Katerndahl D A, Talamantes M
Department of Family Practice, University of Texas Health Science Center at San Antonio, 78284-7795, USA.
J Clin Psychiatry. 2000 Jun;61(6):422-7. doi: 10.4088/jcp.v61n0606.
Although some evidence suggests a bimodal age at onset of panic attacks, the literature comparing subjects with early versus late onset is limited. Previous work suggests that people with late-onset panic attacks may have fewer panic symptoms and exhibit less avoidance. This study sought to compare late-onset panic attacks and early-onset panic attacks with regard to (I) comorbidity, (2) health care utilization, and (3) illness behaviors and coping.
This community-based study involved interviewing randomly selected adults for the presence of DSM-III-R panic attacks. If panic attacks were confirmed, subjects were asked questions concerning panic characteristics, psychiatric comorbidity, symptom perceptions, illness attitudes, coping, and family characteristics. Subjects reporting early-onset panic (panic onset < 50 years of age) were compared with those reporting late onset (onset > or = 50 years of age). Significant univariate analyses were controlled for differences in age, panic duration, and socioeconomic status by using analysis of covariance and logistic regression.
Subjects with late-onset panic attacks (N = 9) utilized the mental health sector less, but were more likely to present to family physicians for their worst panic. Patients with late-onset panic felt that choking and numbness more strongly disrupted function, but felt less strongly that either depersonalization or sweating disrupted function. Subjects with late-onset had fewer comorbid conditions and lower Symptom Checklist-90 scores. Late-onset subjects also had less hypochondriasis and thanatophobia while coping less through avoidance or wishful thinking.
Late-onset panic attacks are associated with less mental health utilization, lower levels of comorbidity, less hypochondriasis, and a greater number of positive coping behaviors.
尽管有证据表明惊恐发作的发病年龄呈双峰分布，但比较早发和晚发患者的文献有限。先前的研究表明，晚发性惊恐发作的患者可能惊恐症状较少，回避行为也较少。本研究旨在比较晚发性惊恐发作和早发性惊恐发作在以下方面的差异：（1）共病情况；（2）医疗保健利用情况；（3）疾病行为和应对方式。
这项基于社区的研究包括对随机选取的成年人进行访谈，以确定是否存在DSM-III-R惊恐发作。如果确诊为惊恐发作，则询问受试者有关惊恐发作特征、精神共病、症状认知、疾病态度、应对方式和家庭特征等问题。将报告早发性惊恐发作（发病年龄<50岁）的受试者与报告晚发性惊恐发作（发病年龄≥50岁）的受试者进行比较。通过协方差分析和逻辑回归控制年龄、惊恐发作持续时间和社会经济地位差异，对显著的单变量分析进行校正。
晚发性惊恐发作的受试者（N = 9）较少利用心理健康服务部门，但在惊恐发作最严重时更倾向于去看家庭医生。晚发性惊恐发作的患者认为窒息和麻木对功能的干扰更大，但认为人格解体或出汗对功能的干扰较小。晚发性惊恐发作的受试者共病情况较少，症状自评量表-9（SCL-90）得分较低。晚发性惊恐发作的受试者疑病和死亡恐惧较少，通过回避或一厢情愿的想法进行应对的情况也较少。
晚发性惊恐发作与较少利用心理健康服务、较低的共病水平、较少的疑病症状以及更多积极的应对行为相关。
