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A 15-year follow-up study of patients with panic disorder

Published online by Cambridge University Press:  16 April 2020

Sven Andersch  and
Jerker Hetta
Sven Andersch*
Affiliation:
Department of Psychiatry, Institute of Clinical Neuroscience, Göteborg University, Gothenburg, Sweden
Jerker Hetta
Affiliation:
Department of Psychiatry, Institute of Clinical Neuroscience, Göteborg University, Gothenburg, Sweden
*
*Corresponding author. Present address: Psychiatric Outpatient Centre, Sahlgrenska University Hospital, Mellanvårdsteamet, Lilla Badhusgatan 2, 41121 Gothenburg, Sweden. E-mail address: [email protected] (S. Andersch).
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Abstract

Background

Panic disorder (PD) is generally regarded as a chronic condition with considerable variation in severity of symptoms.

Aims

To describe the long-term outcome of naturalistically treated PD.

Methods

Fifty-five outpatients with PD, who participated in a placebo-controlled drug trial of the efficacy of alprazolam and imipramine 15 years ago were reassessed with the same instruments used in the original study.

Results

Complete recovery (no panic attacks and no longer on medication during the last 10 years) was seen in 18% of patients, and an additional 13% recovered but were still on medication. Fifty-one percent experienced recurrent anxiety attacks whereas 18% still met diagnostic criteria for PD. The incidence of agoraphobia decreased from 69% to 20%. Patients with agoraphobia at admission tended to have a poorer long-term outcome according to daily functioning compared with patients without agoraphobia at admission, although both groups reported improved daily functioning at follow-up. Maintenance medication was common. No benzodiazepine abuse was reported.

Conclusion

PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.

Keywords

Anxiety disorderPanic disorderAgoraphobiaLong-term outcome
Type
Original articles
Information
European Psychiatry , Volume 18 , Issue 8 , December 2003 , pp. 401 - 408
Copyright
Copyright © 2003 European Psychiatric Association

