OBJECTIVE: Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder. METHODS: We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI). RESULTS: There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001). CONCLUSION: IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.
Anxiety ; Cognitive Therapy* ; Depression ; Depressive Disorder ; Diagnosis ; Humans ; Panic Disorder* ; Panic* ; Uncertainty*

OBJECTIVE: This study aimed to test the possible association between cholecystokinin (CCK) promoter gene and panic disorder. METHODS: 267 patients with panic disorder and 82 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Genotype and allele distribution of CCK promoter -36C>T polymorphism patients with panic disorder was not significantly different from those of the controls. In addition, after excluding panic disorder patients with major depressive disorder, we did not find out the association of CCK-36C>T with the panic disorder without comorbidities. CONCLUSION: This study suggested that the CCK promoter -36C>T polymorphism may have not a potential role for susceptibility to panic disorder in the Korean population. Thus calls for consecutive studies in order to pile up the data with larger different ethnic background.
Alleles ; Cholecystokinin* ; Comorbidity ; Depressive Disorder, Major ; Diagnosis* ; Drug Therapy* ; Genotype ; Humans ; Panic Disorder* ; Panic*

The Korean Association of Anxiety Disorders developed a Korean guideline for the treatment of panic disorders in 2018 to help clinicians make treatment decisions. This study investigated the consensus about treatment strategies for initial and maintenance treatment, non-responsive cases, comorbid conditions, and psychotherapy in patients with panic disorder. The executive committee developed questionnaires about treatment strategies for patients with panic disorder based on guidelines, algorithms, and clinical trials previously published in foreign countries and Korea. Seventy-two 61% of 112 experts on a committee reviewing panic disorders responded to the questionnaires. We classified the consensus of expert opinions into 3 categories (first-line, second-line, and third-line treatment strategies) and identified the treatment of choice according using the chi-square test and 95% confidence intervals. This study presents useful information about the consensus among Korean experts regarding pharmacotherapy and cognitive behavior therapy for patients with panic disorder.
Anxiety Disorders ; Cognitive Therapy ; Consensus ; Drug Therapy ; Expert Testimony ; Humans ; Korea ; Panic Disorder ; Panic ; Psychotherapy

OBJECTIVES: Mindfulness-base cognitive therapy (MBCT) has been used to treat patients with depression to prevent relapse. The purpose of this study was to examine the effectiveness of Mindfulness- Base Cognitive Therapy for patients who suffer with generalized anxiety disorder or panic disorder for 1 year. METHODS: 19 patients with generalized anxiety disorder or panic disorder were assigned to receive MBCT for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used at 0 weeks, 8 weeks and 1 year to assess the results. RESULTS: MBCT demonstrated significantly decreases on all the anxiety scale scores (HAM-A, p=0.00 ; BAI, p=0.00) and depressive scale scores (HAM-D, p=0.00 ; BDI, p=0.00). The patients who received 8-week of MBCT showed a higher remission rate (15/19, 78%) during the 1-year followup period. CONCLUSION: MBCT may be effective at relieving the anxiety and depressive symptoms of patients who suffer with generalized anxiety disorder or panic disorder for 1 year. However, further well-designed controlled trials are needed to assess the value of MBCT.
Anxiety ; Anxiety Disorders ; Cognitive Therapy ; Depression ; Follow-Up Studies ; Humans ; Panic ; Panic Disorder ; Recurrence

BACKGROUND: Internet-delivered psychological treatments have been suggested as a chance to expand the access to professional help. However, little is known about the usefulness of different support formats and approaches of digital treatments for panic disorder among clinicians. OBJECTIVE: This narrative review aimed to explore the recent evidence base on the efficacy and acceptability of different internet-delivered treatments for adults with panic disorder. METHODS: A systematic search in electronic databases (Pubmed/Medline, PSYNDEX) and a hand search were performed to identify articles on randomized controlled trials published within the past five years (2012/12/10–2017/12/12) in English peer-reviewed journals. RESULTS: Eight studies (1,013 participants) involving 10 interventions met the inclusion criteria. Nine interventions were primarly based on Cognitive Behavioral Therapy principles. Most interventions were effective, when compared to a control condition (6 of 8 comparisons). Minimal guidance was associated with improved outcomes in one study and adherence in two studies (3 comparisons). Furthermore, no differences were found based on treatment approach (2 comparisons). Regarding acceptability, the attrition rates were moderate to high, ranging from 9.8% to 42.1% of randomized participants. Adherence rates also varied largely (7.8–75%), whereas participant satisfaction of program completers was assessed overall high (5 studies). CONCLUSION: Diverse effective internet-delivered treatments are available for the self-management of panic symptoms. Especially selfguided and transdiagnostic Cognitive Behavioral Therapy approaches appear being efficient options for the dissemination in routine care. However, due to the limited evidence base, further efforts are required to improve the actual uptake of internet-delivered treatments and identify moderators of outcomes.
Adult ; Anxiety Disorders ; Cognitive Therapy ; Hand ; Humans ; Internet ; Panic Disorder ; Panic ; Self Care ; Telemedicine

