Panic and Phobias

Isaac Marks, Institute of Psychiatry, London Human emotion seems to have changed Westphal's perceptive label. Many factor analytic studies in Europe and the USA since DSM-III burst on the world in 1980. The mere fear or anxiety that people used showed that fears of public places are sali­ ent in this problem, and that such agora­ to feel has been transformed into dramatic phobic panic and avoidance was also fre­ panic attacks, and it has become vital to know whether 3 of these occurred over the quently accompanied by other nonphobic (nonsituational) features like tonic tension last 3 weeks. A rash of papers has appeared proving that 'panic disorder' is a disease and phasic panics independent of any with a specific genetic background, child­ special cue, depression and depersonal­ hood antecedents, biological markers, and ization. Unlike agoraphobia, panic is a pharmacological treatment. With alacrity rather nonspecific term. Spontaneous panic 'panic disorder' has been clutched to the is almost as frequent in anxious depression psychiatric bosom as proof of our medical as in panic disorder, while phobic panic is a identity. hallmark of nearly all severe phobias, be Alas, we have been here before. Did not they specific, social or agoraphobias.

1. Introduction.- I. Diagnostic Reliability and Epidemiology of DSM-III Anxiety Disorders.- 2. Diagnostic Reliability of Anxiety Disorders.- 1. Introduction.- 2. Definition and Classification of Anxiety Disorders.- 3. Aims.- 4. Methods.- 5. Results.- 5.1. Diagnostic Test-Retest Reliability.- 5.2. Test-Retest Reliability of Symptom Questions.- 5.3. Comparison of Two Diagnostic Methods (DSM-III checklist versus CIDI).- 6. Discussion.- 7. References.- 3. Epidemiology of Panic Attacks and Panic Disorders.- 1. Introduction: Contribution of Epidemiological Data to the Classification of Anxiety Disorders.- 2. Aims.- 3. Methods.- 3.1. Description of the Munich Follow-up Study (MFS).- 3.2. Design and Instruments.- 3.3. Data from the NIMH Epidemiological Catchment Area (ECA) Program.- 3.4. Analysis.- 4. Results.- 4.1. Prevalence Rates and Biosocial Characteristics of DSM-III Anxiety Disorders.- 4.2. Frequencies of Symptoms and Syndromes Related to Panic Disorders.- 4.3. Age of Onset of Anxiety Disorders.- 5. Discussion.- 6. References.- II. Theoretical Models and Empirical Evidence.- 4. Panic Attacks: Theoretical Models and Empirical Evidence.- 1. Introduction.- 2. Biological Models of Panic Attacks.- 2.1. Klein’s and Sheehan’s Models.- 2.2. Empirical Evidence.- 2.2.1. Specificity of Drug Treatments.- 2.2.2. Panic Induction.- 2.2.3. Family and Twin Studies.- 2.2.4. Spontaneity of Panic Attacks.- 2.2.5. Separation Anxiety and School Phobia.- 3. Psychophysiological Models of Panic Attacks.- 3.1. Principles of Psychophysiological Models.- 3.2. Empirical Evidence.- 3.2.1. Positive Feedback Loops in Panic.- 3.2.2. Role of Cognitions.- 3.2.3. Role of Hyperventilation.- 3.2.4. Role of Cardiovascular Events.- 3.2.5. Role of Vestibular Dysfunction.- 4. Discussion and Conclusions.- 5. References.- 5. Experimental Panic: Biobehavioral Notes on Empirical Findings.- 1. Introduction.- 2. Phobias.- 2.1 Some Behavioral Models.- 2.2 Biological Aspects of Behavioral Models of Phobias.- 3. Panic.- 3.1 Biological Models.- 3.2 Behavioral Aspects of Pharmacological Panic Models.