Panik bozukluğu hastalarında sosyodemografik özellikler ve komorbidite

Amaç: Bu çalışmanın amacı, panik bozukluğu (PB) hastalarında sosyodemografik özellikleri ve eşlik eden Eksen I tanıların sıklığını araştırmaktır. Yöntem: Çalışmaya, Vakıf Gureba Eğitim Araştırma Hastanesi ve Şişli Etfal Eğitim Araştırma Hastanesi psikiyatri polikliniklerine başvuran ve DSM-IV tanı ölçütlerine göre panik bozukluğu tanısı alan 77 hasta dahil edilmiştir. Eşlik eden psikiyatrik tanılar SCID-I (DSM-IV Eksen I Bozuklukları için Yapılandırılmış Klinik Görüşme) ile değerlendirilmiştir. Bulgular: Hastaların 56’sı (%72.7) kadın, 21’i (%27.3) erkekti. Ortalama yaş 35.53±12.25 idi. Hastaların %37.7’sinin aile öyküsünde Eksen I psikiyatrik bozukluk tanısı olduğu görüldü. Hastaların %93’ünde panik bozukluğun yanında, psikiyatrik bir eştanı saptandı. En sık saptanan eştanı ise majör depresyon (%47.2) idi. Tartışma: Literatürdeki diğer çalışmalarla kıyaslandığında, kadın hasta sayısının fazla olmakla birlikte, kadın/erkek oranının daha düşük olduğu belirlenmiştir. Majör depresyon eştanı oranı literatürle uyumlu iken, yaygın anksiyete bozukluğu (YAB) ve sosyal anksiyete bozukluğu (SAB) eştanı oranlarının düşük olduğu saptanmıştır. Agorafobisi bulunan PB hastalarındaki SAB birlikteliği, agorafobisi bulunmayan PB grubuna göre anlamlı derecede daha yüksek bulunmuştur. Sonuç: PB hastalarının yaklaşık yarısında majör depresyon görülürken, agorafobinin eşlik ettiği hastalarda eştanı sıklığının, özellikle de SAB sıklığının arttığı saptanmıştır.

Sociodemographic characteristics and comorbidity in panic disorder patients

Aim: The aim of the present study is to investigate the sociodemographic characteristics and the frequency of comorbid Axis I diagnosis in panic disorder (PD) patients. Method: 77 patients who referrred to the psychiatry outpatient clinic of Vakıf Gureba Training and Research Hospital and Şişli Etfal Training and Research Hospital and who were diagnosed with panic disorder according to DSM-IV diagnostic criteria were included in the study. Comorbid psychiatric diagnoses were evaluated by SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders). Results: Fifty six of the patients (72.7%) were female, and 21 (27.3%) were male. Mean age was 35.53±12.25. Among patients, 37.7% had Axis I psychiatric disorder diagnosis in their family histories. In 93% of the patients, a psychiatric comorbidity was diagnosed along with panic disorder. The most common Axis I comorbidity was major depression (47.2%). Discussion: Although the number of female patients was higher when compared to other studies, female/male ratio was determined to be lower. The rate of major depression was compatible with the literature, while comorbidity rates for generalized anxiety disorder and social anxiety disorder (SAD) were found to be lower than the groups in similar literature. SAD comorbidity rate in PD patients with agoraphobia was found to be significantly higher than the PD group without agoraphobia. Conclusion: Nearly half of the PD patients had major depression, while in patients with comorbid agoraphobia, prevalence of comorbid disorders, particularly of SAD, was shown to increase.