OBJECTIVE: This study aimed to test the possible association between Cholecystokinin B receptor (CCKBR) promoter gene and panic disorder. METHODS: 262 patients with panic disorder and 76 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Allele distribution of CT repeat polymorphism in patients with panic disorder was not different from those of the controls. However, after excluding the patients with panic disorder comorbid with major depressive disorder and other anxiety disorder, we found out the significant association of CCKBR (CT)n repeat with the panic disorder without comorbidities. And we analysed the data as a di-allelic polymorphism with a short (140-162 bp) and a long (164-180 bp) allele. In the di-allelic analysis, there was an excess of the shorter allele in patients with panic disorder. CONCLUSION: The present study suggested that the CCKBR promoter dinucleotide polymorphism may have a potential role for susceptibility to panic disorder in the Korean population and thus calls for consecutive studies in order to pile up the data with larger different ethnic background.
Alleles ; Anxiety Disorders ; Cholecystokinin* ; Comorbidity ; Depressive Disorder, Major ; Diagnosis* ; Drug Therapy* ; Humans ; Panic Disorder* ; Panic* ; Receptor, Cholecystokinin B*

OBJECTIVE: This study was designed to examine the effects of 3 months of pharmacological treatment on anxiety sensitivity in patients with panic disorder. METHODS: Patients (N=32) who met DSM-IV criteria for panic disorder with or without agoraphobia were treated with paroxetine and/or benzodiazepines for 3 months. Symptom improvement was assessed by using PDSS (Panic Disorder Severity Scale), and anxiety sensitivity using Anxiety Sensitivity Index Revised (ASI-R), Agoraphobic Cognition Questionnaire (ACQ), Body Sensation Questionnaire (BSQ). Ttest, paired T-test, and paired F-test were performed. RESULTS: Patients with panic disorder showed significant reduction in the measurement of severity of illness and anxiety sensitivity after 3 months of pharmacotherapy. However, they still showed higher scores in the ASI-R and ACQ after 3 months of pharmacotherapy compared to normal control subjects. After pharmacotherapy, they showed significant changes in ASI-R after controlling for changes in ACQ and BSQ. CONCLUSIONS: This study suggests that short-term pharmacological treatment is effective on anxiety sensitivity reduction in panic disorder patients with or without agoraphobia. But this study doesn't show that short-term pharmacological treatment normalizes anxiety sensitivity to levels that are characteristic of normal control samples.
Agoraphobia ; Anxiety* ; Benzodiazepines ; Cognition ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy* ; Humans ; Panic Disorder* ; Panic* ; Paroxetine ; Surveys and Questionnaires ; Sensation

OBJECTIVES: We examined the impact of 12-session group cognitive behavioral trerapy(GCBT) on quality of life in patients with panic disorder, and also investigated correlation with the change of some clinical characteristics. METHODS: Patients(N=108) who met DSM-IV criteria for panic disorder with or without agoraphobia were treated by 12-session GCBT. We assessed the quality of life using SF-36 and some clinical characteristics including symptom profiles. We measured anxiety and depression levels using the Spielberger State-Trait Anxiety Inventory(STAI) and the Beck Depression Inventory(BDI), and also measured some cognitive behavioral indexes typically found in panic patients using the Anxiety Sensitivity Index(ASI), the Agoraphobic Cognition Questionnaire(ACQ), the Panic Belief Questionnaire(PBQ), and the Body Sensation Questionnaire(BSQ). RESULTS: GCBT-treated patients showed significant improvement in quality of life in all subscales of SF-36(general health, t=-5.23; , physical functioning, t=-5.89; , role physical, t=-3.67; , body pain, t=-6.36; , vitality t=-8.29; , social functioning, t=-6.56; , role emotion, t=-3.62; , mental health, t=-6.81). Multiple regression analysis showed that the change of anxiety sensitivity was the best predictor of the improvement of SF-36(mental health, R2=.19, p<0.001;, vitality, R2=.14, p<0.001; , social functioning, R2=.15, p<0.001). Otherwise the change of panic belief(general health, R2=.11, p< 0.01; , body pain, R2=15, p<0.001), BDI(role emotion, R2=.08, p<0.05) could explain the improvement of one of subscales of SF-36. CONCLUSION: Our results suggested that 12-session GCBT could significantly improve quality of life in patients with panic disorder. Especially, the reduction of anxiety sensitivity, panic belief and depression with the correction of cognitive distortion and sensitivity might play an important role in improving quality of life in panic patients.
Agoraphobia ; Anxiety ; Cognition ; Cognitive Therapy* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mental Health ; Panic Disorder* ; Panic* ; Quality of Life* ; Sensation

