Frank Ellen, Cyranowski Jill M, Rucci Paola, Shear M Katherine, Fagiolini Andrea, Thase Michael E, Cassano Giovanni B, Grochocinski Victoria J, Kostelnik Bryan, Kupfer David J
Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
Arch Gen Psychiatry. 2002 Oct;59(10):905-11. doi: 10.1001/archpsyc.59.10.905.
Given the observed association between panic disorder and bipolar disorder and the potential negative influence of panic symptoms on the course of bipolar illness, we were interested in the effects of what we have defined as "panic spectrum" conditions on the clinical course and treatment outcome in patients with bipolar I (BPI) disorder. We hypothesized that lifetime panic spectrum features would be associated with higher levels of suicidal ideation and a poorer response to acute treatment of the index mood episode in this patient population.
A sample of 66 patients with BPI disorder completed a self-report measure of lifetime panic-agoraphobic spectrum symptoms. Patients falling above and below a predefined clinical threshold for panic spectrum were compared for clinical characteristics, the presence of suicidal ideation during acute treatment, and acute treatment response.
Half of this outpatient sample reported panic spectrum features above the predefined threshold. These lifetime features were associated with more prior depressive episodes, higher levels of depressive symptoms, and greater suicidal ideation during the acute-treatment phase. Patients with BPI disorder who reported high lifetime panic-agoraphobic spectrum symptom scores took 27 weeks longer than those who reported low scores to remit with acute treatment (44 vs 17 weeks, respectively).
The presence of lifetime panic spectrum symptoms in this sample of patients with BPI disorder was associated with greater levels of depression, more suicidal ideation, and a marked (6-month) delay in time to remission with acute treatment. Alternate treatment strategies are needed for patients with BPI disorder who endorse lifetime panic spectrum features.
鉴于惊恐障碍与双相情感障碍之间已观察到的关联，以及惊恐症状对双相情感障碍病程的潜在负面影响，我们对我们所定义的“惊恐谱系”状况对双相I型（BPI）障碍患者的临床病程和治疗结果的影响感兴趣。我们假设，在该患者群体中，终生惊恐谱系特征将与更高水平的自杀意念以及对首发情绪发作的急性治疗反应较差相关。
66例BPI障碍患者的样本完成了一项关于终生惊恐-广场恐怖谱系症状的自我报告测量。将惊恐谱系高于和低于预先定义临床阈值的患者在临床特征、急性治疗期间自杀意念的存在情况以及急性治疗反应方面进行比较。
该门诊样本中有一半报告惊恐谱系特征高于预先定义的阈值。这些终生特征与更多既往抑郁发作、更高水平的抑郁症状以及急性治疗阶段更高的自杀意念相关。报告终生惊恐-广场恐怖谱系症状评分高的BPI障碍患者在急性治疗中达到缓解的时间比评分低的患者长27周（分别为44周和17周）。
在该BPI障碍患者样本中，终生惊恐谱系症状的存在与更高水平的抑郁、更多自杀意念以及急性治疗缓解时间显著延迟（6个月）相关。对于认可终生惊恐谱系特征的BPI障碍患者，需要采用替代治疗策略。