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References

American Psychiatric Association. Benzodiazepines. Dependence, toxicity and abuse. A task force report of the American Psychiatric Association. Washington (DC): APA; 1990.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington (DC): APA; 1980.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington (DC): APA; 1987 [revised, DSM-III-R].Google Scholar
Andersch, SRosenberg, NKKullingsjo, HOttosson, JOBech, PBruun-Hansen, Jet al.Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicenter study. Acta Psychiatr Scand Suppl 1991;83(Suppl 365):18–27.CrossRefGoogle Scholar
Andersch, SHansson, LHällström, T. Panic disorder: a 5-year follow-up study in 52 patients. Eur J Psychiatry 1997;11:145–55.Google Scholar
Ballenger, JCBurrows, GDDuPont, RL JrLesser, IMNoyes, R JrPecknold, JCet al.Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry 1988;45(5):413–22.Google ScholarPubMed
Busto, USellers, EMNaraujo, CACappell, HSanchez-Craig, MSykora, A. Withdrawal reaction after long-term therapeutic use of benzodiazepines. New Engl J Med 1986;315:854–9.CrossRefGoogle ScholarPubMed
Cross-National Collaborative Panic Study SPI. Drug treatment of panic disorder. Comparative efficacy of alprazolam, imipramine and placebo. Br J Psychiatry 1992;160:191–202.CrossRefGoogle Scholar
Derogatis, LRLipman, RSCovi, L. SCL-90: an outpatient psychiatric rating scale. Psychopharmacol Bull 1973;9(1):13–28.Google ScholarPubMed
Good, P. Permutation tests.A practical guide to resampling methods for testing hypotheses. NewYork: Springer; 2000. p. 51–2.Google Scholar
Good, P.Permutation tests.A practical guide to resampling methods for testing hypotheses. NewYork: Springer; 2000. p. 36–7.Google Scholar
Katschnig, HAmering, MStolk, JMKlerman, GLBallenger, JCBriggs, Aet al. Long term follow-up after a drug trial for panic disorder. Br J Psychiatry 1995;167:487–94.CrossRefGoogle ScholarPubMed
Keller, MYonkers, KWarshaw, MPratt, LGollan, JMassion, Aet al.Remission and relapse in subjects with panic disorder and panic with agoraphobia: a prospective short interval naturalistic follow-up. J Nerv Ment Dis 1994;182:290–6.CrossRefGoogle ScholarPubMed
Kelly, DGuirguis, WFrommer, EMitchell-Heggs, NSargant, W. Treatment of phobic states with antidepressants.A retrospective study of 246 patients. Br J Psychiatry 1970;116(533):387–98.CrossRefGoogle ScholarPubMed
Klein, DFRoss, DCCohen, P.Panic and avoidance in agoraphobia. Arch Gen Psychiatry 1987;44:377–89.CrossRefGoogle ScholarPubMed
Klein, DF. Anxiety reconceptualized. In: Klein, DFRaskin, J editors. Anxiety: new research and changing concepts. New York: Raven Press; 1981. p. 235–63.Google Scholar
Lepine, JChignon, JTeherani, M. Suicide attempts in patients with panic disorder. Arch Gen Psychiatry 1993;50:144–9.CrossRefGoogle ScholarPubMed
Liebowitz, MR. Panic disorder as a chronic illness. J Clin Psychiatry 1997;58(Suppl 13):5–8.Google ScholarPubMed
Maier, WBuller, R. One-year follow-up of panic disorder. Outcome and prognostic factors. Eur Arch Psychiatry Neurol Sci 1988;238(2): 105–9.Google ScholarPubMed
Maier, WRosenberg, RArgyle, NBuller, RRoth, MBrandon, Set al. Avoidance behaviour and major depression in panic disorder: a report from the Cross-National Collaborative Panic Study. Psychiatr Dev 1989;7(2):123–42.Google ScholarPubMed
Noyes, R JrClancy, JWoodman, CHolt, CSSuelzer, MChristiansen, Jet al. Environmental factors related to the outcome of panic disorder. A 7-year follow-up study. J Nerv Ment Disord 1993;181(9): 529–38.CrossRefGoogle ScholarPubMed
Noyes, R JrReich, JChristiansen, JSuelzer, MPfohl, BCoryell, WA. Outcome of panic disorder. Relationship to diagnostic subtypes and comorbidity. Arch Gen Psychiatry 1990;47(9):809–18.CrossRefGoogle ScholarPubMed
Pollack, MHSmoller, JW. The longitudinal course and outcome of panic disorder. Psychiatr Clin North Am 1995;18(4):785–801.CrossRefGoogle ScholarPubMed
Rickels, KSchweizer, ECsanalosi, ICase, WGChung, H. Longterm treatment of anxiety and risk of withdrawal. Arch Gen Psychiatry 1988;45:444–50.CrossRefGoogle Scholar
Rosenberg, RBech, PMellergard, MOttosson, JO. Secondary depression in panic disorder: an indicator of severity with a weak effect on outcome in alprazolam and imipramine treatment. Acta Psychiatr Scand Suppl 1991;365:39–45.CrossRefGoogle ScholarPubMed
Roth, MArgyle, N. Anxiety, panic and phobic disorders: an overview. J Psychiatr Res 1988;22:33–54.CrossRefGoogle ScholarPubMed
Roy-Byrne, PPCowley, DS. Course and outcome in panic disorder: a review of recent follow-up studies. Anxiety 1994;1(4):151–60.CrossRefGoogle ScholarPubMed
Sheehan, DVLecrubier, YSheehan, KHAmorim, PJanavs, JWeiller, Eet al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl 20):22–33.Google ScholarPubMed
Sheehan, D. The anxiety disease. New York: The Scribner Book Company Incorporated; 1983. p. 135–8.Google Scholar
Sheehan, D. Benzodiazepines in panic disorder and agoraphobia. J Affect Disord 1987;13:169–81.CrossRefGoogle ScholarPubMed
Spitzer, RWilliams, J. Structured clinical interview for DSM-III-Upjohn Version (SCID-UP 12/15/83). New York: Biometrics Research Department, NewYork State Psychiatric Institute; 1983.Google Scholar
Spitzer, RLWilliams, JB. Revised diagnostic criteria and a new structured interview for diagnosing anxiety disorders. J Psychiatr Res 1988;22(Suppl 1):55–85.CrossRefGoogle Scholar
Warshaw, MGMassion, AOPeterson, LGPratt, LAKeller, MB. Suicidal behaviour in patients with panic disorder: retrospective and prospective data. J Affect Disord 1995;34(3):235–47.CrossRefGoogle ScholarPubMed
Weissman, MMKlerman, GLMarkowitz, JSOuellette, R. Suicidal ideation and suicide attempts in panic disorder and attacks. New Engl J Med 1989;321(18):1209–14.CrossRefGoogle ScholarPubMed
Weissman, MMBland, RCCanino, GJet al. The cross-national epidemiology of panic disorder. Arch Gen Psychiatry 1997;54:305–9.CrossRefGoogle ScholarPubMed
Wittchen, HU. Epidemiology of panic attacks and panic disorder. In: Hand, IWittchen, HU editors. Panic and phobias: empirical evidence of theoretical models and longterm effects of behavioral treatments. Berlin: Springer; 1986. p. 18–2811.CrossRefGoogle Scholar
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