphobics scored higher on measures of interpersonal sensitivity, depression, feelings of inadequacy, and hostility. They also reported higher fear of bodily sensations. Although definitive conclusions need to be postponed until prospective studies have been conducted, there is evidence suggesting that the development of agoraphobia in panic patients is associated with hypersensitivity to bodily sensations and interpersonal situations.This research was supported by Grant 560-268-009 of the Dutch Organization for Scientific Research.     

Family Transitions and Developmental Processes in Panic-Disordered Patients

Although there is increasing evidence for a familial role in panic disorder, little research exists on the family interaction patterns and relational stressors that may contribute to this disorder. Using DSM-III-R criteria, 52 families were classified into Panic Disorder, Major Depressive Disorder, and Nonclinical Control groups. A semi-structured interview and self-report measures were then used to examine family processes. MANOVA results were highly significant, suggesting that, compared to depressed and nonclinical control families, panic-disordered families had unresolved life-cycle issues, were enmeshed, used triangulation, and failed to resolve conflicts. These findings suggest that dysfunctional family processes may be involved in the expression and maintenance of panic disorder.     

Sociocultural theories,academic achievement,and African American adolescents in a multicultural context: a review of the cultural incompatibility perspective

Some theories have posited that African American youth are academic underachievers because of sociocultural factors. We label this point of view the cultural incompatibility perspective. Ogbu’s oppositional culture theory and Steele’s stereotype threat theory are selected as popular examples of this viewpoint. A critical review of the literature on these particular theories was conducted. It was concluded that there is limited empirical support for the cultural incompatibility perspective on African American academic achievement. This raises questions about the focus on academic underachievement among African Americans versus high achievement among other ethnic/racial groups. Implications of the empirical findings on the incompatibility perspective for the role of African American culture in Black student achievement are discussed.     

Panic-Related fears in persons reporting a family history of panic disorder

Abstract We administered the Body Sensations Questionnaire, Health Hardiness Index, Panic Attack Questionnaire, and the Symptom Checklist 90-R to college students (n=71) who either reported or did not report a family history of panic disorder. Participants who reported a family history of panic disorder reported significantly less perceived control over their health status, a greater fear of bodily arousal, and greater frequency of unexpected panic attacks compared to participants without such a history, although no significant group differences were detected for Symptom Checklist-90-R scales that measure negative emotional experiences. After controlling for personal history of panic, differences between the positive family history group remained only for the control over health measure. We discuss the results as preliminary evidence that certain cognitive responses are overrepresented in self-classified first-degree relatives of persons with panic disorder.     

Cognitive-behavioral therapy for panic disorder: a review of treatment elements,strategies, and outcomes

This article provides an overview of cognitive-behavioral therapy (CBT) for panic disorder. CBT is currently considered a first-line treatment for panic disorder. It offers benefit after short-term intervention, typically consisting of 12-15 sessions conducted in either an individual or a group format. The treatment focuses on the elimination of the patterns that underlie and perpetuate the disorder. Through CBT, patients learn about the nature of the disorder and acquire a set of strategies that counter the fears of panic attacks themselves, and break the recurring cycle of anticipatory anxiety, panic, and agoraphobic avoidance. The collaborative format of treatment, and a focus on elimination of core fears may be factors in enhancing longer-term outcome. In this article, we review the efficacy of CBT as a first-line treatment, a strategy for medication nonresponders, a replacement strategy for patients who wish to discontinue pharmacotherapy, and a potential preventive strategy for at-risk individuals. We also discuss some of the complex issues involved with combination-treatment strategies.     

Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more?

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with "straying" to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the 1-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent-to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with 'straying' to CBT for comorbid disorders.     

TO BE FEMALE, MIDDLE CLASS, ANXIOUS, AND BLACK

Women of color theorists have suggested that the double minority status of gender and ethnicity places African American women at higher risk for anxiety. However, little information is available about anxiety disorders among African American women. The existing literature subsumes Black women under the general category of African Americans and focuses on low-income samples. In this study, we examine the manifestation of panic disorder in a sample of 15 predominantly middle-class African American women. We then compare these women to a group of 35 predominantly middle-class African American women without panic disorder on several factors, including presence of isolated sleep paralysis, presence of other anxiety disorders, help-seeking behavior, and victimization. Results indicate that African American women with panic disorder experienced isolated sleep paralysis, and that both groups had high levels of sexual victimization. Help-seeking among women with panic and other anxiety disorders was limited to relationship difficulties, sexual assault, and bereavement.     

