Panic and Agoraphobia Scale (P&A/PAS)

By B. Bandelow, Göttingen, Germany  

Languages - Clinical Trials - Publications

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The Panic and Agoraphobia Scale

The PAS is the first ever scale for assessing the severity of panic disorder with or without agoraphobia. Compatible with both DSM-IV and ICD-10 classifications, and available in both self-rated and observer-rated versions, the PAS was specially developed for monitoring the efficacy of both drug and psychotherapy treatments.

The PAS has excellent psychometric properties, and is quick to use (the observer-rated version can be completed in 5-10 minutes). It has been successfully applied in both double-blind placebo-controlled studies and open treatment trials, and can be used by clinicians as well as for research purposes.

Order the Panic and Agoraphobia Scale Here

This manual describes the development of the scale, shows how to use it and evaluate results, and details its psychometric properties. In addition, both the self-rated and the observer-rated versions in all 17 different languages are reproduced. Contents:The PAS: An overview ˇ The development of the Panic and Agoraphobia Scale ˇ How to use and evaluate the scale ˇ Psychometric properties ˇ Conclusion ˇ Different language versions of the Panic and Agoraphobia Scale

 

 

CPMP Guidelines Recommend the Use of the P&A

According to the "Note for the Guidance for the Clinical Investigation of Medicinal Products indicated for the Treatment of PANIC DISORDER", edited by the CPMP (Committee for Proprietary Medicinal Products) of the EMEA (European Agency for the Evaluation Medicinal Products), it is recommended to use the P&A as primary efficacy measure for clinical trials in panic disorder.

 

Download CPMP Guidelines

 

 

 

Language Versions

In addition to the English scale, translations are available in:

Afrikaans

Arabic

Danish

Dutch

French

French - Canadian

German

Greek

Hebrew

 

 

 

 

 

Hungarian

Italian

Japanese

Polish

Portuguese

Serbian

Spanish

Swedish

Turkish

 

The psychometric properties of the German, Turkish and French version of PAS have been published

 

 

Use in Clinical Trials

The PAS has been used in a number of clinical trials, also including randomized double-blind multicenter studies for measuring the efficacy of drugs, including:

Onasetant

Imipramine

Clomipramine

Sertraline

Paroxetine

Pregabalin

Escitalopram

Citalopram

 

An Example for the Use of the P&A

 

Stahl SM, Gergel I, Li D (2003): Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 64:1322-7.

 

Both escitalopram and citalopram statistically significantly reduced panic disorder symptoms and severity versus placebo at endpoint (p </=.05), as measured by the Panic and Agoraphobia Scale total score

 

 

 

 

Scientific Publications Regarding the Panic and Agoraphobia Scale (P&A)

 

  1. kiyoshi J, Hieda K, Aoki Y, Nagayama H (2003): Frontal brain hypoactivity as a biological substrate of anxiety in patients with panic disorders. Neuropsychobiology 47:165-70.

  2. Andrews G (2003): Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia. Aust N Z J Psychiatry 37:641-656.

  3. Asnis GM, Hameedi FA, Goddard AW, et al (2001): Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients. Psychiatry Res 103:1-14.

  4. Bandelow B (1995): Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology 10:73-81.

  5. Bandelow B (1997): Panik- und Agoraphobieskala (PAS). Göttingen/Bern/Toronto/Seattle: Hogrefe.

  6. Bandelow B (1999): Panic and Agoraphobia Scale (PAS). Göttingen/Bern/Toronto/Seattle: Hogrefe & Huber Publishers.

  7. Bandelow B, Behnke K, Lenoir S, et al (2002): Sertraline vs. paroxetine in the treatment of panic disorder: a multinational randomized double-blind 15-week study. European Neuropsychopharmacology 12 (Suppl 3):S364.

  8. Bandelow B, Broocks A, Pekrun G, et al (2000a): The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial. Pharmacopsychiatry 33:174-81.

  9. Bandelow B, Brunner E, Beinroth D, et al (1999): Application of a new statistical approach to evaluate a clinical trial with panic disorder patients. European Archives Of Psychiatry And Clinical Neuroscience 249:21-7.

  10. Bandelow B, Brunner E, Broocks A, et al (1998): The use of the Panic and Agoraphobia Scale in a clinical trial. Psychiatry Res 77:43-9.

  11. Bandelow B, Hajak G, Holzrichter S, Kunert HJ, Rüther E (1995a): Assessing the efficacy of treatments for panic disorder and agoraphobia. I. Methodological problems. International Clinical Psychopharmacology 10:83-93.

  12. Bandelow B, Sengos G, Wedekind D, et al (1997): Urinary excretion of cortisol, norepinephrine, testosterone, and melatonin in panic disorder [published erratum appears in Pharmacopsychiatry 1997 Nov;30(6):278]. Pharmacopsychiatry 30:113-7.

