Dannon Pinhas N, Iancu Iulian, Lowengrub Katherine, Grunhaus Leon, Kotler Moshe
The Rehovot Community Mental Health and Rehabilitation Clinic, Ness Ziona-Beer Yaakov Medical Campus, Rehovot, Israel.
Clin Neuropharmacol. 2006 May-Jun;29(3):132-7. doi: 10.1097/01.WNF.0000220821.73017.14.
The aim of this naturalistic follow-up study was to examine the effect of pregnancy as a predicting factor of relapse in patients with panic disorder (PD).
Eighty-five female patients with PD (between the ages of 20 and 35 years) were included in this study. They were divided into 2 groups based on whether the onset of PD had been during pregnancy (PD-pregnancy [PD-P]) or whether the onset of PD had been while not pregnant (PD-nonpregnant [PD-NP]). Patients were treated with paroxetine up to 40 mg/day for 12 months, and the full responders were tapered off their medication and were monitored for an additional 6 years. Treatment response was assessed using the Panic Self-Questionnaire (PSQ) with full response being defined as "0" panic attacks. Assessments using the PSQ were made at baseline and every 4 weeks for the first twelve months. During the 6-year drug-free follow-up period, patients were assessed using the PSQ every 3 months. Relapse was defined as the occurrence of a panic attack in any phase of the study. The effect of group membership (PD-P vs. PD-NP) and new pregnancies as risk factors for relapse were explored.
Sixty-eight patients completed the 6-year follow-up, and each of the study groups (PD-P and PD-NP) was composed of 34 patients. Twenty-six of 34 (76.6%) patients in the PD-P group had another pregnancy, and 15/26 (57%) in this group experienced a relapse during the subsequent pregnancy. Three of 8 (37%) PD-P patients experienced a relapse without pregnancy. Among the second group (PD-NP), 18/34 (52.9%) became pregnant and 8/18 (44.4%) experienced a relapse at the time of pregnancy, whereas 4/16 (25%) experienced a relapse while not pregnant. Patients who relapsed during pregnancy had a more severe relapse (as defined by the severity of the PSQ score) compared with nonpregnant relapsers.
Our naturalistic follow-up study demonstrated that pregnancy might confer an increased risk of relapse in PD. Moreover, when compared with patients who develop PD while not pregnant (PD-NP), patients who develop PD during pregnancy (PD-P) appear to have a higher risk of relapse at the time of a subsequent pregnancy (P < 0.001).
本自然随访研究旨在探讨妊娠作为惊恐障碍（PD）患者复发预测因素的作用。
本研究纳入了85例年龄在20至35岁之间的女性PD患者。根据PD发病是否在孕期（孕期惊恐障碍[PD-P]）或非孕期（非孕期惊恐障碍[PD-NP]），将她们分为两组。患者接受帕罗西汀治疗，剂量最高达40mg/天，持续12个月，完全缓解者逐渐减药，并额外监测6年。使用惊恐自评问卷（PSQ）评估治疗反应，完全缓解定义为“0”次惊恐发作。在基线时以及治疗的前十二个月每4周使用PSQ进行评估。在6年的停药随访期内，每3个月使用PSQ对患者进行评估。复发定义为在研究的任何阶段出现惊恐发作。探讨了分组（PD-P与PD-NP）和新妊娠作为复发危险因素的作用。
68例患者完成了6年随访，每个研究组（PD-P和PD-NP）各有34例患者。PD-P组34例患者中有26例（76.6%）再次怀孕，其中15/26（57%）在随后的孕期复发。8例PD-P患者中有3例（37%）在未怀孕时复发。在第二组（PD-NP）中，18/34（52.9%）怀孕，其中8/18（44.4%）在孕期复发，而4/16（25%）在非孕期复发。与非孕期复发的患者相比，孕期复发的患者复发更为严重（根据PSQ评分的严重程度定义）。
我们的自然随访研究表明，妊娠可能会增加PD患者的复发风险。此外，与非孕期患PD的患者（PD-NP）相比，孕期患PD的患者（PD-P）在随后孕期复发的风险似乎更高（P<0.001）。
