German Journal of Psychiatry ISSN 1455-1033
2000, Vol. 3, Supplement 1, S4
Predictors for Slow Response to Treatment in Panic Disorder
Berger, G. Sachs, M. Amering, A. Holzinger, D. Doby, B. Bankier, H. Katschnig
Department of Psychiatry,
Division of Social Psychiatry, University of Vienna, Austria
Background: In the
treatment of panic disorder improvement starts usually within the first two
months, but some patients may improve after prolonged treatment. At present it
is not known what predicts early or late response. The aim of the study was to
analyzed the impact of pretreatment characteristics and personality disorders on
the onset of remission in the treatment of panic disorder.
Methods: Data of
seventy-three out-patients suffering from panic disorder with or without
agoraphobia and who completed at least 6 weeks of a randomized trial of 24 weeks
of either paroxetine only or paroxetine combined with cognitive group-therapy
were analyzed in a Cox-proportional hazards model. Structured diagnostic interviews (SCID
and IPDE) were used to assess Axis I and Axis II disorders.
Results: The likelihood
to respond to treatment (defined by absence of panic attacks and a clinical
rating of improvement) at any point of time for patients without a personality
disorder was 2.8 times greater than for patients with a personality disorder,
and twice as high for patients without agoraphobia than with agoraphobia. Median
time to response in patients with and without a personality disorder was 20
weeks and 8 weeks, respectively, and in patients with and without agoraphobia 10
and 8 weeks, respectively.
Conclusion: In previous
studies personality disorders and phobic avoidance have been found as predictors
for non-response in panic disorder. Our study shows that patients with these
characteristics have a chance to profit from treatment, but they may need a
substantially longer time. This has to be considered before classifying a
patient as non-responder and switch to another treatment.