Pharmacopsychiatry 2000; 33(5): 174-181
DOI: 10.1055/s-2000-12982
Original Paper

© Georg Thieme Verlag Stuttgart · New York

The Use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial[1]

B. Bandelow1 , A. Broocks1 , G. Pekrun1 , A. George1 , T. Meyer2 , L. Pralle3 , U. Bartmann4 , U. Hillmer-Vogel5 , E. Rüther1
  • 1 Department of Psychiatry, University of Göttingen, Germany
  • 2 Institute of Sports and Preventive Medicine, University of Saarbrücken, Germany
  • 3 Dept. of Statistics, Penn State University, U.S.A.
  • 4 Dept. of Medical Statistics, University of Göttingen, Germany
  • 5 Dept. of Sports Medicine, University of Göttingen, Germany
Further Information

Publication History

26.04.1999

03.03.2000

Publication Date:
31 December 2000 (online)

Background: A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about health). The application of this scale in a double-blind placebo-controlled panic disorder trial is described. At the same time, the aim of the study was to compare the therapeutic effects of aerobic exercise with a treatment of well-documented efficacy. Methods: Patients with Panic disorder (DSM-IV) were randomly assigned to three treatment modalities: running (n = 45), clomipramine (n = 15) or placebo (n = 15). Treatment efficacy was measured with the Panic and Agoraphobia Scale (P & A) and other rating scales. Results: According to the P & A and other scales, both exercise and clomipramine led to a significant decrease of symptoms in comparison to placebo treatment. Clomipramine was significantly more effective and improved anxiety symptoms significantly earlier than exercise. The evaluation of the P & A subscales revealed that exercise exerted its effect mainly reducing anticipatory anxiew and panic-related disability. Conclusions: The new Panic and Agoraphobia Scale was shown to be sensitive to differences between different panic treatments. Analysis of the scales five subscores may help to understand mechanisms of action of panic disorder treatments.

1 This study was supported by a public grant from the Volkswagen Foundation, Hannover, Germany

References

  • 1 Akritas M G, Brunner E. Rank tests for patterned alternatives in factorial designs with interactions. In: Brunner E, Denker M (eds) Research Developments in Probability and Statistics. Festschrift in honor of Madan L. Puri on the occasion of the 65th birthday. Utrecht; VSP International Science Publishers 1996: 277-288
  • 2 Akritas M G, Brunner E. A unified approach to rank tests in mixed models.  J Statistical Planning and Interference. 1997;  61 249-277
  • 3 Ballenger J C, Burrows G D, DuPont R L, Lesser I M, Noyes R, Pecknold J C, Rifkin A, et al. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment.  Arch Gen Psychiat. 1988;  45 413-422
  • 4 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
  • 5 Bandelow B, Brunner E, Broocks A, Beinroth D, Hajak G, Pralle L, R E. The use of the new Panic and Agoraphobia Scale in a clinical trial.  Psychiat Res. 1998;  77 43-49
  • 6 Bandelow B, Hajak G, Holzrichter S, Kunert H J, Rüther E. Assessing the efficacy of treatments for panic disorder and agoraphobia. I. Methodological problems.  Int Clin Psychopharmacol. 1995;  10 83-93
  • 7 Beck A T, Epstein N, Brown R, Steer R A. An inventory for measuring clinical anxiety: psychometric properties.  J Consult Clin Psychol. 1988;  56 893-897
  • 8 Beck A T, Ward C H, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression.  Arch Gen Psychiat. 1961;  41 561-571
  • 9 Bouchard S, Co^te¿ G, Laberge B. The assessment of panic using self-rating: a comprehensive survey of validated instruments.  J Anxiety Dis. 1997;  11 17-32
  • 10 Broocks A, Bandelow B, Pekrun G, George A, Meyer T, Bartmann U, Hillmer-Vogel U, et al. Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder.  Am J Psychiat. 1998;  155 603-609
  • 11 CNCPS . Cross-national collaborative panic study. Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine, and placebo.  Br J Psychiat. 1992;  160 191-202
  • 12 Hamilton M. The assessment of anxiety states by rating.  Br J Med Psychol. 1959;  32 50-55
  • 13 Marks I M, Matthews A M. Brief standard self-rating for phobic patients.  Behariour Research and Therapy. 1979;  17 263-267
  • 14 Montgomery A S, Åsberg M. A new depression sale designed to be sensitive to change.  Br J Psychiat. 1979;  134 382-389
  • 15 NIMH .National Institute of Mental Health. 028 CGI. Clinical Global Impressions. In: Guy E (ed) ECDEU Assessment Manual for Psychopharmacology, Revised Edition. Maryland; Rockville 1976: 217-222
  • 16 Röhmel J. Therapeutic equivalence investigations: statistical considerations.  Stat Med. 1998;  17 1703-1714
  • 17 SAS .SAS User's Guides. Cary, NC; SAS Institute Inc 1995
  • 18 Shear K M, Maser J D. Standardized assessment for panic disorder research. A conference report.   Archives of General Psychiatry. 1994;  51 346-354
  • 19 Snaith R, Baugh S, Clayden A, Sipple M. The clinical anxiety scale - an instrument derived from the Hamilton anxiety scale.  Br J Psychiat. 1982;  141 518-523
  • 20 Wittchen H U, Zaudig M, Schramm E, Spengler H, Mombour W, Klug J, Horn R. Strukturiertes Klinisches Interview für DSM-III-R. Weinheim, Basel; Beltz 1990

1 This study was supported by a public grant from the Volkswagen Foundation, Hannover, Germany

Priv. Doz. Dr. Borwin Bandelow

Department of Psychiatry
University of Göttingen

von-Siebold-Straße 5

37075 Göttingen

Germany

Phone: + 49-551-396607

Fax: + 49-551-392004

Email: bbandel@gwdg.de