OBJECTIVE: Panic disorder has been suggested to be divided into the respiratory and non-respiratory subtypes in terms of its clinical presentations. The present study aimed to investigate whether there are any differences in treatment response and clinical characteristics between the respiratory and non-respiratory subtypes of panic disorder patients. METHODS: Among the 48 patients those who completed the study, 25 panic disorder patients were classified as the respiratory subtype, whereas 23 panic disorder patients were classified as the non-respiratory subtype. All patients were treated with escitalopram or paroxetine for 12 weeks. We measured clinical and psychological characteristics before and after pharmacotherapy using the Panic Disorder Severity Scale (PDSS), Albany Panic and Phobic Questionnaire (APPQ), Anxiety Sensitivity Index-Revised (ASI-R), State-Trait Anxiety Inventory (STAI-T, STAI-S), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D). RESULTS: The prevalence of the agoraphobia was significantly higher in the respiratory group than the non-respiratory group although there were no differences in gender and medication between the two groups. The respiratory group showed higher scores on the fear of respiratory symptoms of the ASI-R. In addition, after pharmacotherapy, the respiratory group showed more improvement in panic symptoms than the non-respiratory group. CONCLUSION: Panic disorder patients with the respiratory subtype showed more severe clinical presentations, but a greater treatment response to SSRIs than those with non-respiratory subtype. Thus, classification of panic disorder patients as respiratory and non-respiratory subtypes may be useful to predict clinical course and treatment response to SSRIs.
Agoraphobia ; Anxiety ; Citalopram ; Classification ; Depression ; Drug Therapy ; Humans ; Panic ; Panic Disorder* ; Paroxetine ; Prevalence ; Surveys and Questionnaires ; Serotonin Uptake Inhibitors ; Treatment Outcome

OBJECTIVE: There have been much effort to find reliable indicators predicting treatment response in panic disorder. This study aimed to find the effect of pharmacotherapy on biofeedback measurement variables in panic disorder patients. METHOD: We recruited 38 panic disorder patients (M:25, F:13) in the Samsung Medical Center, who were diagnosed by the ADIS-IV (Anxiety Disorder Interview Schedule-IV), and 33 normal control subjects (M:21 F:12). Panic patients were treated with paroxetine for 3 months. All subjects were assessed on forearm and frontal electromyography (EMG), electrodermal response (EDR), and skin temperature in baseline, stress, recovery phases using the Procomp & Biograph biofeedback instrument. Psychological measures such as Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D), Beck depression inventory (BDI), Spielberger state-trait anxiety inventory (STAI-S, STAI-T), and Anxiety sensitivity index (ASI) were also assessed. All measurements were performed at the beginning of the study and after 3 months of paroxetine treatment. RESULT: Panic patients had significantly higher scores on psychological measures such as HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) before treatment. After 3months of treatment, panic patients showed significant improvement on baseline EDR (z=-2.824, p=0.005), stress EDR (z=-2.691, p=0.007), and recovery EDR (z=-3.416, p=0.001). They also showed significant improvement on HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) after treatment. CONCLUSION: Electrodermal response, one of the biofeedback measurement variables, was suggested to be the possible indicator predicting treatment response in panic disorder.
Anxiety ; Biofeedback, Psychology* ; Depression ; Drug Therapy* ; Electromyography ; Forearm ; Galvanic Skin Response ; Humans ; Panic Disorder* ; Panic* ; Paroxetine* ; Skin Temperature