The bodily panic symptoms and predisposing stressors in Korean patients with panic disorder

Objectives The purpose of this study was to investigate the distinctive features of bodily panic symptoms and the predisposing conditions in Korean patients with panic disorder. Methods This was a retrospective chart review study and the data were collected from twelve university-affiliated hospitals in Korea. The patients selected met the diagnostic criteria for panic disorder, were older than 20 years of age, and had initially visited a psychiatry department. The assessments included the chief complaints related to bodily panic symptoms, recent stressors, recent history of alcohol and sleep problems, and time to visit an outpatient clinic. Results A total of 814 participants were included in the study. The most commonly experienced symptoms were cardiovascular and respiratory symptoms, which were observed in 63.9% and 55.4% of participants, respectively. Just before the onset of a panic attack, 25.6% of participants experienced sleep-related problems. Episodic binge drinking was also frequently observed (13.2%) and was more prevalent in men than in women (22.6% vs. 4.9%, p<0.001). About 75% of participants experienced stressful life events just before panic onset. Work-related issues were more prevalent in men than in women (22.0% vs. 13.4%, p=0.001). Family-related issues (4.8% vs. 14.1%, p<0.001) and conflict with a spouse or partner (4.0% vs.11.7%, p<0.001) were more prominent in women than in men. Conclusion Our results suggest that cardiovascular symptoms are the most common bodily panic symptoms in Korean patients. Our results suggest that a substantial portion of the Korean patients experienced stressful life events, sleep problems, and/or episodic binge drinking just before the onset of panic disorder.ope

Korean Medication Algorithm for Panic Disorder 2008 : Diagnosis, Treatment Response and Remission of Panic Disorder in Korea

Objective : This article is a part of the Korean Medication Algorithm Project for Panic Disorder, which aims to build consensus regarding the diagnosis, treatment response and achievement of clinical remission for patients with panic disorder in Korea. Methods : The questionnaire used in this article had parts : 1) diagnosis, 2) treatment response, and 3) remission for patients with panic disorder. The questionnaire was completed by each of 54 Korean psychiatrists who had much experience in treating patients with panic disorder. We classified the experts' opinions into 3 categories (first-line, second-line, and third-line) using the ${\chi}^2$-test. Results : Five factors were considered in this research : panic attack, anticipatory anxiety, phobic avoidance, severity of illness, and psychosocial disability. Most reviewers agreed that the presence of a panic attack was the most important factor in the diagnosis of patients with panic disorder. Phobic avoidance was included in the first-line category, whereas the severity of illness and psychosocial disability were included in the second-line category. Most reviewers also agreed that the presence of a panic attack was the most important factor in determining the appropriate treatment response, and it was included in the first-line category along with several other items. To determine remission status, the patients' scores on tests pertaining to the severity of panic attack, anticipatory anxiety, phobic avoidance, severity of illness and psychosocial disability should be less than 3.0-3.3 on a 9-point Likert scale. Conclusion : We suggest useful information for making a diagnosisof panic disorder, determining the appropriate treatment response and identifying remission in panic disorder patients on the basis of the results of a nationwide survey of experts in Korea.ope

Efficacy and Safety of Venlafaxine Extended-release in Panic Disorder

SSRIs have been considered as the first line of treatment for patients with panic disorder since 1990s along with cognitive behavioral treatments. High potency benzodiazepines (e.g. alprazolam, clonazepam) have had advantages in anti-panic effects. However, these drugs have limitations of treating panic disorder because of their dependency, tolerance and withdrawal. Serotonin and noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine were introduced as antidepressants since 1990s. Recently, it is confirmed that SNRIs have the remarkable anti-panic effects although some concerns about its cost, tolerance, withdrawal, side effects such as dry mouth, constipation, and hypertension have emerged. In this regard, further study is required to confirm the efficacy of long term treatment of panic disorder. Despite these concerns, venla-faxine extended-release is an effective treatment in patients with panic disorder.ope

Korean Medication Algorithm for Panic Disorder 2008: Consensus Regarding Treatment Strategies in Cases of Non-Responsive and Comorbid Conditions

