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Pharmacopsychiatry 2006; 39(2): 60-65
DOI: 10.1055/s-2006-931543
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Predictors of Symptom Resolution in Panic Disorder After One Year of Pharmacological Treatment: A Naturalistic Study

C. Marchesi1 , A. Cantoni1 , S. Fontò1 , M. R. Giannelli1 , C. Maggini1
  • 1Dipartimento di Neuroscienze, Sezione di Psichiatria, Università di Parma, Italy
Further Information

Publication History

Received: 21.3.2005 Revised: 20.10.2005

Accepted: 20.10.2005

Publication Date:
23 March 2006 (online)

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Objective: In this naturalistic and prospective study, patients with panic disorder (PD) were treated for one year 1) to verify the rate of patients achieving the resolution of full-symptom attacks, limited-symptom attacks, anticipatory anxiety, phobic avoidance and depression; and 2) to identify the predictors of symptom resolution for each domain. Method: One hundred patients with PD, according to DSM-IV criteria, participated in the study. In all patients, a baseline and a follow-up with monthly evaluations of SCL-90, Ham-A, Ham-D and panic diaries were carried out over a one-year period. All patients were treated with paroxetine or citalopram. Results: Seventy-one patients completed the study, whereas the remaining 29 dropped out. Among completers, remission of full- and limited-symptom panic attacks was observed in 76 % of patients, whereas complete remission (resolution of panic attacks, anticipatory anxiety, phobic anxiety, and depression) was achieved by only 46 % of patients. Predictors of absence of symptom remissions were obsessive-compulsive disorder (OCD) and recurrent major depression (MD) comorbidity (for panic attacks), pre-treatment severity of anxious symptoms (for anticipatory anxiety), phobic anxiety (for phobic avoidance), and depressive symptoms (for depression). Conclusion: This naturalistic study shows that the high comorbidity of OCD and MD and the greater pre-treatment severity of anxious, phobic and depressive symptoms reduced the likelihood of achieving complete remission of symptoms in PD patients who completed the protocol, even though they were adequately treated with SSRI medication.

