Evaluating The Subtypes of Panic Disorder by using Principal Component Analysis

Amaç: Panik bozukluğunun (PB) değişik alt tiplerinin olduğu ve farklı alt tiplerin belirlenmesinin tanı, tedavi ve sonlanım açısından önemli olduğu ileri sürülmektedir. PB'nin psikopatolojisinin kantitatif değerlendirilmesi konusundaki çalışmalar azdır. Çalışmamızda, panik atak belirtilerinin faktör analizine dayanan alt tiplerinin belirlenmesi amaçlanmıştır.Yöntem: Çalışmamız, Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi ikinci basamak polikliniklerine başvuran ve çalışmaya dahil edilme ölçütlerini karşılayan 159 hasta üzerinde gerçekleştirildi. Çalışmada, araştırıcılar tarafından hazırlanan sosyodemografik bilgi formu, DSM-IV Eksen I Bozukluklar İçin Yapılandırılmış Klinik Görüşme Formu (SCID-I), Panik Agorafobi Ölçeği (PAÖ), Hamilton Depresyon Derecelendirme Ölçeği (HAM-D), Beck Anksiyete Ölçeği (BAÖ) kullanıldı. DSM IV-TR panik atak tanı ölçütlerinde bulunan 13 maddeye, "felç olma korkusu" ile "kaçma isteği, yerinde duramama hali"nin eklenmesiyle toplam 15 maddeden oluşan değişkenlere, katılımcıların son panik ataklarında yaşadıklarını bildirdikleri belirtilere göre Ana Bileşenler Analizi uygulandı.Bulgular: Ana Bileşenler Analizinde toplam varyansın %56'sını açıklayan 6 ayrık faktör kümesi elde edildi. Birinci küme otonomik aktivasyon kümesi, ikinci küme vestibüler belirtiler, üçüncü küme kardiovasküler belirtiler, dördüncü küme psödonörolojik belirtiler, beşinci küme solunum sistemi belirtileri ve altıncı küme ölüm korkusu kümesi olarak adlandırıldı.Sonuç: Çalışmamızda elde edilen belirti profilleri DSM-IV-TR tanı ölçütlerini desteklemektedir. Ana Bileşenler Analizinde, varyansın önemli bir kısmını açıklayan anlamlı alt tipler oluşmuştur

Ana bileşenler analizi ile panik bozukluğu alt tiplerinin değerlendirilmesi

Objective: Panic disorder is put forward to have a heterogeneous structure and multiple subtypes. Evaluating the different subtypes is important for diagnosis, treatment and prognosis. Studies about the quantitative psychopathology assessment are so rare. We aim to determine the subtypes with principal component analysis of panic attack symptoms.Method: 159 outpatients with panic disorder who had referred to the anxiety disorder outpatient unit in Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were included in the study. A sociodemographic questionnaire that was prepared by the investigators, The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Panic and Agoraphobia Scale (PAS), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory (BAI) were used in the study. Variables with 15 items were created adding ‘Fear of stroke’ and ‘desire to escape, restlessness’. Principal Component Analysis was applied according to the panic symptoms that the patiens declared.Results: Six loading factors were obtained explaning 56% of total variance in Principal Component Analysis. The first set was named autonomic activation, the second was vestibular symptoms, the third was cardiovascular symptoms, the fourth was pseudoneurologic symptoms, the fifth was respiratory system symptoms and the sixth was fear of death.Conclusion: Symptom profiles in our study were compatible with DSM-IV-TR diagnostic criteria. Significant panic disorder subtypes were found in principal component analysis

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1. Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, Huang B, Saha TD. The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006; 67:363-374.

2. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Koroglu E (Translation editor). Forth Edition, Ankara: Hekimler Yayın Birliği, 2001. (Turkish)

3. Ley R. The many faces of PN: psychological and physiological differences among three types of panic attacks. Behav Res Ther 1992; 30:347-357.

4. Seguí J, Salvador-Carulla L, García L, Canet J, Ortiz M, Farré JM. Subtyping panic disorders according to their symptoms. Med Clin (Barc) 1998; 110:524-528.

5. Seguí J, Salvador-Carulla L, García L, Canet J, Ortiz M, Farré JM. Semiology and subtyping of panic disorder. Acta Psychiatr Scand 1998; 97:272-277.

6. Aronson TA, Logue JM. Phenomenology of panic attacks: a descriptive study of panic disorder patients’ self reports. J Clin Psychiatry 1988; 49:8-13.

7. Briggs AC, Stretch DD, Brandon S. Subtyping of panic disorder by symptom profile. Br J Psychiatry 1993; 163:201-209.

8. Shioiri T, Someya T, Murashita J, Takahashi S. The symptom structure of panic disorder: a trial using factor and cluster analysis. Acta Psychiatr Scand 1996; 93:80-86.

9. Starcevic V, Kellner R, Uhlenhuth EH, Pathak D. The phenomenology of panic attacks in panic disorder with and without agoraphobia. Comp Psychiatry 1993; 34:36-41.

10. Sarisoy G, Boke O, Arik AC, Sahin AR. Panic disorder with nocturnal panic attacks: symptoms and comrbidities. Eur Psychiatry 2008; 23:195-200.