OBJECTIVE: This study investigated the consensus about treatment strategies for non-responsive and comorbid conditions in panic disorder, which represents one subject addressed by the Korean medication algorithm project for panic disorders 2008. METHODS: The executive committee developed questionnaires about treatment strategies for patients with panic disorder based on guidelines or algorithms and clinical trial studies previously published in foreign countries. This study analyzed the treatment strategies in cases of non-responsive panic disorder and comorbid conditions accompanying panic disorder. Fifty-four (68%) of 80 experts on a committee reviewing panic disorders responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using a chi-square test and 95% confidence interval. RESULTS: The consensus about first-line treatment strategies in cases of non-responsive panic disorder included "switch from a selective serotonin reuptake inhibitor to venlafaxine XR or vice versa" and "clonazepam or alprazolam can be combined with another drug even from the initial period". Second-line strategies included tricyclic antidepressants (clomipramine, imipramine) and high dosages of high potency benzodiazepines (alprazolam, clonazepam). The consensus about treatment strategy in cases of comorbid disorders (e.g., depression or other anxiety disorders) recommended antidepressants combined with anxiolytics and cognitive-behavioral therapy as the treatments of choice. Antidepressants combined with anxiolytics were recommended as the first-line strategy, and antidepressant monotherapy and antidepressants combined with cognitive-behavioral therapy emerged as second-line strategies. In cases of comorbid conditions accompanying panic disorder, paroxetine was selected as the treatment of choice. Escitalopram, venlafaxine XR, sertraline, citalopram, alprazolam, and clonazepam were selected as first-line treatments and fluoxetine, mirtazapine, and imipramine were selected as second-line treatments. CONCLUSION: This study provided information about the consensus among Korean experts in regard to treatment strategies for non-responsive panic disorder and comorbid conditions accompanying panic disorderope

Development of the Medication Algorithm for Panic Disorder(3) - Cognitive Behavioral Therapy -

Objective : A working group of psychiatrists from the Korean Academy of Anxiety Disorders was established to determine the appropriate medication algorithm for treating patients with panic disorder. In this article, we discussed the consensus among psychiatrists regarding the use of cognitive behavior therapy (CBT) in the development of a treatment algorithm for panic disorder in Korea. Methods : Based on the guidelines or algorithms published by the American Psychiatric Association, National Institute for Clinical Excellence, and Canadian Psychiatric Association, we constructed questionnaires regarding the core components and contents of CBT for patients with panic disorder. Fifty-four experts in panic disorder completed the questionnaires. Results : There was statistically significant consensus among the experts in the belief that cognitive reconstruction and psychological education are the core components of CBT for the treatment of patients with panic disorder. However, there was some inconsistency between the opinions of some experts regarding the content and frequency of CBT and the results of studies published outside of Korea. Conclusions : CBT, especially the psychological education and cognitive reconstruction components, should be considered when treating patients with panic disorder. However, further consideration needs to be put into the design of a more detailed treatment guideline for the use of CBT in the treatment of patients with panic disorder.ope

Korean Medication Algorithm for Panic Disorder 2008 : Initial Treatment Strategies

The Korean Association of Anxiety Disorders developed a Korean treatment algorithm for panic disorder to help clinicians make treatment decisions. This study investigated a consensus about initial treatment strategies as part of developing a medication algorithm for panic disorders in Korea. Methods：Based on current treatment algorithms published by the American Psychiatric Association, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association, we developed questionnaires about initial treatment strategies for patients with panic disorder. Fifty-four experts in panic disorder answered the questionnaires. We classified expert opinions into three categories (first-, second-, and third-line treatment strategies) by χ2 tests. Results：Antidepressants and anxiolytics were recommended as first-line strategies for the initial treatment of panic disorder. A combination of medical treatment and cognitive-behavioral therapy was also recommended for more severe cases. Paroxetine, escitalopram, alprazolam, and clonazepam were preferred from among many anti-panic drugs. The mean starting dose of anti-panic drugs in the initial treatment for panic disorder was relatively lower than that for such other psychiatric illnesses as major depressive disorder. Conclusion：These results, reflecting recent studies and clinical experiences, may provide guidelines about initial treatment strategies for panic disorder.ope

From the Onset of Panic Symptoms to Getting to a Psychiatric Treatment : The Change by Improved Public Awareness of Panic Disorder in Korea