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1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fourth ed. (DSM-IV). Washington: American Psychiatric Association, 1994.
2. American Psychiatric Association. Diagnostic and satistical manual of mental disorders. Fourt ed. Text revision (DSM-IVTR). Washington: American Psychiatric Association, 2000.
3. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Oakley-Browne MA, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen HU, Yeh EK. The cross-national epidemiology of panic disorder. Arch Gen Psychiatry 1997; 54:305-309.
4. Ateşçi Ç, Karadağ F, Amuk T, Özdel O, Oğuzhanoğlu NK. Panik bozukluğunda özkıyım düşünceleri. Anadolu Psikiyatri Dergisi 2003; 4:81-86.
5. Noyes R Jr, Hoehn-Saric R (editors). Panic disorder and agoraphobia. In: The Anxiety Disorders. Cambridge, England: Cambridge University Press, 1998, 86-157.
6. Onur E, Alkin T, Monkul ES, Fidaner H. Panic-agoraphobic spectrum. Turk Psikiyatri Derg 2004; 15:215-223.
7. Yates WR. Phenomenology and epidemiology of panic disorder. Ann Clin Psychiatry 2009; 21:95-102.
8. Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Baldwin DS, den Boer JA, Kasper S, Shear MK. Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry 1998; 59 (Suppl.8):47-54.
9. Angst J, Wicky W. The epidemiology of frequent and less frequent panic attacks: In Montgomery SA (editor). Psychopharmacology of Panic. New York: Oxford Medical Publications, 1993,7-24.
10. Starcevic V, Kellner R, Uhlenhuth EH, Pathak D. Panic disorder and hypochondriacal fears and beliefs. J Affect Disord. 1992; 24:73-85.
11. Tsygankov DB, Malygin VL, Agasarian EG, Tsygankov BD. Psychological defenses in patients with alcoholism and panic disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2008; 108:96-97.
12. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006; 63:415-424.
13. Chambless DL. The relationship of severity of agoraphobia to associated psychopathology. Behav Res Ther 1985; 23:305-310.
14. Crino RD, Andrews G. Personality disorder in obsessive compulsive disorder: a controlled study. J Psychiatr Res 1996; 30:29-38.
15. Clark LA. Temperament as a unifying basis for personality and psychopathology. J Abnorm Psychol 2005; 114:505-521.
16. Gregory AM, Caspi A, Moffitt TE, Koenen K, Eley TC, Poulton R. Juvenile mental health histories of adults with anxiety disorders. Am J Psychiatry 2007; 164:301-308.
17. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Clinical Version. Washington DC: American Psychiatric Press Inc., 1997.
18. Çorapçıoğlu A, Aydemir Ö, Yıldız M, Köroğlu E. “DSM-IV Eksen I Bozuklukları (SCID-I) için Yapılandırılmış Klinik Görüşme”. Klinik Versiyon. Hekimler Yayın Birliği, Ankara,1999.
19. Breier A, Charney DS, Heninger GR. Major depression in patients with agoraphobia and panic disorder. Arch Gen Psychiatry 1984; 41:1129-1135.
20. Gorman JM. Anxiety disorders: Introduction and overview: In Sadock B, Sadock V (editors). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Seventh Ed. Philadelphia: Lippincott Williams & Wilkins, 2000, 1441.
21. Sheikh JI, Leskin GA, Klein DF. Gender differences in panic disorder: findings from the National Comorbidity Survey. Am J Psychiatry 2002; 159:55-58.
22. Tükel R. Panik Bozukluğu. Psikiyatri Dünyası 1997; 1:12-17. 23 Köroğlu E. Anksiyete Bozuklukları. Hekimler Yayın Birliği, Ankara, 1995.
24. Eaton WW, Dryman A, Weismann MM. Panic and phobia in psychiatric disorders in America: The epidemiologic catchment area study: In Robins LN, Regier DA (editors). Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press, 1991,155-179.
25. Kılıç C. Türkiye Ruh Sağlığı Profili -Erişkin nüfusta ruhsal hastalıkların yaygınlığı, ilişkili faktörler, yetiyitimi ve ruh sağlığı hizmeti kullanım sonuçları. Ankara: T.C Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü, 1998, 77-98.
26. Özbulut Ö. Panik bozukluğunda komorbidite. Uzmanlık Tezi, Dicle Üniversitesi Tıp Fakültesi, Diyarbakır, 2001.
27. Carpiniello B, Baita A, Carta MG, Sitzia R, Macciardi AM, Murgia S, Altamura AC. Clinical and psychosocial outcome of patients affected by panic disorder with or without agoraphobia: results from a naturalistic follow-up study. Eur Psychiatry 2002; 17:394-398.
28. Uhde TW, Boulenger JP, Roy-Byrne PP, Geraci MF, Vittone BJ, Post RM. Longitudinal course of panic disorder: clinical and biological considerations. Prog Neuropsychopharmacol Biol Psychiatry 1985; 9:39-51.
29. Noyes R, Clancy J, Garvey MJ, Anderson DJ. Is agoraphobia a variant of panic disorder or a separate illness? J Anx Dis 1987; 1:3-13.
30. Kikuchi M, Komuro R, Oka H, Kidani T, Hanaoka A, Koshino Y. Panic disorder with and without agoraphobia: comorbidity within a half-year of the onset of panic disorder. Psychiatry Clin Neurosci 2005; 59:639-643.
31. Mc Nally RJ. Panic disorder: a critical analysis. New York: Guilford Press, 1994.
32. Schneier FR, Martin LY, Ross D, Manuzza S, Liebowitz MR, Gorman JM, Klein DF. A comparison of phobic subtypes within panic disorder. J Anx Dis 1991; 5:65-75.
33. Barlow DH, Blanchard EB, Vermilyea JA, Vermilyea BB, DiNardo PA. Generalized anxiety and generalized anxiety disorder: description and reconceptualization. Am J Psychiatry 1986; 143:40-44.
34. Starcevic V, Latas M, Kolar D, Vucinic-Latas D, Bogojevic G, Milovanovic S. Co-occurrence of Axis I and Axis II disorders in female and male patients with panic disorder with agoraphobia. Compr Psychiatry 2008; 49:537-543.
35. Clayton AH, Stewart RS, Fayyad R, Clary CM. Sex differences in clinical presentation and response in panic disorder: pooled data from sertraline treatment studies. Arch Womens Ment Health 2006; 9:151-157.
36. Merikangas KR, Angst J, Eaton W, Canino G, Rubio-Stipec M, Wacker H, Wittchen HU, Andrade L, Essau C, Whitaker A, Kraemer H, Robins LN, Kupfer DJ. Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. Br J Psychiatry 1996; 168(Suppl.30):58-67.
37. Marshall JR. Comorbidity and its effects on panic disorder. Bull Menninger Clin. 1996; 60:39-53.
38. Roy-Byrne PP, Stang P, Wittchen HU, Ustun B, Walters EE, Kessler RC. Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking. Br J Psychiatry 2000; 176:229-235.
39. Baldwin D. Depression and panic: Comorbidity. Eur Psychiatry 1998; 13 (Suppl.2):65-70.
40. Slaap BR, den Boer JA. The prediction of nonresponse to pharmacotherapy in panic disorder: a review. Depress Anxiety 2001; 14:112-122.