Meuret Alicia E, White Kamila S, Ritz Thomas, Roth Walton T, Hofmann Stefan G, Brown Timothy A
Department of Psychology, Southern Methodist University, 6424 Hilltop Lane, Dallas, TX 75205, USA.
J Psychiatr Res. 2006 Sep;40(6):520-7. doi: 10.1016/j.jpsychires.2005.09.006. Epub 2005 Nov 15.
Subtyping panic disorder by predominant symptom constellations, such as cognitive or respiratory, has been done for some time, but criteria have varied considerably between studies. We sought to identify statistically symptom dimensions from intensity ratings of 13 DSM-IV panic symptoms in 343 panic patients interviewed with the Anxiety Disorders Interview Schedule for DSM-IV Lifetime Version. We then explored the relation of symptom dimensions to selected illness characteristics. Ratings were submitted to exploratory maximum likelihood factor analysis with a Promax rotation. A three-factor solution was found to account best for the variance. Symptoms loading highest on the first factor were palpitations, shortness of breath, choking, chest pain, and numbness, which define a cardio-respiratory type (with fear of dying). Symptoms loading highest on the second factor were sweating, trembling, nausea, chills/hot flashes, and dizziness, which defines a mixed somatic subtype. Symptoms loading highest on the third factor were feeling of unreality, fear of going crazy, and fear of losing control, which defines a cognitive subtype. Subscales based on these factors showed moderate intercorrelations. In a series of hierarchical multiple regression analyses, the cardio-respiratory subscale was a strong predictor of panic severity, frequency of panic attacks, and agoraphobic avoidance, while the cognitive subscale mostly predicted worry due to panic. In addition, patients with comorbid asthma had higher scores on the cardio-respiratory subscale. We conclude that partly independent panic symptom dimensions can be identified that have different implications for severity and control of panic disorder.
根据主要症状群对惊恐障碍进行亚型划分，比如认知型或呼吸型，已经开展了一段时间，但不同研究之间的标准差异很大。我们试图从343名惊恐障碍患者对13种DSM-IV惊恐症状的强度评分中，通过《DSM-IV焦虑障碍访谈量表终生版》访谈来确定统计学上的症状维度。然后我们探讨了症状维度与选定的疾病特征之间的关系。评分被提交至采用斜交旋转的探索性极大似然因子分析。发现一个三因子解决方案能最好地解释方差。在第一个因子上负荷最高的症状是心悸、呼吸急促、窒息感、胸痛和麻木，这些症状定义了一种心肺型（伴有濒死恐惧）。在第二个因子上负荷最高的症状是出汗、颤抖、恶心、寒战/潮热和头晕，这些症状定义了一种混合躯体亚型。在第三个因子上负荷最高的症状是现实解体感、害怕发疯和害怕失控，这些症状定义了一种认知亚型。基于这些因子的分量表显示出中等程度的相互关联。在一系列分层多元回归分析中，心肺分量表是惊恐严重程度、惊恐发作频率和场所恐惧回避的有力预测指标，而认知分量表主要预测因惊恐所致的担忧。此外，合并哮喘的患者在心肺分量表上得分更高。我们得出结论，可识别出部分独立的惊恐症状维度，它们对惊恐障碍的严重程度和控制具有不同的意义。
