Bucholz, Kathleen K

Heath, Andrew C

Klein, Donald F

Lessov, Christina N

Madden, Pamela A.F

Nelson, Elliot C

Pergadia, Michele

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Washington University School of MedicineDigital Commons@BeckerPosters 2003: Drinking and the High School Student2003Panic symptoms, cigarette smoking and drinking inadolescent female twinsMichele PergadiaWashington University School of Medicine in St. LouisAndrew C. HeathWashington University School of Medicine in St. LouisKathleen K. BucholzWashington University School of Medicine in St. LouisElliot C. NelsonWashington University School of Medicine in St. LouisChristina N. LessovSRI InternationalSee next page for additional authorsFollow this and additional works at: http://digitalcommons.wustl.edu/guzeposter2003Part of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the 2003: Drinking and the High School Student at Digital Commons@Becker. It has beenaccepted for inclusion in Posters by an authorized administrator of Digital Commons@Becker. For more information, please contactengeszer@wustl.edu.Recommended CitationPergadia, Michele; Heath, Andrew C.; Bucholz, Kathleen K.; Nelson, Elliot C.; Lessov, Christina N.; Klein, Donald F.; and Madden,Pamela A.F, "Panic symptoms, cigarette smoking and drinking in adolescent female twins" (2003). Posters. Paper 1 Samuel B. GuzeSymposium on Alcoholism.http://digitalcommons.wustl.edu/guzeposter2003/1AuthorsMichele Pergadia, Andrew C. Heath, Kathleen K. Bucholz, Elliot C. Nelson, Christina N. Lessov, Donald F.Klein, and Pamela A.F MaddenThis poster is available at Digital Commons@Becker: http://digitalcommons.wustl.edu/guzeposter2003/1Panic Symptoms, Cigarette Smoking and Drinking in Adolescent Female TwinsMichele Pergadia, Andrew C. Heath, Kathleen K. Bucholz, Elliot C. Nelson, Christina N. Lessov†, Donald F. Klein*, Pamela A.F. MaddenWashington University School-of-Medicine, St. Louis, †SRI International, Menlo Park*Columbia University, New YorkIntroduction• In adults, cigarette (Breslau & Klein, 1999; Goodwin &Hamilton, 2002) and alcohol use (Merikangas et al., 1998) are significantly associated with panic disorder symptoms, even after adjusting for other anxiety disorders.• In adolescents, cigarette smoking is associated with panic symptoms, even after controlling for other anxiety disorders (Johnson et al., 2000).Introduction• Twin studies find substantial genetic influences on smoking and drinking (Heath, Madden, and Martin, 1998; Heath and Madden, 1995) with heritability estimates as high as 40-80 percent.• There is evidence from family studies (Horwath et al., 1995; Fyer et al., 1996) and twin studies (Kendler et al., 1993; Scherrer et al., 2000) that panic disorder runs in families, and this is at least in part due to genetic factors in adults.• Molecular genetics studies have found a polymorphic duplication on human chromosome 15 (15q24-26; DUP25) that is highly associated with panic disorder (Gratacos et al., 2001).Introduction• Drinking, smoking, other substance use, and other co-morbid psychopathologies have an age of onset that predates the development of panic disorder.– Associations between drinking and smoking and panic disorder may be due to causative effects of drinking and smoking on panic symptoms• E.g. Klein’s “suffocation-false alarm hypothesis model”, or– Drinking, Smoking and Panic may share some common etiologies (environmental and genetic)– They may be related through some third unmeasured factor• Examination of familial effects on panic and unique associations between panic and cigarette and alcohol use remains unexplored in adolescents.Aims• The aim of the proposed research is to examine the extent to which:– 1) There are familial effects on panic severity in adolescent girls– 2) Smoking and Drinking-related problems are uniquely  associated with panic symptoms, after adjusting for familial influences on panic, other substance use, personality, and major depression, conduct disorder and social phobiaSample• Twins from the Missouri Adolescent Female Twin Study (MOAFTS) were ascertained from Missouri State birth records– Interview and mailed-questionnaire-data from a survey conducted in 1995-1997 of adolescent female twins (N=1422 individuals)– Age Range: 16-23Lifetime Panic Severity(outcome measure)– Panic severity: four level variable:• 1) never had an attack• 2) uncued anxiety attack (“came out of the blue”)• 3) DSM-IV diagnostic uncued panic attacks • 4) DSM-IV Panic DisorderLifetime Smoking Behavior – Ever smoking: reports having tried cigarettes – Regular smoking : reports smoking weekly for three weeks or more – Subclinical Nicotine Dependence: reports 2 or more DSM-IV nicotine dependence itemsLifetime Drinking Behavior– Ever drinking: reports having a full drink of alcohol– Regular drinking : reports drinking at least one drink every month for 6 months or more – Subclinical Alcohol Dependence: