OBJECTIVES: The objective of this study was to investigate the differences in sociodemographic and clinical characteristics, temperaments, and quality of life between panic disorder (PD) patients with and without major depressive disorder (PD+MDD and PD−MDD patients, respectively). METHODS: We compared 411 PD−MDD and 219 PD+MDD patients. All patients who were drug-free for at least 1 month were assessed at initial outpatient visits before the administration of medication. The following instruments were used for assessment: the NEO Personality Inventory-Neuroticism (NEO-N) ; the Temperament and Character Inventory-Harm Avoidance (TCI-HA) ; the State-Trait Anxiety Inventory (STAI) ; the Intolerance of Uncertainty Scale-Short (IUS); the Anxiety Sensitivity Index-Revised (ASI-R); the Beck Depression Inventory (BDI) ; the Beck Anxiety Inventory (BAI); the Penn State Worry Questionnaire (PSWQ) ; the Generalized Anxiety Disorder for 7 item (GAD-7) ; the Albany Panic and Phobia Questionnaire (APPQ) ; the Panic Disorder Severity Scale (PDSS) ; the Early Trauma Inventory Self Report-Short Form (ETISR-SF) ; the Scale for Suicidal Ideation (SSI) ; the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) ; the Sheehan Disability Scale (SDS) ; and the Short Form health survey (SF-36). RESULTS: Compared to the PD−MDD patients, the PD+MDD patients were younger and more likely to be unmarried. They showed higher rates of unemployment, lower levels of education and income, younger age of onset, more previous suicide attempts, a greater incidence of agoraphobia, and more previous treatments. The PD+MDD patients showed significantly higher scores on the NEO-N, the TCI-HA, the STAI, the IUS, the ASI-R, the BDI, the BAI, the PSWQ, the GAD-7, the APPQ, the PDSS, the ETISR-SF, and the SSI. In addition, the PD+MDD patients showed significantly lower quality of life than did the PD−MDD patients. In contrast with previous studies, we observed no significant differences between the two groups in terms of gender, duration until treatment, and psychiatric comorbidities. CONCLUSIONS: This study showed that the PD+MDD patients have more early trauma experiences, higher levels of anxiety-related temperaments, more severe panic and depressive symptoms, and lower quality of life than the PD−MDD patients.
Age of Onset ; Agoraphobia ; Anxiety ; Anxiety Disorders ; Comorbidity ; Depression ; Depressive Disorder, Major* ; Education ; Health Surveys ; Humans ; Incidence ; Outpatients ; Panic Disorder* ; Panic* ; Phobic Disorders ; Quality of Life ; Single Person ; Suicidal Ideation ; Suicide ; Temperament ; Uncertainty ; Unemployment ; World Health Organization

OBJECTIVE: Despite the increasing number of North Korean defectors, research on their mental health conditions and suicidal thoughts and behaviors has not been conducted systematically. We examined the prevalence and risk factors of suicidal thoughts and behaviors in North Korean defectors. METHODS: This study focused on 300 North Korean defectors recruited from regional resettlement centers in South Korea. In-person interviews based on the North Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders and assess suicidal thoughts and behaviors. Logistic regression analyses were performed to evaluate the association between suicidal thoughts and behaviors and socio-demographic variables, and DSM-IV mental disorders. RESULTS: Lifetime prevalence of suicidal ideation, plans, and attempts were 28.3, 13.3, and 17.3%, respectively. Female sex (OR: 2.0, 95% CI: 1.0–3.9), presence of health problems in the past year (2.6, 95% CI: 1.4–4.6), and absence of both South Korean acquaintances (1.9, 95% CI: 1.0–3.4) and North Korean family (1.7, 95% CI: 1.0–2.9) were associated with higher odds of suicidal thoughts and behaviors, after adjusting for participant age, sex, and education. Presence of a mental disorder was associated with a significantly increased odd of suicide ideation, plan, and attempt. Of all mental disorder categories, agoraphobia had the strongest association with suicidal ideation (6.5, 95% CI: 2.0–21.6), plans (7.7, 95% CI: 2.5–23.2) and attempts (12.0, 95% CI: 3.5–40.8). CONCLUSION: Suicidal thoughts and behaviors among North Korean defectors are higher than the general population in South Korea, especially show high rates in transit countries. Further study should focus on the changes in suicidal thoughts and behaviors according to the settlement process and early prevention.
Agoraphobia ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Female ; Friends ; Humans ; Korea ; Logistic Models ; Mental Disorders ; Mental Health ; Prevalence* ; Risk Factors ; Suicidal Ideation ; Suicide

