Long-term prognosis of panic disorder (minimum 30 months)

Hisanobu Kaiya, M.D.1), Ysohikazu Miyamae, M.S.1)2), Nobuya Ishida, M.D.1) 3),
Natsuko Kaiya1)
1) Panic Disorder Research Center,Nagoya Mental Clinic
2) Graduate School of Human Sciences,Waseda University
3) Department of Psychiatry, Shiga University of Medical Science

Abstract

The purpose of this research is to investigate the long-term outcome of panic disorder (PD) and identify factors to predict outcome. Two hundred-eight patients meeting DSM-III-R criteria for PD (those with or without agoraphobia) and those suffering panic attacks with agoraphobia were selected, and at least 30 months had passed since diagnosis. Among them we obtained 121 patient self-assessments. Thirty-six percent of all patients experienced at least one panic attack during the follow-up. Forty-two percent suffered from agoraphobia irrespective of severity. Ninety percent, however, were not disabled at work significantly. These results imply that PD is a persistent disorder but the impairment due to it is relatively slight. Multiple regression analysis indicates that poor educational background, lower age at onset, higher symptom number at intake and nausea at onset are related to higher attack frequency. Drug doses are determined by these factors: dizziness at onset, paresthesia at onset, trembling at intake and depression at intake. Presence of heart pounding at intake, dizziness at onset and trembling at onset decrease scores on the global assessment scale. The rate of working performance as a dependent variable is predicted by severity of agoraphobia at intake and feelings of choking at intake. Heart pounding at intake, lower age at onset and poor educational background are related to higher phobic avoidance frequency. 

Subjects

Patients assessed at least 30 months after being diagnosed with Panic Disorder (with or without agoraphobia) or agoraphobia with panic attacks according to DSM-III-R. 
Present Patients: those who visited during the last 2 months. 
Recent Patients: those who visited at least 6 times but not during the last 2 months. 
Infrequent Patients: those who visited less than 6 times.
Fig. 1 
Table 1. Percentage of patients using medication 
 
Total 
Present 
Recent 
Infrequent 
 
(N=113) 
(N=80) 
(N=25) 
(N=8) 
regularly 
71% 
84% 
40% 
38% 
occasionally 
11% 
7%
20%
12%
not at all 
18% 
9%
40%
50% 
Fig. 2 
 
Fig. 3 
Fig. 4 
Fig. 5 
Table 2.Multiple regression analysis for panic attack frequency 
 
Panic attack frequency 
R (R2
0.507 (0.257)*** 
School career 
-0.248** 
Age of onset 
-0.248** 
Symptom number at intake 
0.243** 
Nausea at the onset 
0.206* 
***p<.001; **p<.01; *p<.05; N=99 
Table 3.Multiple regression analysis for drug doses 
 
Drug Doses 
R (R2
0.557(0.310)*** 
Dizziness at the onset 
0.292** 
Paresthesia at the onset 
0.260* 
Trembling at intake 
0.253* 
Depression at intake 
0.234* 
***p<.001; **p<.01; *p<.05; N=75 
Table 4.Multiple regression analysis for the Global Assessment Scale 
 
Global Assessment Scale 
R (R2) 
0.409 (0.167)*** 
Heart pounding at onset 
-0.234* 
Dizziness at the onset 
-0.229* 
Trembling at the onset 
-0.208* 
***p<.001; *p<.05; N=102 
Table 5.Multiple regression analysis for rate of working performance 
 
Rate of working performance 
R (R2
0.405 (0.164)*** 
Agoraphobia at intake 
-0.311** 
Feelings of choking at intake 
-0.226* 
***p<.001; **p<.01; *p<.05; N=100
Table 6.Multiple regression analysis for avoidance frequency 
 
Avoidance frequency
R (R2) 
0.384 (0.147)** 
Heart pounding at intake 
0.240* 
Age of onset 
-0.225* 
School career 
-0.224* 
**p<.01; *p<.05; N=95