Panic disorder subtypes: Further clinical differences

Panic disorder (PD) is a heterogeneous phenomenon with respect to symptom profile. Most studies agree that a group of patients with prominent respiratory symptoms emerged as a distinct PD subtype. In this study we compared a range of clinical features associated with PD and agoraphobia in patients with respiratory (RS) and nonrespiratory (NRS) subtypes of PD. The participants were 124 patients with PD (79 women and 45 men), with or without agoraphobia, diagnosed by DSM-IV criteria. Following the observer-rated Panic Disorder Severity Scale assessment, subjects completed self-report measures, including the Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale; the Beck Anxiety Inventory; and the Panic-Agoraphobic Spectrum Scale (PAS-SR). Multivariate analysis of variance (MANOVA) showed significant group differences [Pillai's trace= 0.95, F(5, 118)(=)2.48, P=.036]. Patients in RS group had higher mean total scores on the ASI (F= 5.00, df= 1, P=.027) and PAS-SR (F = 11.23, df= 1, P =. 001) than patients in NRS group. Also, patients with RS attained higher scores than patients with NRS on four domains of PAS-SR (panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking). A descriptive discriminant analysis of the data correctly identified 69.4% of the patient group in general and 86.1% of RS group (Wilks's lambda = 0.87, df = 8, P =. 048). The significant discriminating factors of the RS and NRS groups were domains of panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking. Our findings suggest that anxiety sensitivity and panic-agoraphobic spectrum symptoms might be particularly relevant to understanding subtypes of PD

The mean platelet volume, neutrophil lymphocyte ratio, platelet lymphocyte ratio and red cell distribution width in panic disorder

Objective: Assessment of the systemic inflammatory response of the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) is shown as a new biomarker. Red cell distribution width (RDW) is the size of red blood cells and have been found related to adverse events in many diseases. Mean platelet volume (MPV) indicates platelet volume and platelet volume is a potential indication of platelet activity. The aim of our study is to investigate hematological changes in patients with panic disorder (PD) through readily available markers such as NLR, PLR, RDW and MPV. Methods: Thirty-nine patients between the ages of 18 and 75 who were diagnosed with PD according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and forty healthy control subjects were included in the study. MPV, NLR, PLR and RDW were measured and recorded for groups. Hamilton Depression Scale, Hamilton Anxiety Scale, Clinical Global Impressions Scale (CGI-S) and Panic Disorder Severity Scale were applied to the patients. Results: There were no statistically significant differences between groups in terms of sociodemographic characteristics. No significant correlation was found between NLR, PLR and RDW values and clinical scales. MPV was negatively correlated with the severity of panic disorder. There was no correlation between MPV and other variables. Conclusion: Our study is the first study to examine NLR, PLR and RDW associations in PD patients. There are studies showing that increased sympathetic activity leads to increased MPV. In our study, the MPV value did not differ between PD and control group. However, there was a negative correlation between the severity of panic disorder and MPV

Treatment Approach to Sleep Terror: Two Case Reports

Parasomnias are a group of disorders characterized by abnormal behaviors, physical activities, and autonomic arousal symptoms while transition to sleep or continuation of sleep. Sleep terror (ST) is classified under parasomnias characterized by sudden fear attacks beginning with crying attacks or high-frequency screams and continuing with increased autonomic symptoms. ST occurs in the first few hours of sleep during the delta phase. Further, the lifetime prevalence of ST in adults is less than 1%. It is important to obtain; anamnesis from patients' bed partner for a clinical evaluation of ST. Methods, such as evaluating sleep diaries and video recordings, can help ST diagnosis. It is also important to evaluate patients' medical history, history of substance or alcohol abuse, psychological traumatic experiences, primary or secondary incomes, and detailed neurological aspects. Physician can select some serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCADs) as medical treatment if patients have a high frequency of attacks. Because of addiction and relapse of ST episodes, benzodiazepines are not preferred as the first-line treatment. In this study, we will discuss ST, which is rare in adulthood, and use of long-acting benzodiazepine based on two cases

Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES)

