Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
J Affect Disord. 2010 Feb;121(1-2):30-8. doi: 10.1016/j.jad.2009.05.003. Epub 2009 May 27.
Although panic disorder is generally considered to be a chronic condition, little is known about the natural history of panic attacks and the factors predicting the prognosis of panic. It is expected that data derived from the community show more variation in the prognosis of panic and that subjects with less severe, 'subthreshold panic disorder' have a better prognosis.
Using a large, representative population-based study, the 2-year course of panic attacks and its predictors were investigated among 155 subjects with panic disorder and subthreshold panic disorder. Presence and frequency of attacks were studied using structured interviews. Putative risk-indicators of chronicity included socio-demographics, psychobiological, environmental, psychiatric and panic-related factors.
Thirty-nine percent of those with panic disorder and 17% of those with subthreshold panic disorder reported panic episodes during more than 75% of the observed time periods in the Life Chart Interview. Forty-three percent of those with panic disorder and 14% of those with subthreshold panic disorder reported over 24 attacks per 3-month period. Male gender, severity of panic and agoraphobia predicted a high proportion of time spent in panic episodes. Low self-esteem, limited positive life events and severity of panic predicted highly frequent attacks.
The sample size was small, thereby limiting statistical power. The reported outcome may have overestimated chronicity.
As was expected, the 2-year prognosis of panic was more varied than is often found in clinical studies. Although subthreshold panic disorder had a more favourable prognosis than full-blown panic disorder, a sizeable proportion of those with subthreshold panic disorder had an unfavourable prognosis.
尽管惊恐障碍通常被认为是一种慢性疾病,但人们对惊恐发作的自然病程以及预测惊恐预后的因素知之甚少。预计来自社区的数据会显示出惊恐预后的更多变化,且症状较轻的“阈下惊恐障碍”患者的预后较好。
使用一项大型、具有代表性的基于人群的研究,对 155 例惊恐障碍和阈下惊恐障碍患者的惊恐发作及其预测因素进行了为期 2 年的随访。使用结构化访谈来研究发作的存在和频率。慢性病程的潜在风险指标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。
39%的惊恐障碍患者和 17%的阈下惊恐障碍患者在生命图表访谈中超过 75%的观察期内报告有惊恐发作。43%的惊恐障碍患者和 14%的阈下惊恐障碍患者报告每 3 个月发作超过 24 次。男性性别、惊恐和广场恐怖症的严重程度预测了有较多时间处于惊恐发作状态。低自尊、有限的积极生活事件和惊恐的严重程度预测了发作频率较高。
样本量较小,从而限制了统计效力。报告的结果可能高估了慢性病程。
正如预期的那样,惊恐的 2 年预后比临床研究中常见的预后变化更大。尽管阈下惊恐障碍的预后优于全面性惊恐障碍,但仍有相当一部分阈下惊恐障碍患者的预后不佳。