11. Meuret AE, White KS, Ritz T, Roth WT, Hofmann SG, Brown TA. Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder. J Psychiatr Res 2006; 40:520-527.

12. Biber B, Alkin T. Panic disorder subtypes: differential responses to CO2 challenge. Am J Psychiatry 1999; 156:739-744.

13. Mellman TA, Uhde TW. Sleep panic attacks; new clinical findings and theoretical implications. Am J Psychiatry 1989; 146:1204-1207.

14. Labbate LA, Pollack MH, Otto MW, Langenauer S, Rosenbaum JF. Sleep panic attacks: an association with childhood anxiety and adult psychopathology. Biol Psychiatry 1994; 36:57-60.

15. Katon WJ. Panic disorder and somatization: review of 55 cases. Am J Med 1984; 77:101-106.

16. Garssen B, de Beurs E, Buikhuisen M, van Balkom A, Lange A, van Dyck R. On distinguishing types of panic. J Anxiety Disord 1996; 10:173-184.

17. Nardi AE, Nascimento I, Valença AM, Lopes FL, Mezzasalma MA, Zin WA, Versiani M. Respiratory panic disorder subtype: acute and long-term response to nortriptyline, a noradrenergic tricyclic antidepressant. Psychiatry Res 2003; 120:283-293.

18. Jacob RG, Møller MB, Turner SM, Wall C 3rd. Otoneurological examination in panic disorder and agoraphobia with panic attacks: a pilot study. Am J Psychiatry 1985; 142:715-720.

19. Lydiard RB, Greenwald S, Weissman MM, Johnson J, Drossman DA, Ballenger JC. Panic disorder and gastrointestinal symptoms: findings from the NIMH epidemiologic catchment Area Project. Am J Psychiatry 1994; 151:64-70.

20. Cassano GB, Petracca A, Perugi G, Toni C, Tundo A, Roth M. Derealization and panic attacks: a clinical evaluation of 150 patients with panic disorder/agoraphobia. Compr Psychiatry 1989; 30:5-12. 21. Boer JA. Defining panic: a diagnostic dilemma. Hum Psychopharmacol Clin Exp 1997; 12 (Suppl.1): 3-6.

22. Cox BJ, Hasey G, Swinson RP, Kuch K, Cooke R, Warsh J, Jorna T. The symptom structure of panic attacks in depressed and anxious patients. Can J Psychiatry 1993; 38:181-184.

23. de Beurs E, Garssen B, Buikhuisen M, Lange A, van Balkom A, Van Dyck R. Continuous monitoring of panic. Acta Psychiatr Scand 1994; 90:38-45.

24. Bandelow B, Amering M, Benkert O, Marks I, Nardi AE, Osterheider M, Tannock C, Tremper J, Versiani M. Cardiorespiratory and other symptom clusters in panic disorder. Anxiety 1996; 2:99-101.

25. Konkan R, Yacinkaya S, Erkiran M, Erkmen H. Panic disorder and comorbidity. Düşünen Adam The Journal of Psychiatry and Neurological Sciences 2003;16:219-222. (Turkish)

26. Cox BJ, Endler NS, Norton GR. Levels of “nonclinical panic”. J Behav Ther Exp Psychiatry 1994; 25:35-40.

27. First MB, Spitzer RL, Gibbon M. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Clinical Version, Washington DC: American Psychiatric Pres Inc, 1997.

28. Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Hekimler Yayin Birligi, Ankara, 1999. (Turkish)

29. Bandelow B, Brunner E, Broocks A, Beinroth D, Hajak G, Pralle L, Rüther E. The use of the Panic and Agoraphobia Scale (PAS) in a Clinical Trial. Psychiatry Res 1998; 77:43-49.

30. Tural U, Fidaner H, Alkin T, Bandelow B. Validity and reliability of the Turkish version of the Panic and Agoraphobia Scale. Turk Psikiyatri Derg 2000; 11:29-39. (Turkish)

31. Williams JB. A structured interview guide for Hamilton Depression Rating Scale. Arch Gen Psychiatr 1988; 45:742-747.

32. Akdemir A, Orsel S, Dag I, Turkcapar H, Iccan N, Ozbay H. Clinical use and the reliability and validity of the Turkish version of the Hamilton Depression Rating Scale (HDRS). Journal of Psychiatry Psychology and Psychopharmacology 1996; 4:251- 259. (Turkish)

33. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56:893-897.

34. Ulusoy M, Sahin N, Erkmen H. Turkish Version of The Beck Anxiety Inventory: psychometric properties. J Cognitive Psychotherapy: Int Quaterly 1998; 12:28-35.

35. Turgeon L, Marchand A, Dupuis G. Clinical features in panic disorder with agoraphobia: a comparison of men and women. J Anxiety Disord 1998; 12:539-553.

36. Shioiri T, Someya T, Fujii K, Noguchi T, Takahashi S. Differences in symptom structure between panic attack and limited symptom panic attack: a study using cluster analysis. Psychiatry Clin Neurosci 1997; 51:47-51.
Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi-Cover
  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984
  • Yayıncı: Kare Yayıncılık
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