Background: The objective of the study is to describe the community prevalence of psychiatric disorder, mainly posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) 3 years after a devastating earthquake. Methods: Three years after the Marmara Earthquake, 683 individuals from the epicentre were randomly selected to form a representative sample and were assessed with Composite International Diagnostic Interview (CIDI), General Health Questionnaire (GHQ), Traumatic Stress Symptom Checklist (TSSC) and Beck Depression Inventory (BDI). Results: The 36 months prevalence of PTSD and MDD after the Marmara Earthquake were 19.2% and 18.7% respectively. The current prevalence of PTSD and MDD in the affected community was found to be 11.7% and 10.5%, respectively. PTSD and MDD were the most prevalent disorders after the disaster and showed a decrease over time. However, only 38.9% of the PTSD cases identified at any time over the 3 years were in remission at the 3rd-year. The co-occurrence of MDD with PTSD resulted in a decrease in the rate of recovery from PTSD. MDD was also the most prevalent disorder accompanying PTSD. Of all the subjects 37.5% with PTSD still met the MDD criteria at the 3rd year postearthquake. Conclusions: In comparison with the data from pre-earthquake national mental health profile, the present study showed that the prevalence of MDD, panic disorder, OCD, GAD, social phobia and special phobias were still higher in the affected region 3 years after the earthquake

Development and validation of the Subjective Recovery Assessment Scale for patients with schizophrenia

OBJECTIVE Studies investigating the recovery from schizophrenia revealed two concepts of recovery; one is clinical recovery, and the other is personal or subjective recovery. Both states of recovery require specific assessment tools and therapeutic approaches. While current measures of clinical recovery can be used upon consensus all over the world, measures of subjective recovery which are based on cultural and individual values are yet to be investigated. The aim of this study was to develop and validate the Subjective Recovery Assessment Scale (SubRAS) for patients with schizophrenia. METHODS The SubRAS consisting of 17-item was prepared using related literature with focus group interviews. Internal consistency reliability was assessed by Cronbach’s alpha coefficients, and test–retest reliability was assessed. Exploratory factor analyses and correlations with Global Assessment of Functioning (GAF), The Heinrichs-Carpenter Quality of Life Scale (QLS), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression – Severity (CGI-S) were used to examine the factor-based validity and construct validity of the SubRAS. RESULTS The participants consisted of 127 patients with schizophrenia (n = 110) and schizoaffective disorder (n = 17), with 63.6% being male and a mean age of 41.2 years. Cronbach’s alpha coefficient of the scale was calculated as 0.98 while item-total score correlation coefficients were measured between 0.83 and 0.94. Test–retest reliability (r = .98) was very satisfactory. As for construct validity, a one-factor solution was obtained that could explain 83.0% of the variance. The scale showed a high correlation with the GAF (r = .82), the QLS (r = .76), PANSS (r = −.74), and CGI-S (r = −.74). CONCLUSIONS SubRAS is a valid and reliable instrument that can be utilized for patients with schizophrenia to assess their subjective recovery states. It is a culture-sensitive self-assessment instrument and easy to use for Turkish patients with schizophrenia

Predictors of psychosocial functionality in obese women

Objective: The aim of this study is to determine the level of depression, self-esteem, body satisfaction and quality of life in obese women as well as the predictors of psychosocial functionality. Methods: The study group consisted of 110 obese women participating in a diet and exercise program held in Kocaeli University Faculty of Medicine. Beck Depression Inventory, Rosenberg Self Esteem Scale, Body Satisfaction Scale and Obesity Related Problems Scale were used. Weight and height measurements were done using a calibrated digital scale and a height scale. Results: Psychosocial functionality of the study group was found to be moderately deteriorated and it showed significant relationship with depression, self-esteem and body dissatisfaction but not with BMI. In the linear regression model, in addition to self-esteem and body dissatisfaction, educational status of the obese women were determined as the predictors for psychosocial functionality. Discussion: Self-esteem, depression and body satisfaction are all concepts that are intertwined in obese individuals. In conclusion this study shows that body satisfaction and self-esteem were more important for psychosocial function of obese women, rather than BMI per se. The severe deterioration of psychosocial functionality of obese women with a higher educational status might well be related to more exposure to stigmatization and discrimination as a result of taking a more active role in society. There is a need for future studies where stigmatization is also investigated as a triggering cause of body dissatisfaction and low self-esteem, thus leading to a decrease in quality of life

Psychiatric comorbidity and childhood trauma in fibromyalgia syndrome

Objectives: In this study, we aimed to compare patients with fibromyalgia syndrome (FMS) and those with myofascial pain syndrome (MPS) and healthy women and to investigate the prevalence of childhood traumatic experiences (CTEs) in relation to comorbid mood and anxiety disorders

Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: Cluster analysis based evidence

Background: Antidepressants are known to induce manic switch in patients with depression. Treatment-induced mania is not considered as bipolar disorder in DSM IV. The aim of this study was to assess whether clinical characteristics of patients with unipolar depression with a history of treatment-induced mania were similar to those of patients with bipolar disorder