Peritraumatic and persistent panic attacks in acute stress disorder

This study examined the prevalence of peritraumatic and persistent panic symptoms following trauma. Survivors of civilian trauma (n=30) with either acute stress disorder (ASD) or no acute stress disorder (non-ASD) were administered the Panic Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed the Impact of Event Scale, Acute Stress Disorder Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Anxiety Sensitivity Index. Panic attacks were experienced by 77% of participants during their trauma, and 47% reported recurrent panic attacks post-trauma. ASD participants demonstrated more panic symptoms during and after their trauma than non-ASD participants. Posttraumatic panic was most strongly associated with anxiety sensitivity. These findings are discussed in terms of cognitive factors that may mediate posttrauma panic and treatment implications for managing posttraumatic anxiety.There is increasing evidence that panic attacks play a role in psychopathological response to trauma. A significant proportion of people with panic disorder report a history of trauma (). Moreover, two-thirds of trauma survivors report panic attacks within the previous 2 weeks (). There is also evidence that people with posttraumatic stress disorder (PTSD) display elevated levels of anxiety sensitivity (). Recent attention has focused on acute panic reactions because of proposals that panic during trauma may condition trauma-related cues to subsequent panic (). There is evidence that panic attacks occur in 53-90% of trauma survivors during the traumatic experience (). Further, people with acute stress disorder (ASD) are more likely to report peritraumatic panic attacks than non-ASD individuals. ASD is a useful framework in which to investigate the role of panic in posttraumatic stress because ASD describes acute responses to trauma that are strongly predictive of chronic PTSD ().This study investigated the relationship between peritraumatic panic and ongoing panic attacks following trauma. Specifically, we indexed panic attacks during trauma and subsequent to trauma in trauma survivors with and without ASD. We also indexed the extent to which distorted interpretations about somatic sensations may be associated with panic attacks following trauma. We considered that the strong evidence that maladaptive appraisals of somatic sensations mediate panic () is directly relevant to posttraumatic panic. We hypothesized that ASD participants would report more peritraumatic and persistent panic than non-ASD participants, and that this panic would be associated with dysfunctional interpretations about somatic stimuli.     

A comparison of metacognitions in patients with hallucinations,delusions, panic disorder,and non-patient controls

This study tested the hypothesis that metacognitions are a general vulnerability factor for psychological disorder. It was predicted that patients with psychosis (hallucinations or delusions), and patients with panic disorder would score higher than non-patients on measures of metacognition. Moreover, it was hypothesised that patients showing most dysregulation of thinking (voice-hearers) would endorse significantly higher metacognition scores than individuals in the other groups. The Meta-Cognitions Questionnaire (MCQ: ) was administered to patients who met DSM-IV criteria for schizophrenia spectrum disorders with auditory hallucinations, patients who met DSM-IV criteria for schizophrenia spectrum disorders with persecutory delusions, patients who met DSM-IV criteria for panic disorder and non-patients. The results showed that psychotic patients who experience auditory hallucinations tended to exhibit higher levels of dysfunctional metacognitive beliefs than other patient groups, scoring significantly higher than at least two of the three control groups on positive beliefs about worry, negative beliefs about uncontrollability and danger, cognitive confidence and negative beliefs including superstition, punishment and responsibility. It was also found that the metacognitive beliefs of patients with persecutory delusions and panic patients were often similar to each other, and elevated in comparison to non-patients, suggesting that such beliefs are generic vulnerability factors. The theoretical and clinical implications of these findings are discussed.     

Family Values, Religiosity, and Emotional Reactions to Schizophrenia in Mexican and Anglo-American Cultures

This study was designed to test whether two sociocultural variables, family cohesion and religiosity, related to affective reactions toward schizophrenia. It was hypothesized that increasing perceptions of one's family as cohesive and religious would be associated with the expression of more favorable and less unfavorable emotions toward patients with the disorder. Eighty-eight Anglo-American undergraduates from Los Angeles and 88 Mexican undergraduates from Guadalajara read vignettes of a hypothetical family member described as meeting DSM-IV criteria for schizophrenia. Results of this study suggest that perceptions of family unity may be one important factor underlying emotional reactions toward schizophrenia. As expected, increasing perceptions of family cohesion were associated with greater reports of favorable emotion and decreased reports of unfavorable emotion toward the patient. However, after controlling for social desirability, family cohesion no longer significantly predicted unfavorable affect. Contrary to expectations, religiosity was not found to predict unfavorable or favorable emotions. However, religiosity was found to covary with nationality. Mexicans, compared to Anglos, reported greater moral-religious values in their families. No national differences were found with respect to family cohesion. Implications of this study are discussed along with suggested directions for future research.     

Cognitive factors in panic disorder, agoraphobic avoidance and agoraphobia

There remains a lack of consensus regarding the possibility that especially high levels of panic-related cognitions characterise panic disorder with agoraphobia. We administered the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire and the Anxious Thoughts and Tendencies Scale as well as measures of agoraphobic avoidance to patients diagnosed with panic disorder with agoraphobia (n=75) and without agoraphobia (n=26). Patients with panic disorder with agoraphobia did not score significantly higher on any of the cognitive variables than did panic disorder patients without agoraphobia. However, most of the cognitive variables showed small to moderate-strength correlations with self-report measures of agoraphobic avoidance. Our findings suggest that anxiety sensitivity, catastrophising of the consequences of panic and a general anxiety-prone cognitive style, although to some extent associated with agoraphobic avoidance, do not discriminate panic disorder with agoraphobia from panic disorder without agoraphobia.