The therapeutic effect of cognitive-behavioral therapy(CBT) for panic disorder and agoraphobia (PD/PDA) has been supported by evidences from the several studies. We the have experienced good results of CBT for more than 50 patients with PD/PDA for last two years. In spite of the powerful therapeutic effect, CBT has not been utilized well by psychiatrists in this country. We described the cognitive conceptualization of panic and agoraphobia, fiequently used assessments and homeworks in CBT for PD/PDA, and detailed concepts and methods of the each component of CBT based on our experience. Also, we discussed the comparative studies of the therapeutic results and factors that could influence the effect of CBT for PD/PDA.
Agoraphobia ; Humans ; Panic Disorder* ; Panic* ; Psychiatry

We aimed to investigate whether agoraphobia (A) in panic disorder (PD) has any effects on oxidative and anti-oxidative parameters. We measured total antioxidant capacity (TAC), paraoxonase (PON), arylesterase (ARE) antioxidant and malondialdehyde (MDA) oxidant levels using blood samples from a total of 31 PD patients with A, 22 PD patients without A and 53 control group subjects. There was a significant difference between the TAC, PON, ARE and MDA levels of the three groups consisting of PD with A, PD without A and the control group. The two-way comparison to clarify the group creating the difference showed that the TAC, PON, and ARE antioxidants were significantly lower in the PD with A group compared to the control group while the MDA oxidant was significantly higher. There was no significant difference between the PD without A and control groups for TAC, PON, ARE and MDA levels. We clearly demonstrated that the oxidative stress and damage to the anti-oxidative mechanism are significantly higher in the PD group with A. These findings suggest that oxidative/anti-oxidative mechanisms may play a more important role on the pathogenesis of PB with A.
Agoraphobia* ; Antioxidants ; Aryldialkylphosphatase ; Humans ; Malondialdehyde ; Oxidative Stress* ; Panic Disorder* ; Panic*

OBJECTIVES: Panic disorder is a chronic condition that may carry significant negative impact on the quality of life in patients. However, the association between quality of life in panic patients and their clinical characteristics has not been investigated. Aim of this study is to compare quality of life in panic patients and healthy controls by using WHO Quality of Life(QOL) Scale that evaluates the domains of physical health, psychological health, social relationship and environment. Additionally, relationship between clinical factors in patients with panic disorders and their quality of life were explored. METHOD: 64 patients with panic disorder and 27 healthy controls were recruited in this study and WHO QOL Scales were completed. Total scores and scores of domains of WHO QOL Scale in two groups were compared. Correlation analysis and multiple regression analysis were performed to examine the relationship between quality of life and the clinical characteristics in patients with panic disorder. RESULTS: Total scores and scores of all domains except environmental domain of WHO QOL scale in patients with panic disorder were decreased compared to those in healthy controls. Clinical characteristics including the severity of agoraphobia and depression, number of symptoms during panic attacks and the frequency of panic attacks showed significant correlation with quality of life in general and most of subscales of QOL. Multiple regression revealed that the severity of depression, the number of symptoms during panic attacks and the severity of agoraphobia in the presence of accompanied persons were factors directly affecting the quality of life in the patients with panic disorder. CONCLUSION: Quality of life in patients with panic disorder was poorer than that of healthy controls. The severity of depression, the number of symptoms during panic attacks and the severity of agoraphobia in the presence of accompany were related to the quality of life in the patients with panic disorder.
Agoraphobia ; Depression ; Humans ; Panic Disorder* ; Panic* ; Quality of Life* ; Weights and Measures

OBJECTIVES: The Albany Panic and Phobia Questionnaire (APPQ) was developed to assess fear of activities that may elicit physical sensation in panic patients. There are three subscales (Agoraphobia, Social phobia, and Interoceptive fear) in the scale. The present study was conducted to determine the validity and reliability of APPQ in Korean population. METHODS: One hundred thirty five panic patients and 135 community samples and were enrolled in this study. All subjects completed a psychometric assessment package which included APPQ, ASI-R, ACQ, BSQ, BAI, BDI. RESULTS: 1) APPQ showed good internal consistency (Cronbach's alpha=.95) and high test-retest reliabilities (r=.77). 2) APPQ showed moderate correlations with ASI-R (r=.67), ACQ (r=.67), BSQ (r=.59) and BAI (r=.64). 3) An exploratory factor analysis revealed 3 factors (Agoraphobia, Social Phobia and Intorceptive fear). 4) Panic patients (with or without agoraphobia) had significantly higher sores of the APPQ interoceptive subscale than the community samples (F(2,27)=24.27, p<.001). CONCLUSION: We found that APPQ and its 3 subscales carry valuable internal consistency, test-retest reliability, and convergent and construct validity. These results suggest that APPQ is a reliable and valid instrument to assess patients with panic disorder.
Agoraphobia ; Humans ; Panic Disorder ; Panic* ; Phobic Disorders* ; Psychometrics ; Surveys and Questionnaires ; Reproducibility of Results ; Sensation