References

  • 1 Albus M, Scheibe G. Outcome of panic disorder with or without concomitant depression: a 2-year prospective follow-up study.  Am J Psychiatry. 1993;  150 1878-1880
    PubMedSearch in Google Scholar
  • 2 Albus M, Scheibe G, Scherer J. Panic disorder with or without concomitant depression 5 years after treatment: a prospective follow-up.  J Affect Disord. 1995;  34 109-115
    CrossrefPubMedSearch in Google Scholar
  • 3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised. Washington, DC; American Psychiatric Association 1994
    Search in Google Scholar
  • 4 American Psychiatric Association. Practice Guideline for the Treatment of Patients With Panic Disorder. Am J Psychiatry 1998 155(5, suppl): 1-34
    Search in Google Scholar
  • 5 Ballenger J C. Clinical guidelines for establishing remission in patients with depression and anxiety.  J Clin Psychiatry. 1999;  60 (suppl 22) 29-34
    PubMedSearch in Google Scholar
  • 6 Ballenger J C. Treatment of anxiety disorders to remission.  J Clin Psychiatry. 2001;  62 (suppl 12) 5-9
    PubMedSearch in Google Scholar
  • 7 Ballenger J C, Wheadon D E, Steiner M, Bushnell W, Gergel I P. Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder.  Am J Psychiatry. 1998;  155 36-42
    PubMedSearch in Google Scholar
  • 8 Ballenger J C, Davidson J RT, Lecrubier Y, Nutt D J, Baldwin D S, den Boer J A. et al . Consensus statement on panic disorder from the international consensus group on depression and anxiety.  J Clin Psychiatry. 1998;  59 (suppl 8) 47-54
    PubMedSearch in Google Scholar
  • 9 Davidson J RT. The long-term treatment of panic disorder.  J Clin Psychiatry. 1998;  59 (suppl 8) 17-21
    PubMedSearch in Google Scholar
  • 10 den Boer J A. Pharmacotherapy of panic disorder: differential efficacy from a clinical viewpoint.  J Clin Psychiatry. 1998;  59 (suppl 8) 30-36
    CrossrefPubMedSearch in Google Scholar
  • 11 Derogatis L R. SCL-90-R (revised) version manual I. Clinical Psychometrics Research Unit - John Hopkins University School of Medicine 1977
    Search in Google Scholar
  • 12 Doyle A C, Pollack M H. Establishment of remission criteria for anxiety disorders.  J Clin Psychiatry. 2003;  suppl 15 40-45
    PubMedSearch in Google Scholar
  • 13 Doyle A C, Pollack M H. Long-term management of panic disorder.  J Clin Psychiatry. 2004;  65 (suppl 5) 24-28
    PubMedSearch in Google Scholar
  • 14 Faravelli C, Paterniti S, Scarpato A. 5-year prospective, naturalistic follow-up study of panic disorder.  Compr Psychiatry. 1995;  36 271-277
    CrossrefPubMedSearch in Google Scholar
  • 15 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;  23 56-62
    CrossrefPubMedSearch in Google Scholar
  • 16 Hamilton M. The assessment of anxiety states by rating.  Br J Med Psychol. 1959;  32 50-55
    CrossrefPubMedSearch in Google Scholar
  • 17 Katschnig H, Amering M. The long-term course of panic disorder and its predictors.  J Clin Psychopharmacol. 1998;  18 (suppl 2) 6-11
    CrossrefPubMedSearch in Google Scholar
  • 18 Keller M B, Yonkers K A, Warshaw M G, Pratt L A, Gollan J K, Massion A O,. et al . Remission and relapse in subjects with panic disorder and panic with agoraphobia.  J Nerv Ment Dis. 1994;  182 290-296
    PubMedSearch in Google Scholar
  • 19 Lecrubier Y. The impact of comorbidity on the treatment of panic disorder.  J Clin Psychiatry. 1998;  59 (suppl 8) 11-14
    PubMedSearch in Google Scholar
  • 20 Lecrubier Y, Bakker A, Dunban G, Judge R and the collaborative paroxetine panic study i nvestigators. A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder.  Acta Psychiatr Scand. 1997;  95 145-152
    PubMedSearch in Google Scholar
  • 21 Maddock R J, Blacker K H. Response to treatment in panic disorder with associated depression.  Psychopathol. 1991;  24 1-6
    PubMedSearch in Google Scholar
  • 22 Maier W, Buller R. One-year follow-up of panic disorder: outcome and prognostic factors.  Eur Arch Psychiatry Clin Neurosci. 1988;  238 105-109
    PubMedSearch in Google Scholar
  • 23 Massion A O, Dyck I R, Shea M T, Philips K A, Warshaw M G, Keller M B. Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder.  Arch Gen Psychiatry. 2002;  59 434-440
    PubMedSearch in Google Scholar
  • 24 Noyes R J, Clancy J, Woodman C, Holt C S, Suelzer M, Christiansen J. et al . Environmental factors related to the outcome of panic disorder.  J Nerv Ment Dis. 1993;  181 529-538
    PubMedSearch in Google Scholar
  • 25 Noyes R Jr, Reich J, Christiansen J, Suelzer M, Pfohl B, Coryell W A. Outcome of panic disorder. Relationship to diagnostic subtypes and comorbidity.  Arch Gen Psychiatry. 1990;  47 809-818
    PubMedSearch in Google Scholar
  • 26 Pollack M H, Algulander C, Bandelow B, Cassano G B, Greist J H, Hollander E. et al . WCA recommendations for the long-term treatment of panic disorder.  CNS Spectr. 2003;  8 (suppl 1) 17-30
    PubMedSearch in Google Scholar
  • 27 Pollack M H, Otto M W, Rosenbaum J F, Sachs G S, O'Neil C, Asher R. et al . Longitudinal course of panic disorder: findings from the Massachusetts General Hospital Naturalistic Study.  J Clin Psychiatry. 1990;  51 Suppl A 12-16
    PubMedSearch in Google Scholar
  • 28 Pollack M H, Otto M W, Tesar G E, Cohen L S, Meltzer Brody S, Rosenbaum J F. Long-term outcome after acute treatment with alprazolam or clonazepam for panic disorder.  J Clin Psychopharmacol. 1993;  13 257-263
    PubMedSearch in Google Scholar
  • 29 Rosenbaum J F, Pollack M H, Pollock R A. Clinical issues in the long-term treatment of panic disorder.  J Clin Psychiatry. 1996;  57 (suppl 10) 44-48
    PubMedSearch in Google Scholar
  • 30 Scheibe G, Albus M. Predictors of outcome in panic disorder: A 5-year prospective follow-up study.  J Affect Disord. 1996;  41 111-116
    PubMedSearch in Google Scholar
  • 31 Shear M K, Clark D, Freske U. The road to recovery in panic disorder: response, remission, and relapse.  J Clin Psychiatry. 1998;  59 (Suppl 8) 4-8
    PubMedSearch in Google Scholar
  • 32 Shinoda N, Kodama K, Sakamoto T, Yamanouchi N, Takahashi T, Okada S. et al . Predictors of 1-year outcome for patients with panic disorder.  Compr Psychiatry. 1999;  40 39-43
    CrossrefPubMedSearch in Google Scholar
  • 33 Slaap B R, den Boer J A. The prediction of nonresponse to pharmacotherapy in panic disorder: a review.  Depr Anx. 2001;  14 112-122
    PubMedSearch in Google Scholar
  • 34 Toni C, Perugi G, Frare F, Mata B, Vitale B, Mengali F. et al . A prospective naturalistic study of 326 panic-agoraphobic patients treated with antidepressants.  Pharmacopsychiat. 2000;  33 121-131
    PubMedSearch in Google Scholar
  • 35 Warshaw M G, Massion A O, Shea M T, Allsworth J, Keller M B. Predictors of remission in patients with panic with and without agoraphobia: prospective 5-year follow-up data.  The J Nerv Ment Dis. 1997;  185 517-519
    CrossrefPubMedSearch in Google Scholar
  • 36 Zamorski M A, Albucher R C. What to do when SSRIs fail: eight strategies for optimizing treatment of panic disorder.  Am Fam Physician. 2002;  66 477-1484
    PubMedSearch in Google Scholar

Carlo Marchesi

Università di Parma

Dipartimento di Neuroscienze

Sezione di Psichiatria

Strada del Quartiere 2

43100 PARMA

ITALY

Phone: ++39/0521/703523-508

Fax: ++39/0521/230611

Email: carlo.marchesi @unipr.it