Mehtap DELİCE ARSLAN, Abdülkadir TABO, Gazi ALATAŞ, Murat İlhan ATAGÜN

Gender differences in terms of Axis I and Axis II comorbidity in patients with panic disorder

Amaç: Eştanılı durumlar psikiyatrik hastalıkların klinik seyrini, belirti şiddetini ve tedavi cevabını önemli ölçüde etkilerler. Panik bozukluğu, önemli ölçüde yeti yitimine neden olabilen, kişilerarası ilişkilerde azalma, belirli sosyal durumlardan kaçınma, yüksek riskli işlerde çalışmaktan uzak durma, dolayısıyla çalışma performansında azalma ve işsiz kalma gibi ağır sonuçları olabilen bir hastalıktır. Diğer psikiyatrik bozukluklarla sıklıkla birlikte bulunabilmekte, bu durum da yeti yitimini artırmaktadır. Birçok çalışmada panik bozukluğunun kadınlarda sık görülen bir hastalık olduğu, kadın cinsiyetinin panik bozukluğu gelişmesinde önemli bir risk faktörü olduğu gösterilmiştir. Bu çalışmada panik bozukluğuna eşlik eden Eksen I ve Eksen II eştanıları dağılımının cinsiyetler arasında farklılık gösterip göstermediğinin incelenmesi amaçlanmıştır. Yöntem: Çalışmaya içerme ölçütlerini karşılayan ve DSM-IVe göre panik bozukluğu tanısı alan 31i (%49.2) kadın, 32si (%50.8) erkek toplam 63 hasta alınmıştır. Tanı SCID-I kullanılarak konulmuş, sosyodemografik veriler araştırmacılar tarafından geliştirilen formla toplanmış, kişilerin tamamına Panik Agorafobi Ölçeği uygulanmış, çocukluk çağı ayrılık anksiyetesi varlığı araştırılmıştır. Eksen II kişilik bozuklukları SCID-II uygulanarak araştırılmıştır. Sonuçta panik bozukluğu olan her iki cinsiyet arasında demografik, klinik, Eksen I ve Eksen II eştanısı açısından bir fark olup olmadığı araştırılmıştır. Bulgular: Kadın hastaların anlamlı derecede daha fazla ayrılık anksiyetesi öyküsü bildirdikleri, depresyon, sosyal anksiyete bozukluğu, özgül fobi eştanısının kadın hastalarda daha fazla görüldüğü, alkol kullanım bozuklukları eştanısının ise, erkek panik bozukluğu hastalarında daha sık görüldüğü tespit edildi. Eksen 2 eştanıları açısından gruplar arasında fark yoktu. Sonuç: Panik bozukluğuna eşlik eden Eksen I ve Eksen II bozuklukları cinsiyet farklılığı açısından karşılaştıran çalışmamızın bulguları göstermiştir ki depresyon, sosyal anksiyete bozukluğu, özgül fobi ve alkol kullanım bozukluğu eştanısı açısından her iki cins birbirinden farklıdır. Çalışmamız, Eksen II eştanısı açısından cinsiyetler arasında farklılık değil benzerlik olduğunu göstermiştir.

Panik bozukluğu olan hastalarda Eksen I ve Eksen II eştanısı açısından cinsiyet farklılıkları

Objectives: Comorbidity in psychiatric disorders significantly affects the clinical course, the severity of symptoms, and the response to the treatment. Panic disorder can cause considerable disability, reduction of interpersonal relationships, avoidance of certain social situations, and staying away from high-risk jobs and consequently lowering work performance causing loss of job. A number of studies have shown that panic disorder is observed more frequently in females, indicating a gender risk factor. This study investigated potential gender differences in the distribution of Axis I and Axis II comorbidity. Method: A total of 63 patients who satisfied the inclusion criteria and had been diagnosed with panic disorder according to DSM-IV participated in this study. 31 (49.2%) patients were female, and 32 (50.8%) were male. Panic disorder was diagnosed with SCID-I (Structured Clinical Interview for DSM-IV-TR Axis I Disorders). Sociodemographic data were collected using a form developed by the researchers, and the Panic Agoraphobia scale was applied in all cases. The existence of possible childhood separation anxiety was also investigated, and SCID-II was applied to identify Axis II personality disorders. Gender differences in demographic and clinical characteristics and in the comorbidity of Axis I and Axis II disorders were then investigated. Results: The reported prevalence of separation anxiety was considerably higher in the female than in the male patients. Depression, social anxiety disorder, and specific phobias were more common in the female patients, whereas alcohol abuse was more common among the male patients. There was no gender difference in Axis II comorbidity. Conclusions: This comparison of gender differences in Axis I and Axis II disorders that coexist with panic disorders indicated that comorbidities of depression, social and specific phobias, and alcohol abuse comorbidities are different among the genders. However, there appeared to be gender differences in Axis II comorbidities.