OBJECTIVES: Aim of this study was to compare quality of life (QOL) in obsessive compulsive disorder (OCD), panic disorder (PD) and healthy controls. Additionally, relationship between clinical factors in patients and their QOL were explored. METHODS: 49 patients with OCD, 109 patients with PD and 54 healthy controls were recruited. Total scores and scores of each domain of WHO Quality of Life scale (WHOQOL) were compared in the three groups. Correlation analysis and regression analysis were performed to examine the relationship between QOL and the clinical characteristics in the patient group. RESULTS: Total scores and scores of all domains except environmental domain of WHOQOL in patient group were decreased compared to those in healthy control. Scores of social and psychological domains in the OCD group were lower than those in the PD group. The severity of agoraphobia and depression were factors affecting the QOL in the PD group. For the OCD group, comorbid depression was related to social and psychological domain of WHOQOL. CONCLUSION: QOL in patients with OCD and PD was poorer than that of healthy controls. Social relationships and psychological functioning may be poorer in patients with OCD than patients with PD. The severity of depression and agoraphobia predicted QOL in patients with PD. Comorbid depression in OCD might be a predictor of poor QOL.
Agoraphobia ; Depression ; Humans ; Obsessive-Compulsive Disorder* ; Panic Disorder* ; Panic* ; Quality of Life*

OBJECTIVE: Given the association between the pathophysiology of panic disorder and prefrontal cortex function, we aimed to perform a volumetric MRI study in patients with panic disorder and healthy controls focusing on the in vivo neuroanatomy of the OFC. METHODS: Twenty right-handed patients with panic disorder and 20 right-handed healthy control subjects were studied. The volumes of whole brain, total white and gray matters, and OFC were measured by using T1-weighted coronal MRI images, with 1.5-mm-thick slices, at 1.5T. In addition, for psychological valuation, Hamilton Depression Rating (HDRS) and Panic Agoraphobia Scales (PAS) were administered. RESULTS: Unadjusted mean volumes of the whole brain volume, total white and gray matter were not different between the patients and healthy controls while the patient group had significantly smaller left (t=-6.70, p<0.0001) and right (t=-5.86, p<0.0001) OFC volumes compared with healthy controls. CONCLUSION: Our findings indicate an alteration of OFC morphology in the panic disorder and suggest that OFC abnormalities may be involved in the pathophysiology of panic disorder.
Agoraphobia ; Brain ; Depression ; Humans ; Neuroanatomy ; Panic ; Panic Disorder ; Prefrontal Cortex ; Weights and Measures

OBJECTIVES: Depression is a common mental illness and a major cause of suicide. Although serum lipids have been associated with depression and suicide, there has been much debate. In this study, we investigated the relationship between depression, suicide, and serum lipids in patients admitted with depressed mood. METHODS: A total of 134 subjects were divided into 86 non-suicide patients and 48 suicide attempters. The serum lipid levels and sub-scores of the Korean Symptom Checklist-95 (KSCL95) were compared. We also investigated the relationship between serum lipids and sub-scores of KSCL95 and investigated whether serum lipids were risk factors for suicide attempts. RESULTS: There was no difference in serum lipids between the two groups. Among the sub-items of KSCL95, obsession was higher in non-suicide group. Triglyceride showed positive correlations with anxiety, phobic anxiety, agoraphobia, schizophrenia, and self-regulation problem. High triglyceride was a risk factor for suicide attempts. CONCLUSIONS: Triglyceride is associated with depression, anxiety, and self - regulation, and high serum triglyceride levels may be a risk factor for suicide attempts.
Agoraphobia ; Anxiety ; Cholesterol ; Depression ; Humans ; Obsessive Behavior ; Risk Factors ; Schizophrenia ; Self-Control ; Suicide ; Triglycerides

