Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-10T10:00:10.153Z Has data issue: false hasContentIssue false
  • English
  • Français

Origins of the Panic-Agoraphobic Spectrum and Its Implications for Comorbidity

Published online by Cambridge University Press:  07 November 2014

Stefano Pini ,
Jack D. Maser ,
Liliana Dell'Osso  and
Giovanni B. Cassano
Get access Rights & Permissions [Opens in a new window]

Abstract

Available data from the literature supporting the hypothesis that partial manifestations of the panic-agoraphobic spectrum may be as clinically relevant as a full-fledged syndrome were reviewed. These partial expressions of disorder may occur singly or in connection with other mental disorders. In particular, we have examined evidences indicating relationships of panic-agoraphobic spectrum with other mental disorders in childhood and adolescence and with psychotic disorders. Their importance in childhood and adolescence is significant because we believe that these symptoms influence adult behavior and are viewed, at a later time, as atypical symptoms. Panic-agoraphobic spectrum syndromes, both in their full-fledged and partial manifestations frequently co-occur with other mental disorders and are likely to be associated with significant impairment either when occurring singly, partially, or comorbidly. Several conditions typical of childhood, such as separation anxiety, school phobia, and other symptoms related to the concept of “behavioral inhibition” seem to be connected with the panic-agoraphobic spectrum and deserve attention in relation to the development of different anxiety and mood disorders in subsequent phases of the life cycle. Identification of panic-agoraphobic spectrum features is also important within the realm of psychoses where they may substantially affect phenomenology, course of illness, and treatment response.