reports 2 or more DSM-IV alcohol dependence itemsLifetime Marijuana Use Behavior– Ever smoked: reports having tried marijuana– Regular use: reports have used marijuana 40 or more times – Subclinical Marijuana Dependence: reports 2 or more DSM-IV marijuana dependence itemsOther Drugs and Psychopathology• Lifetime Experimentation with other drugs– Stimulants– Opiates– Sedatives– Hallucinogens– Inhalants– Cocaine• Lifetime History of DSM-IV Major Depression, Conduct Disorder, and Social PhobiaSelf-Report Personality MeasuresJunior Eysenck Personality Inventory(JEPI, Eysenck, 1965)• Extraversion:: sociable, lively, active, assertive, sensation-seeking• Neuroticism: anxious, depressed, guilt feelings, low self-esteemtense• Social Non-conformity: (“lie” scale): honest, blatantStatistical AnalysisMultinomial Logistic Regression• PHENOTYPIC ANALYSES: – Dependent Variable: Panic Severity (4 levels)– Independent Variables: smoking and drinking variables, other drugs, major depression, conduct disorder, social phobia and personality • GENETIC ANALYSES: – Dependent Variable: panic status of respondent– Independent Variables: cotwin’s panic status, covariates, smoking and drinking variables of the respondentOutcome Variable Prevalence % (n=1422)Anxiety Attack 8.7Panic Attack 1.6Panic Disorder 1.9Predictor Variables Prevalence % (n=1422)Ever Smoked Cigarettes 64.3Regular Cigarette Smoking 32.7Subclinical Nicotine Dependence 28.5Ever Drinking Alcohol 76.4Regular Alcohol Drinking 39.4Subclinical Alcohol Dependence 25.5Ever Used Marijuana 36.4Regular Marijuana Use 7.8Subclinical Marijuana Dependence 1.8Ever Used Stimulants 5.5Ever Used Opiates 3.5Ever Used Sedatives 2.6Ever Used Hallucinogens 7.9Ever Used Inhalants 2.2Ever Used Cocaine 4.2History of Major Depression 21.5History of Conduct Disorder 2.8History of Social Phobia 17.1Phenotypic Associations with Panic SeverityOdds Ratios (and 95% Confidence Interval) with never having a panic attack as the comparison group-only significant effects shown, after controlling for ageUnadjusted Anxiety Attacks Panic Attacks Panic DisorderEver smoking 2.1 (1.3-3.5) n.s. n.s.Regular Smoking n.s n.s. 4.1 (1.6-10.7)Subclinical Nicotine Dependence1.8 (1.3-2.7) n.s. 6.2 (2.4-16.5)Subclinical Alcohol Dependence1.8 (1.2-2.9) n.s. n.s.Subclinical Marijuana Dependencen.s. 7.3 (1.7-32.0) n.s.Stimulant Use 3.1 (1.6-5.9) n.s. n.s.Opiate Use 3.9 (1.8-8.4) n.s. n.s.Sedative Use 3.0 (1.2-7.5) 4.9 (1.0-23.1) 6.4 (1.3-30.8)Major Depression 2.6 (1.7-4.1) 6.5 (2.5-16.8) 24.8 (8.1-76.2)Conduct Disorder 2.7 (1.04-7.2) n.s. n.s.Social Phobia 2.0 (1.3-3.2) 3.1 (1.2-7.9) 4.7 (1.9-11.6)Neuroticism 1.4 (1.2-1.7) n.s. 1.8 (1.1-3.2)Phenotypic Associations with Panic SeverityOdds Ratios (and 95% Confidence Interval) with never having a panic attack as the comparison group-only significant effects shown, after controlling for ageAdjusted Anxiety Attacks Panic Attacks Panic DisorderSubclinical Nicotine Dependencen.s. n.s. 9.98 (2.5-39.2)Major Depression 2.0 (1.2-3.3) 5.9 (1.8-18.8) 15.0 (3.3-67.6)Social Phobia 1.9 (1.1-3.2) n.s. n.s.Neuroticism 1.3 (1.1-1.6) n.s. n.s.Residual Associations with Panic SeverityOdds Ratios (and 95% Confidence Interval) with never having a panic attack as the comparison group-only significant effects shown, after controlling for age and zygosityUnadjusted Anxiety Attacks Panic Attacks Panic DisorderCotwin’s anxiety attack 8.7 (5.2-14.5) 8.7 (5.2-14.5) n.s.Cotwin’s panic attack n.s. 8.7 (5.2-14.5) n.s.Cotwin’s panic disorder n.s. n.s. 8.7 (5.2-14.5)AdjustedCotwin’s anxiety attack 6.8 (3.8-12.4) 6.8 (3.8-12.4) n.s.Cotwin’s panic attack n.s. 6.8 (3.8-12.4) n.s.Cotwin’s panic disorder 6.8 (3.8-12.4)Subclinical Nicotine Dependencen.s. n.s. 8.1 (2.2-30.0)Major Depression n.s. 4.9 (1.5-15.9) 18.4 (1.1-300.8)Social Phobia 2.3 (1.3-4.0) n.s. n.s.Neuroticism 1.3 (1.07-1.6) n.s. n.s.Discussion• Results confirm that panic severity runs in families in adolescent girls.• Even after accounting for familial effects on panic severity, major depression, social phobia and neuroticism, nicotine dependence remained as a significant risk factor for panic disorder.– However, at the same time, nicotine dependence did not significantly reduce familial effects on panic, suggesting that it does not mediate those familial effects• Relative to alcohol or other psychoactive substances, the relationship between nicotine dependence and panic disorder appears particularly strong.AcknowledgementsThe authors are thankful for Support from the following NIH Grants: AA07535, AA07728, and AA13321 (A.C.H.), DA12540 and DA12854 (P.A.F.M), and AA07580 (M.L.P).Thanks also to Bill Howells for his helpful analytical assistance.

Panic symptoms, cigarette smoking and drinking in adolescent female twins

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Panic symptoms, cigarette smoking and drinking in adolescent female twins

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