OBJECTIVES: We investigated whether the catechol-O-methyltransferase (COMT) and serotonin related gene polymorphisms may be associated with agoraphobia in patients with panic disorder in Korea. METHODS: The COMT gene (rs4680), 5-hydroxytryptamine (serotonin) transporter linked polymorphic region (5-HTTLPR) gene (rs25531), serotonin receptor 1A (HTR1A) gene (rs6295) genotypes were analyzed in 406 patients with panic disorder and age-sex matched 206 healthy controls. Patients with panic disorder were dichotomized by the presence of agoraphobia. The following instruments were applied : the Beck Depression Inventory, the Beck Anxiety Inventory, the Panic Disorder Severity Scale. RESULTS: There was a significant difference in the distribution of 5-HTTLPR genotype between panic patients with agoraphobia and without agoraphobia (p = 0.024). That is, the panic patients with agoraphobia had a significant excess of the less active 5-HTTLPR allele (S allele). (p = 0.039) Also, we replicated previous western reports which indicated a significant difference in the distribution of COMT genotype between the patients with panic disorder and the healthy controls (p = 0.040). However, no significant associations of agoraphobia or panic disorder with HTR1A gene polymorphisms were found. CONCLUSIONS: This result supports that the COMT polymorphisms may be associated with panic disorder and suggests that the 5-HTTLPR polymorphisms may play a role in the pathogenesis of agoraphobia in the Korean patients with panic disorder.
Agoraphobia ; Alleles ; Anxiety ; Catechol O-Methyltransferase ; Depression ; Genotype ; Humans ; Korea ; Panic Disorder* ; Panic* ; Serotonin

OBJECTIVES: This study was performed to investigate the differences of the clinical feature between panic disorder with agoraphobic patients and panic disorder without agoraphobic patients. METHODS: Two hundred nine patients meeting the criteria of DSM-IV panic disorder were recruited. One group was panic disorder with agoraphobia(n=78, 42 male(53.8%), mean age 37.6+/-9.9 years), another was panic disorder without agoraphobia(n=131, 81 male(61.8%), mean age 40.5+/-10.3 years). The numbers and frequency of panic symptoms were compared between two groups with t-test, and the logistic regression analysis were used for predicting panic disorder with agoraphobia. RESULTS: The number of panic symptoms during panic attack was significantly higher in the group of panic disorder with agoraphobia than the group of panic disorder without agoraphobia(p<0.05). 'Sweating', 'nausea or abdominal distress', 'fear of losing control of going crazy', 'chills or hot flushes' were more frequent in the group of panic disorder with agoraphobia(p<0.05). Among panic symptoms on logistic regression analysis, 'sweating', 'nausea or abdominal distress', 'fear of losing control or going crazy' turned out to correlate significantly with risk of development of agoraphobia in panic disorder. CONCLUSION: These results suggest that the frequency of some symptoms during panic attack may be a predictor of agoraphobia in patients with panic disorder.
Agoraphobia* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Logistic Models ; Panic Disorder* ; Panic*

OBJECTIVES: This study was designed to evaluate clinical effect of paroxetine treatment and to explore psychological predictors of treatment response. METHODS: Patients (n=26) who met DSM-IV criteria for panic disorder with or without agoraphobia were treated by paroxetine for 12 weeks. We assessed symptom improvement using Clinical Global Impression (CGI), and clinical characteristics using Anxiety Sensitivity Index (ASI), Anxious Thoughts and Tendencies (AT & T), Agoraphobic Cognition Questionnaire (ACQ), Body Sensation Questionnaire (BSQ), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). T-test, correlation analysis, and stepwise multiple regression analysis were performed. RESULTS: Panic patients showed significant improvement in severity of illness and each clinical characteristic after 12 weeks of paroxetine treatment. There were significant correlations among severity of illness, anxiety, and depression, and subjective severity was related with catastrophic thoughts. The more catastrophic thoughts and the higher sensitivity of body sensation, Patients had the worse symptom improvement they shorved. Multiple regression analysis showed that catastrophic thought related to agoraphobia was the best predictor of symptom improvement (22%). CONCLUSION: This study suggests that short-term treatment of paroxetine is effective in panic disorder with or without agoraphobia, and that catastrophic thought could be a predictor of poor treatment response. Thus cognitive intervention on catastrohic thoughts may play an important role in symptom improvement in panic disorder.
Agoraphobia ; Anxiety ; Cognition ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Panic Disorder* ; Panic* ; Paroxetine* ; Surveys and Questionnaires ; Sensation