Type
Feature Articles
Information
CNS Spectrums , Volume 3 , Issue 4: The Panic-Agoraphobic Spectrum , April 1998 , pp. 49 - 57
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Boyd, JH, Burke, JD, Gruenberg, E, Holzer, CE III, et al.Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy free syndromes. Arch Gen Psychiatry. 1984;41:983–989.CrossRefGoogle ScholarPubMed
2.Robins, L, Regier, DA. Psychiatric Disorders in America. The Epidemiological Catchment Area Study. New York, NY: Free Press; 1992.Google Scholar
3.Kessler, R. The prevalence of psychiatric comorbidity. In: Wetzler, S, Sanderson, WC, eds. Treatment Strategies for Patients with Psychiatric Comorbidity. New York, NY: John Wiley; 1997.Google Scholar
4.Angst, J. Comorbidity of mood disorders: a longitudinal prospective study. Br J Psychiatry. 1996;168(suppl. 30):31–37.Google Scholar
5.Schulberg, HC, McClelland, M, Goodwin, W. Six-months outcomes for medical patients with major depressive disorders. J Gen Intern Med. 1987;2:312–317.Google Scholar
6.Ustun, TB, Sartorius, N, eds. Mental Illness in General Health Care. An International Study. New York, NY: John Wiley; 1994.Google Scholar
7.Coryell, W, Endicott, J, Andreasen, NC, et al.Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. Am J Psychiatry. 1988;145:293–300.Google Scholar
8.Maser, JD, Cloninger, RJ, eds. Comorbidity of Mood and Anxiety Disorders. Washington, DC: American Psychiatric Press; 1990.Google Scholar
9.Wittchen, H-U, Essau, CA, Krieg, JC. Similarities and differences of comorbidity in treated and untreated groups. Br J Psychiatry. 1991;159(suppl 12):23–33.Google Scholar
10.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed (DSM-IV). Washington, DC: American Psychiatric Press; 1994.Google Scholar
11.World Health Organization. International Classification of Diseases. 10th ed (ICD-10). Geneva: World Health Organization; 1992.Google Scholar
12.Pini, S, Goldstein, RB, Wickramaratne, PJ, Weissman, MM. Phenomenology of panic disorder and major depression in a family study. J Affect Disord. 1994;30:257–272.CrossRefGoogle Scholar
13.Savino, M, Perugi, G, Simonini, E, et al.Affective comorbidity in panic disorder: is there a bipolar connection? J Affect Disord. 1993;28:155–163.Google Scholar
14.Chen, Y-W, Dilsaver, SC. Comorbidity of panic disorder in bipolar illness: evidence from the epidemiological catchment area study. Am J Psychiatry. 1995;152:280–282.Google Scholar
15.Pini, S, Cassano, GB, Simonini, E, et al.Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. J Affect Disord. 1996;42:145–153.Google Scholar
16.Klein, DN, Riso, LR. Psychiatric disorders: problems of boundaries and comorbidity. In: Costello, C, ed. Basic Issues in Psychopathology. New York, NY: Guilford Press; 1993:19–66.Google Scholar
17.Wittchen, H-U. What is comorbidity—fact or artefact? Br J Psychiatry. 1996;168(suppl 30):7–8.CrossRefGoogle Scholar
18.Breslau, N, Davis, GC. DSM-III generalized anxiety disorder: an empirical investigation of more stringent criteria. Psychiatry Res. 1985;15:231–238.CrossRefGoogle ScholarPubMed
18a.Stein, MB, Walker, JR, Forde, DR. Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety. Am J Psychiatry. 1994;151(3):408–412.Google Scholar
19.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd Edition (DSM-III). Washington, DC: American Psychiatric Press; 1980.Google Scholar
20.Cassano, GB, Michelini, S, Shear, K, et al.The panic-agoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms. Am J Psychiatry. 1997;154(suppl 6):27–38.Google Scholar
21.Angst, J. Recurrent brief psychiatric syndromes: hypomania, depression, anxiety and neurasthenia. In: Judd, LL, Saletu, B, Filip, V, eds. Basic and Clinical Science of Mental and Addictive Disorders. Basel: Karger; 1997:33–38.Google Scholar
22.Perugi, G. Akiskal, HS, Micheli, C, et al.Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J Affect Disord. 1997;43:169–180.CrossRefGoogle ScholarPubMed
23.Roth, M. Anxiety and anxiety disorders-general overview. In: Roth, M, Noyes, R Jr, Burrows, GD, eds. Handbook of Anxiety. Amsterdam: Elsevier; 1988:1:1–45.Google Scholar
24.Tyrer, PJ. Classification of Neurosis. New York, NY: John Wiley; 1989.Google Scholar
25.American Psychiatric Association. Diagnostic and Statistical Manual of Menial Disorders. 3rd ed rev (DSM-III-R). Washington, DC: American Psychiatric Press; 1987.Google Scholar
26.Ormel, J, VonKorff, M, Ustun, TB, et al.Common mental disorders and disability across cultures. Results from the WHO collaborative study on psychological problems in general health care. JAMA. 1994;272:1741–1748.Google Scholar
27.Barrett, JE, Barrett, JA, Oxman, TE, et al.The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry. 1988;45:1100–1106.Google Scholar
28.Judd, LL, Rapaport, MH, Paulus, MP, et al.Subsyndromal symptomatic depression: a new mood disorder. J Clin Psychiatry. 1994;55:18–28.Google Scholar
29.Wells, KB, Stewart, A, Hays, D, et al.The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989;262:914–919.Google Scholar
30.Sherbourne, CD, Wells, KB, Hays, RD, et al.Subthreshold depression and depressive disorders: clinical characteristics of general medical and mental health specialty outpatients. Am J Psychiatry. 1994;151:1777–1784.Google Scholar
31.Weissman, MM, Klerman, GL, Markowitz, JS, et al.Suicidal ideation and suicide attempts in panic disorder and attacks. N Engl J Med. 1989;321:1209–1214.Google Scholar
32.Van Valkenburg, C, Akiskal, HS, Puzantian, V, et al.Anxious depressions: clinical, family history and naturalistic outcome: comparisons with panic and major depressive disorder. J Affective Disord. 1984;6:67–82.Google Scholar
33.Montgomery, SA. Suicide in chronic and recurrent depressions. In: Akiskal, HS, Cassano, GB, eds. Dysthymia and the Spectrum of Chronic Depressions. New York: Guilford Press; 1997:91–97.Google Scholar