  13. Bandelow B, Sievert K, Rothemeyer M, Hajak G, Broocks A, Rüther E (1995b): Panikstörung und Agoraphobie: Was wirkt? Fortschr Neurol Psychiatr 63:451-64.

  14. Bandelow B, Wedekind D, Pauls J, Broocks A, Hajak G, Rüther E (2000b): Salivary cortisol in panic attacks. Am J Psychiatry 157:454-6.

  15. Bayle FJ (1998): [How should drugs for anxiety be prescribed?]. Encephale 24:272-9.

  16. Biber B, Alkin T (1999): Panic disorder subtypes: differential responses to CO2 challenge. Am-J-Psychiatry 156:739-44.

  17. Boerner RJ (1997a): Alprazolam in the therapy of a severe panic disorder with agoraphobia and depressive disorder. NERVENHEILKUNDE 16:178-182.

  18. Boerner RJ (1997b): Paroxetin in the treatment of agoraphobia and alcohol dependency. NERVENHEILKUNDE 16:412-416.

  19. Bouchard S, Côté G, Laberge B (1997): The assessment of panic using self-rating: a comprehensive survey of validated instruments. Journal of Anxiety Disorders 11:17-32.

  20. Bouchard S, Payeur R, Rivard V (2000): Cognitive behavior therapy for panic disorder with agoraphobia in videoconference: Preliminary results. CYBERPSYCHOL BEHAV 2:999-1007.

  21. Broocks A, Bandelow B, George A, et al (2000): Increased psychological responses and divergent neuroendocrine responses to m-CPP and ipsapirone in patients with panic disorder. Int Clin Psychopharmacol 15:153-61.

  22. Broocks A, Bandelow B, George A, Roed IS (2001): Increased psychobehavioral responsiveness to M-chlorophenylpiperazine (m-CPP) and ipsapirone (IPS) in patients with panic disorder (PDA). Journal of Neurochemistry 78:81-81.

  23. Broocks A, Bandelow B, Koch K, et al (2002): Smoking modulates neuroendocrine responses to ipsapirone in patients with panic disorder. Neuropsychopharmacology 27:270-278.

  24. Broocks A, Bandelow B, Pekrun G, et al (1998): Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. Am J Psychiatry 155:603-9.

  25. Broocks A, Meyer T, Opitz M, et al (2003): 5-HT(1A) responsivity in patients with panic disorder before and after treatment with aerobic exercise, clomipramine or placebo. Eur Neuropsychopharmacol 13:153-64.

  26. Broocks A, Meyer TF, Bandelow B, et al (1997): Exercise avoidance and impaired endurance capacity in patients with panic disorder. Neuropsychobiology 36:182-7.

  27. Davidson JRT, Moroz G (1998): Pivotal studies of clonazepam in panic disorders. Psychoph Bulletin 34:169-174.

  28. de Carvalho SC, Marcourakis T, Artes R, Gorenstein C (2002): Memory performance in panic disorder patients after chronic use of clomipramine. J Psychopharmacol 16:220-6.

  29. Dengler W, Wiedemann G, Pauli P (1999): Associations between cortical slow potentials and clinical rating scales in panic disorder: a 1.5-year follow-up study. Eur Psychiatry 14:399-404.

  30. Eren I, Tukel R, Polat A, Karaman R, Unal S (2003): Evaluation of regional cerebral blood flow changes in panic disorder with Tc99m-HMPAO SPECT. Psychiatry Res 123:135-43.

  31. Foster RH, Goa KL (1997): Paroxetine: a review of its pharmacology and therapeutic potential in the management of panic disorder. CNS Drugs 8:163-188.

  32. Kim SW, Grant JE, Adson DE, Shin YC, Zaninelli R (2002): A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling. J Clin Psychiatry 63:501-7.

  33. Kojima M, Shioiri T, Hosoki T, Sakai M, Bando T, Someya T (2002): Blink rate variability in patients with panic disorder: new trial using audiovisual stimulation. Psychiatry Clin Neurosci 56:545-9.

  34. Kuloglu M, Atmaca M, Tezcan E, Ustundag B, Bulut S (2002): Antioxidant enzyme and malondialdehyde levels in patients with panic disorder. Neuropsychobiology 46:186-9.

  35. Lautenbacher S, Spernal J, Krieg JC (2002): Divided and selective attention in panic disorder A comparative study of patients with panic disorder, major depression and healthy controls. Eur Arch Psychiatry Clin Neurosci 252:210-3.

  36. Marcourakis T, Gorenstein C, Brandao de Almeida Prado E, et al (2002): Panic disorder patients have reduced cyclic AMP in platelets. J Psychiatr Res 36:105-10.

  37. Meyer T, Broocks A, Bandelow B, Hillmer-Vogel U, Rüther E (1998): Endurance training in panic patients: spiroergometric and clinical effects. Int J Sports Med 19:496-502.

