Department of Psychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Mie, Japan.
Biopsychosoc Med. 2012 Apr 11;6(1):12. doi: 10.1186/1751-0759-6-12.
The place where a patient experiences his/her first panic attack (FPA) may be related to their agoraphobia later in life. However, no investigations have been done into the clinical features according to the place where the FPA was experienced. In particular, there is an absence of detailed research examining patients who experienced their FPA at home. In this study, patients were classified by the location of their FPA and the differences in their clinical features were explored (e.g., symptoms of FPA, frequency of agoraphobia, and severity of FPA).
The subjects comprised 830 panic disorder patients who were classified into 5 groups based on the place of their FPA (home, school/office, driving a car, in a public transportation vehicle, outside of home), The clinical features of these patients were investigated. Additionally, for panic disorder patients with agoraphobia at their initial clinic visit, the clinical features of patients who experienced their FPA at home were compared to those who experienced their attack elsewhere.
In comparison of the FPAs of the 5 groups, significant differences were seen among the 7 descriptors (sex ratio, drinking status, smoking status, severity of the panic attack, depression score, ratio of agoraphobia, and degree of avoidance behavior) and 4 symptoms (sweating, chest pain, feeling dizzy, and fear of dying). The driving and public transportation group patients showed a higher incidence of co-morbid agoraphobia than did the other groups. Additionally, for panic disorder patients with co-morbid agoraphobia, the at-home group had a higher frequency of fear of dying compared to the patients in the outside-of-home group and felt more severe distress elicited by their FPA.
The results of this study suggest that the clinical features of panic disorder patients vary according to the place of their FPA. The at-home group patients experienced "fear of dying" more frequently and felt more distress during their FPA than did the subjects in the other groups. These results indicate that patients experiencing their FPA at home should be treated with a focus on the fear and distress elicited by the attack.
患者首次经历惊恐发作（FPA）的地点可能与其日后出现广场恐惧症有关。然而，目前尚无研究针对 FPA 发生地点进行临床特征分析。特别是，缺乏对在家中经历 FPA 的患者进行详细研究。在这项研究中，根据 FPA 的发生地点对患者进行分类，并探讨了他们临床特征的差异（例如，FPA 的症状、广场恐惧症的频率以及 FPA 的严重程度）。
本研究纳入了 830 名惊恐障碍患者，根据 FPA 发生地点将他们分为 5 组（家、学校/办公室、驾驶汽车、公共交通工具内、家以外的地方），并对这些患者的临床特征进行了调查。此外，对于初次就诊即患有广场恐惧症的惊恐障碍患者，比较了在家中经历 FPA 与在其他地方经历 FPA 的患者的临床特征。
在比较 5 组 FPA 时，在 7 个描述符（性别比例、饮酒状态、吸烟状态、惊恐发作严重程度、抑郁评分、广场恐惧症比例和回避行为程度）和 4 个症状（出汗、胸痛、头晕和濒死感）方面存在显著差异。驾驶和公共交通工具组患者共病广场恐惧症的发生率高于其他组。此外，对于共病广场恐惧症的惊恐障碍患者，在家中经历 FPA 的患者比在其他地点经历 FPA 的患者更频繁地感到濒死恐惧，并且他们的 FPA 引起的痛苦程度更高。
本研究结果表明，惊恐障碍患者的临床特征因 FPA 发生地点而异。在家中经历 FPA 的患者比其他组患者更频繁地经历“濒死恐惧”，并且在 FPA 期间感到更严重的痛苦。这些结果表明，在家中经历 FPA 的患者应注重治疗惊恐发作引起的恐惧和痛苦。