34.Montgomery, SA, Montgomery, D, Baldwin, D, Green, M. The duration, nature, and recurrence rate of brief depression. Prog Neuropsychopharmacol Biol Psychiatry. 1990;14:729–735.Google Scholar
35.Angst, J, Vollrath, M, Merikangas, KR, Ernst, C. Comorbidity of anxiety and depression in the Zurich cohort study of young adults. In: Maser, JD, Cloninger, CR, eds. Comorbidity of Mood and Anxiety Disorders. Washington, DC: American Psychiatric Press; 1990:123–137.Google Scholar
36.Olfson, M, Broadhead, E, Weissman, MM, et al.Subthreshold psychiatric symptoms in a primary care group practice. Arch Gen Psychiatry. 1996;53:880–886.Google Scholar
37.Zung, WWK, Magruder-Habib, K, Velez, R, Ailing, W. The comorbidity of anxiety and depression in general medical patients: a longitudinal study. J Clin Psychiatry. 1990;51(Suppl. 6):77–80.Google ScholarPubMed
38.Simon, G, VonKorff, M. Recognition, management, and outcome of depression in primary care. Arch Fam Med. 1995;4:99–105.Google Scholar
39.Brown, C, Schulberg, HC, Madonia, MJ, et al.Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. Am J Psychiatry. 1996;153:1293–1300.Google Scholar
40.Rossi Monti, M, Stanghellini, G. Psychopathology: an edgeless razor? Compr Psychiatry. 1996;37:196–204.Google Scholar
41.Kagan, J, Reznick, JS, Snidman, N. Biological bases of childhood shyness. Science. 1988;240:167.Google Scholar
42.Pollock, RA, Rosenbaum, JF, Marrs, A, et al.Anxiety disorders of childhood. Psych Clin North Am. 1995;18:745–766.Google Scholar
43.Shear, KM. Factors in the etiology and pathogenesis of panic disorder: revisiting the attachment-separation paradigm. Am J Psychiatry. 1996;153(Festschrift Suppl.):25–136.Google Scholar
44.Tyrer, P, Tyrer, S. School refusal, truancy, and adult neurotic illness. Psychol Med. 1974;4:416–421.Google Scholar
45.Perugi, G, Debito, J, Soriani, A, et al.Relationships between panic disorder and separation anxiety with school phobia. Compr Psychiatry. 1988;29:98–107.Google Scholar
46.Hayward, C, Killen, JD, Taylor, CB. Panic attacks in young adolescents. Am J Psychiatry. 1989;146:1061.Google Scholar
47.Moreau, DL, Weissman, MM, Warner, V. Panic disorder in children at high risk for depression. Am J Psychiatry. 1989;146:1059.Google Scholar
48.Moreau, DL, Weissman, MM. Panic disorder in children and adolescents: a review. Am J Psychiatry. 1992;149:1306–1314.Google Scholar
49.Lipsitz, JD, Martin, LY, Mannuzza, S, et al.Childhood separation anxiety disorder in patients with adult anxiety disorders. Am J Psychiatry. 1994;151:927–929.Google Scholar
50.Weissman, MM, Prusoff, BA, Gammon, GD, Merikangas, KR, Leckman, JF, Kidd, KK. Psychopathology in the children (ages 6–18) of depressed and normal parents. J Am Acad Child Psychiatry. 1984;23:78–84.Google Scholar
51.Mavissakalian, M, Hamann, MS. DSM-III personality characteristics of panic disorder with agoraphobia patients in stable remission. Compr Psychiatry. 1992;33:305–309.CrossRefGoogle ScholarPubMed
52.Flick, SN, Roy-Byrne, PP, Cowley, DS, et al.DSM-II-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, and clinical correlates. J Affective Disord. 1993;27:71–79.Google Scholar
53.Roth, M. The panic-agoraphobic syndrome: a paradigm of the anxiety group of disorders and its implications for psychiatric practice and theory. Am J Psychiatry. 1996;153(Suppl. 7):111–124.Google Scholar
54.Kahn, JP, Puertollano, MA, Schane, MD, et al.Adjunctive alprazolam for schizophrenia with panic anxiety: clinical observation and pathogenic implications. Am J Psychiatry. 1988;145:742–744.Google Scholar
55.Sandberg, L, Siris, SG. “Panic disorder” in schizophrenia: a case report. J Nerv Ment Dis. 1987;175:627–628.Google Scholar
56.Siris, SG, Aronson, A, Sellew, AP. Imipramine responsive panic-like symptomatology in schizophrenia/schizoaffective disorder. Biol Psychiatry. 1989;25:485–488.Google Scholar
57.Strakowsky, SM, Tohen, M, Stoll, AL, et al.Comorbidity in mania at first hospitalization. Am J Psychiatry. 1992;149:554–556.Google Scholar
58.Strakowsky, SM, Tohen, M, Stoll, AL, et al.Comorbidity in psychosis at first hospitalization. Am J Psychiatry. 1993;150:752–757.Google Scholar
59.Kendler, KS, Gallagher, TJ, Abelson, JM, et al.Lifetime prevalence, demographic risk factors, and diagnostic validity of non affective psychosis as assessed in a US community sample. Arch Gen Psychiatry. 1996;53:1022–1031.Google Scholar
60.Cassano, GB, Pini, S, Saettoni, M, et al.Occurrence and clinical correlates of psychiatrie comorbidity in patients with psychotic disorders. J Clin Psychiatry. 1998;59:60–68.Google Scholar
61.Black, DW, Winokur, G, Bell, S, et al.Complicated mania. Comorbidity and immediate outcome in the treatment of mania. Arch Gen Psychiatry. 1988;45:232–236.Google Scholar
62.Winokur, G, Black, DW, Nasrallah, A. Depression secondary to other psychiatric disorders and medical illnesses. Am J Psychiatry. 1988;145:233–237.Google Scholar
63.Galynker, I, Ieronimo, C, Perez-Acquino, , et al.Panic attacks with psychotic features. J Clin Psychiatry. 1996;57:402–406.Google Scholar
64.Akiskal, HS, Arana, GW, Baldessarini, RL, et al.A clinical report of thymoleptic-responsive atypical paranoid psychoses. Am J Psychiatry. 1983;140:1187–1190.Google Scholar
65.Roy-Byrne, PP, Uhde, TW, Sack, DA, et al.Plasma HVA and anxiety in patients with panic disorder. Biol Psychiatry. 1986;21:849–853.Google Scholar
66.Stein, MB, Heuser, IJ, Juncos, JL, et al.Anxiety disorders in patients with Parkinson's disease. Am J Psychiatry. 1990;147:217–220.Google Scholar
67.Fagiolini, A, Shear, MK, Cassano, GB, Frank, E. Is lifetime separation anxiety a manifestation of panic spectrum? CNS Spectrums. 1998;3:63–72.Google Scholar