PDF

___

1. Apfeldorf WJ, Spielman LA, Cloitre M, Heckelman L, Shear MK. Morbidity of comorbid psychiatric diagnoses in the clinical presentation of panic disorder. Depress Anxiety 2000; 12:78-84.
2. Yates WR. Phenomenology and epidemiology of panic disorder. Ann Clin Psychiatry 2009; 21:95-102.
3. Noyes R Jr, Hoehn-Saric R (editors). Panic disorder and agoraphobia. In: The Anxiety Disorders. Cambridge, England: Cambridge University Press; 1998; 86-157.
4. King-Kallimanis B, Gum AM, Kohn R. Comorbidity of depressive and anxiety disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry 2009; 17:782-792.
5. Silove D, Manicavasagar V, Curtis J, Blaszczynski A. Is early seperation anxiety a risk factor for adult panic disorder? : a critical review. Compr Psychiatry 1996; 37:167-179.
6. Sareen J, Chartier M, Paulus MP, Stein M. Illicit drug use and anxiety disorders: findings from two community surveys. Psychiatry Res 2006; 142:11-17.
7. Noyes R Jr, Reich JH, Suelzer M. Personality traits associated with panic disorder: change associated with treatment. Compr Psychiatry 1991; 32:283-294.
8. Friborg O, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. Comorbidity of personality disorders in anxiety disorders: a meta- analysis of 30 years of research. J Affect Disord 2013; 145:143-155.
9. Starcevic V, Latas M, Kolar D, Berle D. Are there gender differences in catastrophic appraisals in panic disorder with agoraphobia ? Depress Anxiety 2007; 24:545-552.
10. Eaton WW, Kessler RC, Witchen HU, Magee WJ. Panic and panic disorder in the United States. Am J Psychiatry 1994; 151:413-420.
11. Yonkers KA, Zlotnick C, Allsworth J, Warshaw M, Shea T, Keller MB. Is the Course of panic disorder the same in women and men? Am J Psychiatry 1998; 155:596-602.
12. 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.
13. Foot M, Koszycki D. Gender Differences in anxiety-related traits in patients with panic disorder. Depress Anxiety 2004; 20:123-130.
14. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID- CV). Washington DC: American Psychiatric Press Inc., 1997.
15. Corapcioglu A, Aydemir O, Yildiz M, Koroglu E. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Ankara: Hekimler Yayın Birliği, 1999. (Turkish)
16. Spitzer RL, Williams JBW, Gibbon M, First M. Manual for the Structured Clinical Interview for DSM-III-R Personality Disorders. Washington D.C: American Psychiatric Press, 1990.
17. Sorias S, Saygili R, Elbi H, Vahip S, Mete L, Nifirne Z, Ornek I, Aydin C, Aktener E. Structured Clinical Interview for DSM-III-R Personality Disorders, Turkish edition. Izmir: Ege Universitesi Basimevi, 1990. (Turkish)
18. Bandelow B. Assessing the efficacy of treatments for panic disorder and agoraphobia: II. The Panic and Agoraphobia Scale. Int Clin Psychopharmacol 1995; 10:73-81.
19. Tural U, Fidaner H, Alkin T, Bandelow B. Panic Agoraphobia Scale Turkish adaptation. Turk Psikiyatri Derg 2000; 11:29-39.
20. Barzega G, Maina G, Venturello S, Bogetto F. Gender related differences in the onset of panic disorder. Acta Psychiatr Scand 2001; 103:189-195.
21. Starcevic V, Djordjevic A, Latas M, Bogojevic G. Characteristics of agoraphobia in women and men with panic disorder with agoraphobia. Depress Anxiety 1998; 8:8-13.
22. Burke KC, Burke JD Jr, Regier DA, Rae DS. Age at onset of selected mental disorders in five community populations. Arch Gen Psych 1990; 47:511-518.