  38. Michelson D, Lydiard RB, Pollack MH, et al (1998): Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. Am-J-Psychiatry 155:1570-7.

  39. Monkul S, Fidaner H, Tural U, Tuncel E, Alkin T (2002): Panic disorder severity scale: Reliability and validity of the Turkish version. European Neuropsychopharmacology 12:S340-S341.

  40. Mortimore C, Anderson IM (2000): d-Fenfluramine in panic disorder: a dual role for 5-hydroxytryptamine. Psychopharmacology (Berl) 149:251-8.

  41. Page AC (1998): Assessment of panic disorder. CURR OPIN PSYCHIATR 11:137-141.

  42. Pande AC, Pollack MH, Crockatt J, et al (2000): Placebo-controlled study of gabapentin treatment of panic disorder. J Clin Psychopharmacol 20:467-71.

  43. Roberge P, Marchand L, Grenier S, Marchand A (2003): Validation of the French-Canadian version of the Panic and Agoraphobia Scale. Canadian Journal of Behavioural Science-Revue Canadienne Des Sciences Du Comportement 35:61-66.

  44. Segui J, Salvador L, Garcia L, Canet J, Marquez M, Ortiz M (1999): [Validation of the Panic Attack Symptoms Scale]. Actas Esp Psiquiatr 27:177-83.

  45. Slaap BR, den Boer JA (2001): The prediction of nonresponse to pharmacotherapy in panic disorder: A review. Depression and Anxiety 14:112-122.

  46. Stahl SM, Gergel I, Li D (2003): Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 64:1322-7.

  47. Starcevic V, Kolar D, Latas M, Bogojevic G, Kelin K (2002): Panic disorder patients at the time of air strikes. Depress Anxiety 16:152-6.

  48. Strohle A (2000): Increased response to a putative panicogenic nocebo administration in female patients with panic disorder. J Psychiatr Res 34:439-42.

  49. Strohle A, Holsboer F, Rupprecht R (2000): Increased ACTH concentrations associated with cholecystokinin tetrapeptide-induced panic attacks in patients with panic disorder. Neuropsychopharmacology 22:251-6.

  50. Ströhle A, Holsboer F, Rupprecht R (2000): Increased ACTH concentrations associated with cholecystokinin tetrapeptide-induced panic attacks in patients with panic disorder. Neuropsychopharmacology 22:251-6.

  51. Strohle A, Romeo E, di Michele F, et al (2003): Induced panic attacks shift gamma-aminobutyric acid type A receptor modulatory neuroactive steroid composition in patients with panic disorder: preliminary results. Arch Gen Psychiatry 60:161-8.

  52. Strohle A, Romeo E, di Michele F, et al (2002): GABA(A) receptor-modulating neuroactive steroid composition in patients with panic disorder before and during paroxetine treatment. Am J Psychiatry 159:145-7.

  53. Tural U, Fidaner H, Alkin T, Bandelow B (2002): Assessing the severity of panic disorder and agoraphobia: validity, reliability and objectivity of the Turkish translation of the Panic and Agoraphobia Scale (P&A). J Anxiety Disord 16:331-40.

  54. Vuksic-Mihaljevic Z, Mandic N, Barkic J, Mrdenovic S (1998): A current psychodynamic understanding of panic disorder. Br J Med Psychol 71 ( Pt 1):27-45.

  55. Vythilingam M, Anderson ER, Goddard A, et al (2000): Temporal lobe volume in panic disorder--a quantitative magnetic resonance imaging study. Psychiatry Res 99:75-82.

  56. Wedekind D, Bandelow B, Broocks A, Hajak G, Ruther E (2000): Salivary, total plasma and plasma free cortisol in panic disorder. J Neural Transm 107:831-7.

  57. Weissberg Minutentag N, Antonini Bernik M (2001): Estudo comparativo entre o citalopram e a imipramina no tratamento do trastorno de pânico. Revista de Psiquiatria Clínica 28:1-10.

  58. Wurthmann C, Bogerts B, Gregor J, Baumann B, Effenberger O, Dohring W (1997): Frontal CSF enlargement in panic disorder: a qualitative CT-scan study. Psychiatry Res 76:83-7.

  59. Wurthmann C, Gregor J, Baumann B, Effenberger O, Dohring W, Bogerts B (1998): [Qualitative evaluation of brain structure in CT in panic disorders]. Nervenarzt 69:763-8.

  60. Wurthmann C, Klieser E (1992): [Possibilities in therapy of anxiety disorders in DSM-III-R]. Fortschr Neurol Psychiatr 60:91-103.

  61. Zwanzger P, Baghai TC, Schule C, et al (2001): Tiagabine improves panic and agoraphobia in panic disorder patients. J Clin Psychiatry 62:656-7.

  62. Zwanzger P, Minov C, Ella R, et al (2002): Transcranial magnetic stimulation for panic. Am J Psychiatry 159:315-6.