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

OBJECTIVE: Tamoxifen is an estrogen receptor antagonist used to prevent recurrence of breast cancer, which may provoke depression and anxiety and increase follicle-stimulating hormone (FSH) to patients. We compared anxiety and depression symptoms and FSH levels who received conventional tamoxifen alone and combination treatment of goserelin, a gonadotropin-releasing hormone (GnRH) analogue, with tamoxifen. METHODS: Sixty-four premenopausal women with hormone receptor-positive early-stage breast cancer were included and were assigned randomly to receive either tamoxifen and goserelin combination or tamoxifen alone for 12 months. The participants were evaluated blindly using the Hamilton Depression and Anxiety Rating Scale, the Beck Depression Rating Scale, and the Albany Panic and Phobia Questionnaire (APPQ). Blood FSH levels were assessed at baseline, 6 and 12 months. RESULTS: A significant time×group difference was detected in the agoraphobia trends subscale of the APPQ and in FSH levels. The combination group showed significantly less increases in agoraphobia subscale of APPQ and greater decreases in FSH level than those in the tamoxifen-alone group from baseline to 12 months of treatment. No significant differences for age, tumor grade, body mass index, or family history were found at baseline between the two groups. CONCLUSION: Our results suggest that the combination treatment of tamoxifen and goserelin resulted in less agoraphobia than tamoxifen alone in premenopausal women with breast cancer, which may associated with FSH suppression of goserelin.
Agoraphobia* ; Anxiety ; Body Mass Index ; Breast Neoplasms* ; Breast* ; Depression ; Estrogens ; Female ; Follicle Stimulating Hormone* ; Gonadotropin-Releasing Hormone ; Goserelin* ; Humans ; Panic ; Phobic Disorders ; Prospective Studies* ; Recurrence ; Tamoxifen*

OBJECTIVE: Family and twin studies have suggested genetic liability for panic disorder (PD) and therefore we sought to determine the role of noradrenergic and serotonergic candidate genes for susceptibility for PD in a Japanese population. METHODS: In this age- and gender-matched case-control study involving 119 PD patients and 119 healthy controls, we examined the genotype distributions and allele frequencies of the serotonin transporter gene linked polymorphic region (5-HTTLPR), −1019C/G (rs6295) promoter polymorphism of the serotonin receptor 1A (5-HT1A), and catechol-O-methyltransferase (COMT) gene polymorphism (rs4680) and their association with PD. RESULTS: No significant differences were evident in the allele frequencies or genotype distributions of the COMT (rs4680), 5-HTTLPR polymorphisms or the −1019C/G (rs6295) promoter polymorphism of 5-HT1A between PD patients and controls. Although there were no significant associations of these polymorphisms with in subgroups of PD patients differentiated by gender or in subgroup comorbid with agoraphobia (AP), significant difference was observed in genotype distributions of the −1019C/G (rs6295) promoter polymorphism of 5-HT1A between PD patients without AP and controls (p=0.047). CONCLUSION: In this association study, the 1019C/G (rs6295) promoter polymorphism of the 5-HT1A receptor G/G genotype was associated with PD without AP in a Japanese population.
Agoraphobia ; Asian Continental Ancestry Group ; Case-Control Studies ; Catechol O-Methyltransferase* ; Gene Frequency ; Genotype ; Humans ; Panic Disorder* ; Panic* ; Polymorphism, Genetic* ; Receptor, Serotonin, 5-HT1A* ; Serotonin Plasma Membrane Transport Proteins ; Serotonin*

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

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: Serotonin-1A receptors (5-HTR1A) is suggested to be involved in the etiology of several psychiatric disorders including panic disorder (PD). A few imaging studies have suggested the alterations of the cingulum bundle in PD. The objective of this study is to examine the structural changes of cingulum related to the 5-HTR1A polymorphism rs6295 in the patients with PD. METHODS: Thirty-two right-handed patients with PD [11 men, 21 women; 40.34+/-13.17 (mean+/-SD) age] who met the diagnostic criteria in Structured Clinical Interview for DSM-IV were examined by means of MRI at 3 Tesla. We divided the patients with PD into CC genotype group and non CC genotype group (GG/CG genotype group) of the 5-HTR1A rs6295 polymorphism to compare the cingulum white matter connectivity. RESULTS: Tract-based spatial statistics showed significantly increased fractional anisotropy (FA) values in cingulate gyrus process of left cingulum in 5-HTR1A CC genotype compared to GG/CG genotype in PD. Significant positive correlations were shown between the Albany Panic and Phobia Questionnaire (APPQ) interoceptive fear subscale scores, the Anxiety Sensitivity Inventory-Revised fear of publicly observable anxiety reaction subscale scores and FA values of cingulate gyrus process of left cingulum in 5-HTR1A rs6295 GG/CG genotype group. In CC genotype group, APPQ total, APPQ agoraphobia subscale and APPQ social phobia subscale scores also showed significant positive correlations with FA values of hippocampal process of right cingulum. CONCLUSION: This preliminary study suggests that 5-HTR1A polymorphism may be associated with the cingulum white matter connectivity in PD.
Agoraphobia ; Anisotropy ; Anxiety ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Genotype ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Panic Disorder* ; Panic* ; Phobic Disorders ; Surveys and Questionnaires

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*

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