23. Bland RC, Newman SC, Orn H. Age of onset of psychiatric disorders. Acta Psychiatr Scand Suppl 1988; 338:43-49.
24. Bourdon KH, Boyd JH, Rae DS, Burns BJ, Thompson JW, Locke BZ. Gender differences in phobias: results of the ECA community survey. J Anxiety Disord 1988; 2:227-241.
25. Lee CK, Kwak YS, Yanamamoto J, Rhee H, Kim YS, Han JH, Choi JO. Psychiatric epidemiology in Korea. Part II: Urban and rural differences. J Nerv Ment Dis 1990; 178:247-252.
26. Bekker MHJ. Agoraphobia and gender: A review. Clin Psychol Rev 1996; 16:129-146.
27. Wittchen HU, Essau CA. Epidemiology of panic disorder: progress and unresolved issues. J Psychiatr Res 1993; 27(Suppl.1):47-68.
28. Clum GA, Knowles SL. Why do some people with panic disorders become avoidant? A review. Clin Psychol Rev 1991; 11:295-313.
29. Hayward C, Killen JD, Kraemer HC, Taylor B. Predictors of panic attack in adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39:207-214.
30. Klein RG. Is panic disorder associated with childhood seperation anxiety disorder? Clin Neuropharmacol 1995; 18(Suppl.2):7-14.
31. Chambless DL, Mason J. Sex, sex-role stereotyping and agoraphobia. Behav Res Ther 1986; 24:231-235.
32. Oei TPS, Wanstall K, Evans L. Sex differences in panic disorder with agoraphobia. J Anxiety Dis 1990; 4:317-324.
33. Pollack MH, Otto MW, Rosenbaum JF, Sachs GS, ONeil C, Asher R, Meltzer-Brody S. Longitudinal course of panic disorder: findings from the Massachussetts General Hospital Naturalistic Study. J Clin Psychiatry 1990; 51(Suppl.A):12-16.
34. Clayton, P. The comorbidity factor: establishing the primary diagnosis in patients with mixed symptoms of anxiety and depression. J Clin Psychiatry 1990; 51(Suppl.):35-39. 35. Keller MB, Baker LA. The clinical course of panic disorder and depression. J Clin Psychiatry 1992; 53(Suppl.3):5-8.
36. Stein MB, Shea CA, Uhde TW. Social phobic symptoms in patients with panic disorder: practical and theoritical implications. Am J Psychiatry 1989; 146:235-238.
37. Stein MB, Tancer ME, Uhde TW. Major depression in patients with panic disorder: factors associated with course and recurrence. J Affect Disord 1990; 19:287-296.
38. Starcevic V, Uhlenhuth EH, Kellner R, Pathak D. Patterns of comorbidity in panic disorder and agoraphobia. Psychiatry Res 1992; 42:171-183.
39. Montejo J, Liebowitz MR. Social phobia: Anxiety disorder comorbidity. Bull Menninger Clin 1994; 58(2 Suppl A):A21-42.
40. Himle JA, Crystal D, Curtis GC, Fluent TE. Mode of onset of simple phobia subtypes: further evidence of heterogeneity. Psychiatry Res 1991; 36:37-43.
41. Starcevic V, Uhlenhuth EH, Kellner R, Pathak D. Comorbidity in panic disorder: II. Chronology of appearance and pathogenic comorbidity. Psychiatry Res 1992; 46:285-293.
42. Andersch SE, Hanson LC. Comorbidity of panic disorder in social phobia. Eur J Psychiatry 1993; 7:59-64.
43. Mauri M, Sarno N, Rossi VM, Armani A, Zambotto S, Cassano GB, Akiskal HS. Personality disorders associated with generalized anxiety, panic and recurrent depressive disorders. J Personal Disord 1992; 6:162-167.
44. Brooks RB, Baltazar PL, Munjack DJ. Co-occurence of personality disorders with panic disorder, social phobia, and generalized anxiety disorder: a review of the literature. J Anxiety Disord 1989; 3:259-285.
45. Flick SN, Roy-Byrne PP, Cowley DS, Shores MM, Dunner DL. DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, and clinical correlates. J Affect Disord 1993; 27:71-79.