Universidade Federal do Rio Grande do Sul, Brazil.
Universidade Federal do Rio Grande do Sul, Brazil.
J Affect Disord. 2018 Aug 1;235:474-479. doi: 10.1016/j.jad.2018.04.002. Epub 2018 Apr 12.
Panic disorder (PD) respiratory subtype (RS) was described in order to cluster patients according to their symptoms. These patients are characterized by experiencing a relatively high number of noticeable respiratory symptoms during a panic attack (PA) and a higher reactivity to CO. In this study, we aimed to evaluate the clinical relevance of this diagnostic category, evaluating if there are different responses to cognitive-behavioral therapy in patients with panic disorder RS as compared to those with the non-respiratory subtype (NRS), using serum phosphate as a biological marker.
Patients were assessed by a clinical interview followed by a structured diagnostic interview (M.I.N.I) and classified as RS or NRS based on symptoms. The severity of PD was evaluated throughout the PDSS, CGI, HAM-A, STAI and the BDI rating scales. All patients underwent 12 structured sessions of group-CBT for PD and had their blood collected at baseline and after treatment to assess phosphate levels.
One hundred and thirty-eight patients have been assessed, and 102 were included in this trial. Sixty-nine patients completed the treatment protocol, 42 were classified as RS and 27 as NRS. Both RS and NRS patients improved in all clinical scales (p < 0.001). The mean phosphate levels increased from 2.44 mg/dl ± 0.49 at baseline to 3.38 mg/dl ± 0.52 (p < 0.01) in the RS group as well as from 2.46 mg/dl ± 0.64 at baseline to 3.46 mg/dl ± 0.61 (p < 0.01) in the NSR group.
Small sample size and the lack of assessment of other clinical and physiological parameters, such as respiratory variables.
Our findings suggest that both RS and NRS benefit from group CBT and that there was a change in phosphate levels after effective treatment in both groups. Our data support the idea that there is a reversal of the conditions that promote hypophosphatemia as chronic hyperventilation after CBT treatment, whereas it is in disagreement to the presence of two different PD subtypes based on phosphate levels once their rates did not differ at baseline and had a similar increase after effective treatment.
惊恐障碍（PD）呼吸亚型（RS）是为了根据患者的症状对其进行聚类而描述的。这些患者的特征是在惊恐发作（PA）期间经历相对较高数量的明显呼吸症状，并且对 CO 的反应性更高。在这项研究中，我们旨在评估该诊断类别的临床相关性，通过评估在接受惊恐障碍 RS 的患者与非呼吸亚型（NRS）患者之间，使用血清磷酸盐作为生物标志物，在认知行为疗法方面是否有不同的反应。
通过临床访谈和结构化诊断访谈（MINI）对患者进行评估，并根据症状将其分类为 RS 或 NRS。使用 PDSS、CGI、HAM-A、STAI 和 BDI 评分量表评估 PD 的严重程度。所有患者均接受 12 节团体认知行为疗法（CBT）治疗 PD，并在基线和治疗后采集血液以评估磷酸盐水平。
评估了 138 名患者，其中 102 名患者符合本试验条件。69 名患者完成了治疗方案，其中 42 名被分类为 RS，27 名被分类为 NRS。RS 和 NRS 患者在所有临床量表上均有改善（p<0.001）。RS 组的平均磷酸盐水平从基线时的 2.44mg/dl±0.49 增加到 3.38mg/dl±0.52（p<0.01），NRS 组从基线时的 2.46mg/dl±0.64 增加到 3.46mg/dl±0.61（p<0.01）。
样本量小，缺乏对其他临床和生理参数（如呼吸变量）的评估。
我们的发现表明，RS 和 NRS 均受益于团体 CBT，并且在两组中，治疗有效后磷酸盐水平发生了变化。我们的数据支持这样一种观点，即慢性过度通气后，通过 CBT 治疗逆转了促进低磷酸盐血症的条件，而与基于磷酸盐水平的两种不同 PD 亚型的存在不一致，因为它们在基线时没有差异，并且在有效治疗后有相似的增加。
