Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Psychol Med. 2010 Jan;40(1):147-57. doi: 10.1017/S0033291709005625. Epub 2009 Apr 29.
Panic disorder (PD) is generally considered to be a chronic or intermittent disorder. This view may be biased because of a lack of general population studies investigating panic from the onset of an episode onwards. Data regarding the course of subthreshold panic disorder (sub-PD) and predictors of its course are lacking.
Using data from a large community-based survey, the Netherlands Mental Health and Incidence Study (NEMESIS), that retrospectively assessed the 2-year course of panic with a Life Chart Interview (LCI), this study investigated remission, chronicity and recurrence in subjects with new episodes of PD or sub-PD. Predictor variables of remission consisted of sociodemographics, psychobiological, environmental, psychiatric and panic-related factors.
In PD, remission of panic attacks occurred in 64.5% of subjects, mean time to remission was 5.7 months, and the remission rate was 5.8/100 person-months. In 43.3% of subjects panic was still present after 1 year. Recurrence of panic attacks occurred in 21.4% of those with PD who had achieved remission and for whom sufficient follow-up time was available. In general, the course of sub-PD was more favourable. Predictors of remission were female gender, the absence of ongoing difficulties, subthreshold panic and a low initial frequency of attacks.
These results suggest that the course of panic is diverse in the general population, thereby underlining the need for accurate predictors. This requires further research including biological data and additional psychological data. In addition, given the large proportion with a relapse, relapse prevention should be part of any treatment programme.
惊恐障碍（PD）通常被认为是一种慢性或间歇性疾病。这种观点可能存在偏差，因为缺乏从发作开始就对惊恐进行的一般人群研究。关于阈下惊恐障碍（sub-PD）的病程及其病程预测因素的数据也很缺乏。
本研究使用来自一项大型基于人群的调查（荷兰精神健康和发病研究，NEMESIS）的数据，该调查通过生活图表访谈（LCI）回顾性评估惊恐的 2 年病程。本研究调查了新发 PD 或 sub-PD 患者发作的缓解、慢性和复发情况。缓解的预测变量包括社会人口统计学、心理生物学、环境、精神科和惊恐相关因素。
在 PD 中，64.5%的患者惊恐发作缓解，平均缓解时间为 5.7 个月，缓解率为 5.8/100 人月。在 1 年后，仍有 43.3%的患者存在惊恐。在已缓解且有足够随访时间的 PD 患者中，有 21.4%的患者出现惊恐发作复发。一般来说，sub-PD 的病程更有利。缓解的预测因素是女性性别、无持续困难、阈下惊恐和初始发作频率低。
这些结果表明，惊恐在一般人群中的病程是多样化的，因此需要准确的预测因素。这需要进一步的研究，包括生物学数据和额外的心理数据。此外，鉴于复发的比例较大，复发预防应成为任何治疗计划的一部分。