Objective : This study aimed to investigate the general process from the symptom onset to the psychiatric treatment in Korean panic patients and the effect of improved public awareness on it. Methods : This study has a retrospective design. The subjects were the new patients with panic disorder who visited the psychiatric outpatient clinic in twelve university-affiliated hospitals all across Korea. The medical chart was reviewed retrospectively and the data were collected including chief complaints of symptoms, recent stressors, the time to visit the psychiatric outpatient clinic, and visit of other departments and diagnostic approaches for their symptoms. Results : A total of 814 participants were included in the study. The most common department other than psychiatry the panic patients visited were cardiology (28.3%), general internal medicine (16.0%) and neurology (11.4%). The most frequently used diagnostic tests were a echocardiography (17.9%), 24-hour Holter mon-itoring (11.2%), and brain MRI (8.2%). Only 37.3% of participants visited psychiatric clinic directly. About 80% of participants visited psychiatric department within 1 year after their first panic symptoms and it took 13.8±13.7 weeks on average. Comparing before and after 2012, the number of participants increased who visit directly the psychiatric clinic without visiting other departments (p=0.002) and without visiting emergency room (p＜0.001). Conclusions : Our results suggest that a substantial number of patients visit departments other than psychiatry when they experience first panic symptoms. However, most patients begin psychiatric treatment within 1 year after their first symptoms and the number of patient are increasing who visit psychiatric department directly without visiting other departments.ope

The experiences of depressed pregnant women participating in a cognitive behavioral therapy program via video communication: an exploratory qualitative study

Purpose This study explored the experiences of pregnant women with depressed mood participating in a group cognitive behavioral therapy (CBT) program using video communication, based on Beck’s cognitive theory. Methods The participants were six pregnant women out of 13 women who had participated in an 8-session group CBT program using video communication for women with depressed mood (Edinburgh Postnatal Depression score of ≥9). Data were collected from February 20 through March 25, 2021. In-depth individual interviews were conducted through a video conferencing platform at 1 month post-baseline. Thematic analysis was done. Results Three themes, 10 subthemes, and 38 concepts were derived from experiences of participating in the 4-week group CBT program (twice a week). The first theme, entitled “continuing realization” had subthemes of “a negative and instable self,” “a selfish judgment that excludes others,” and “a strong belief in self-control.” The second theme, entitled “attempt to change for restoration” had subthemes of “shift to rational thinking,” “freedom from suppressed beliefs,” “tolerance of other people,” and “courage for self-expression.” The third theme, entitled “departure for a positive life,” had subthemes of “emotional healing,” “faith in oneself,” and “reestablishing the criteria for happiness.” Conclusion Pregnant women with depressed mood expressed that continuing realizations and attempts to change supported their transition toward a positive direction of healing. Thus, they were able to change their distorted thinking into rational thinking through CBT using video communication. These findings support the use of group CBT using video communication with pregnant women who have depressed mood

Stress and Immunity

스트레스는 면역을 억제하거나 활성화시킨다. 스트레스에 의한 면역반응이 일정하지 않은 것은 스트레스의 정도, 기간, 대응능력에 따른 차이가 영향을 미치기 때문이다. 스트레스와 면역 간의 관계는 중추신경계, 신경내분비계 및 면역계 간의 의사소통, 즉 상호작용에 의해 이루어지고 있다. 중추신경계와 면역계가 상호 작용하는 주요 경로는 임파조직의 신경계 wiring system과 신경내분비계다. 정신사회적 인자와 면역기능 간의 중개자로는 뇌하수체에서 방 출되는 펩타이드, 호르몬 및 자율신경계 물질이 있다. 시상하부는 내분비계, 신경계 및 면역계를 통합하는 역할을 한다. 한편 내분비계는 면역계에 의해서 피드백을 받는다. 스트레스와 면역계 간에는 양 방향의 경로가 있는 것으로 가정된다. 즉 스트레스가 면역계에 영향을 미칠 뿐만 아니라 면역계가 정신사회적 기능에 영향을 미칠 수 있다. 어 떤 상황에서도 면역계, 내분비계 및 신경계 간의 상호작용으로 생체균형 (homeostasis)이 유지되는 것으로 보고 있다. 따라서 스트레스와 면역기능 간의 관계를 규명하기 위해서는 면역계, 내분비계, 자율신경계 및 뇌활동을 동시에 측 정, 비교하여 이들을 통합할 필요가 있다ope

Virtual Reality in Current and Future Psychiatry

Virtual reality technology is now being used in neuropsychological assessment and real-world applications of many psychiatric disorders, including anxiety disorders, schizophrenia, child psychiatric disorders, dementia, and substance related disorders. These applications are growing rapidly due to recent evolution in both hardware and software of virtual reality. In this paper, we review these current applications and discuss the future work of clinical, ethical, and technological aspects needed to refine and expand these applications to psychiatry.ope