- 4. Concluding Remarks.- 5. References.- 6. Experimental Induction of Panic Attacks.- 1. Introduction.- 2. Sodium Lactate and Carbon Dioxide as Panic Challenges ― Historical Development.- 2.1. Lactate Infusion and Panic Attacks.- 2.2. Carbon Dioxide Inhalation and Panic Attacks.- 3. Results of Panic Induction Studies.- 3.1. Effects of Lactate and CO2.- 3.1.1. Self-Reported Anxiety and Symptoms.- 3.1.2. Physiological Effects.- 3.1.3. Biochemical Effects.- 3.2. Incidence of Lactate and CO2-Induced Panic Attacks.- 3.3. Similarity of Laboratory-Induced and Naturally Occurring Panic.- 4. Panic Induction: Limitations and Open Questions.- 4.1. Methodological Considerations.- 4.2. Sensitivity and Specificity of Panic Challenges.- 4.3. Relevance of Baseline Levels of Anxiety and Arousal.- 5. Two Studies on Panic Induction.- 6. Discussion and Conclusions.- 7. References.- 7. Agoraphobia and the Hyperventilation Syndrome ― the Role of Interpretations of Complaints.- 1. Introduction.- 2. Methods.- 3. Results.- 4. Discussion.- 5. References.- 8. Panic Disorder ― Overlap with Symptoms of Somatization Disorder.- 1. Introduction.- 2. Methods.- 2.1. Subjects.- 2.2. The Self-Report Inventory for Somatic Symptoms (SISS).- 2.3. Procedure.- 3. Results.- 3.1. Psychometric Properties of the SISS.- 3.2. Differences between Panic and Control Groups.- 3.3. Relationship between Phobic Avoidance and Major Depression.- 3.4. Relationships with Other Measures.- 4. Discussion.- 5. References.- III. Treatments and Longterm Outcome of Phobias with Panic Attacks.- 9. Longterm Efficacy of Exposure in-Vivo for Cardiac Phobia.- 1. Introduction.- 2. Description of our Exposure Therapy Package.- 2.1. Diagnostic Phase.- 2.2. Cognitive Preparation.- 2.3. Intense Exposure in-Vivo.- 2.4. Self-Control.- 3. Goals and Design of our Study.- 4. Methods.- 4.1. Patients and Therapists.- 4.2. Assessment.- 4.2.1. Questionnaire Measures.- 4.2.2. Behavioral Test.- 4.2.3. Other Symptom-Relevant Variables.- 5. Results.- 5.1. Results for the Entire Patient Group.- 5.1.1. Questionnaire Measures.- 5.1.2. Behavioral Test.- 5.1.3. Other Symptom-Relevant Variables.- 5.2. Comparison of Groups A and B.- 6. Discussion.- 7. References.- 10. Cognitive and Physiological Processes in the Maintainance and Treatment of Panic Attacks.- 1. Introduction.- 2. Effectiveness of Treatment Based on the Cognitive Model of Panic.- 3. Interpretation of Treatment Studies.- 4. Effects of Stress and Panic on Respiration in Panic Patients.- 5. Discussion.- 6. Conclusions.- 7. References.- 11. Exposure In-Vivo with Panic Management for Agoraphobia: Treatment Rationale and Longterm Outcome.- 1. Introduction.- 2. Experimental Design.- 2.1. Treatments: Exposure In-Vivo and Panic Management.- 2.2. Patients.- 2.3. Assessments.- 3. Results.- 3.1. Outcome for Total Patient Sample.- 3.1.1. Symptom Scales: Prospective Follow-Up.- 3.1.2. Interview Data: Retrospective Follow-Up.- 3.1.3. Comparison of Outcome with Three Different Modes of Exposure.- 3.2. Outcome of Mild Agoraphobia.- 3.3. Outcome of Severe Agoraphobia.- 3.3.1. Comparison of Outcome with Group Exposure and Home Based Treatment.- 3.3.2. Comparison of Gainers and Losers.- 3.3.3. Level of Multisymptomatic Disturbance and Outcome in Agoraphobia.- 3.3.4. Changes During Follow-Up.- 4. Summary and Discussion.- 5. References.