Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Clinical Psychology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
Yonsei Med J. 2023 Nov;64(11):670-678. doi: 10.3349/ymj.2022.0592.
This study aimed to compare the clinical features of panic disorder (PD) with comorbid agoraphobia to those of PD alone. We focused on autonomic nervous system (ANS) alterations reflected in heart rate variability (HRV) and executive function deficits reflected in the Stroop test.
We retrospectively compared psychometric features, Stroop test results, and resting-state HRV across three groups: a subclinical group with anxiety attack history, a PD group without agoraphobia, and a PD group with agoraphobia. The subclinical group included 10 male and 34 female, the PD without agoraphobia group included 17 male and 19 female, and the PD with agoraphobia group included 11 male and 18 female.
The PD with agoraphobia group had higher Symptom Checklist-95 scores than the other groups. Both PD groups had longer reaction times in the Stroop test than the subclinical group. There were no significant differences in HRV parameters between the PD groups with and without agoraphobia. Compared with the subclinical group, the PD with agoraphobia group showed significantly lower values of the natural logarithm of low-frequency HRV.
Our results do not support that executive function deficits and ANS alterations are more pronounced with comorbid agoraphobia among PD groups. However, PD with agoraphobia patients showed more complex and severe clinical symptoms in their self-reports. Compared with the subclinical group, PD patients with agoraphobia showed specific features in the natural logarithm of low-frequency HRV. Our findings suggest that agoraphobia comorbidity should be considered when evaluating or treating patients with PD.
本研究旨在比较合并广场恐怖症（PD）与单纯 PD 的临床特征。我们专注于反映在心率变异性（HRV）中的自主神经系统（ANS）改变和反映在 Stroop 测试中的执行功能缺陷。
我们回顾性比较了三个组的心理计量特征、Stroop 测试结果和静息状态 HRV：有焦虑发作史的亚临床组、无广场恐怖症的 PD 组和有广场恐怖症的 PD 组。亚临床组包括 10 名男性和 34 名女性，PD 无广场恐怖症组包括 17 名男性和 19 名女性，PD 有广场恐怖症组包括 11 名男性和 18 名女性。
PD 伴广场恐怖症组的症状清单-95 评分高于其他组。两个 PD 组在 Stroop 测试中的反应时间均长于亚临床组。有和无广场恐怖症的 PD 组之间的 HRV 参数没有显著差异。与亚临床组相比，PD 伴广场恐怖症组的低频 HRV 的自然对数值明显较低。
我们的结果不支持在 PD 组中合并广场恐怖症时执行功能缺陷和 ANS 改变更为明显。然而，PD 伴广场恐怖症患者在自我报告中表现出更复杂和严重的临床症状。与亚临床组相比，PD 伴广场恐怖症患者在低频 HRV 的自然对数中表现出特定特征。我们的发现表明，在评估或治疗 PD 患者时应考虑合并广场恐怖症。
