Panic disorder: symptoms, causes, and treatment approaches

Panic Disorder during Pregnancy and Postpartum Period" (Bandelow, Sojka, et al., 2006), researchers interviewed 128 Caucasian women about panic disorder. The participants were blind to the intent of the study, but the interviewers knew. Pregnant women were asked 16 additional questions. Researchers defined panic disorder according to DSM-IV/ICD-10. They asked the women to describe the first onset of panic symptoms and to rank them, as well as subsequent exacerbations, from mild to very severe). The researchers calculated a PMQ (panic manifestation quotient). They defined panic manifestation as the appearance of symptoms that were at least moderate in severity. The PMQ was divided by the observation time -- 266 days of pregnancy and 180 days of post-partum. Age was also factored in. Researchers asked the participants about breastfeeding and symptoms of postpartum depression. The women assessed their psychosocial stress during pregnancy and afterwards on a scale from no stress to very severe stress and described the kinds of stress they encountered as well. Women who had miscarriages or abortions were compared to women who delivered normally. Some of the women were being treated with drugs or psychological therapy and were asked to rate their improvement from treatment on a scale ranging from very effective to getting worse.

Results showed that manifestations of panic disorder were significantly lower during pregnancy, but significantly increased during the post-partum period: "...a 132-fold increase compared with the non-post-partum period" (p. 497). Women who had never been pregnant had higher PMQs than those who had been. Breastfeeding had no effect on panic disorder, nor did occurrences of miscarriage or abortion.

However, the occurrence of post-partum depression was higher than expected for women who reported panic attacks. Risk of panic attacks also increased in women who reported high stress. Women who were receiving drug therapy for panic disorders reported less improvement than women who were in psychological therapy who rated improvement higher. The researchers concluded that pregnancy somewhat protects women from panic manifestations, but the post-partum period seems to increase their risk. They cite some psychosocial reasons, but argue that biochemical changes are a more likely explanation, mainly drops in hormone levels after birth. They offer no explanation for increased risk of panic disorder in women who have never been pregnant.

In "Maternal Panic Disorder: Infant Prematurity and Low Birth Weight" (Warren, Racu, Gregg & Simmens, 2006), researchers wanted to find out if women with panic disorders give birth more often prematurely or have babies with lower birth weights. They knew that some women have panic attacks during pregnancy and wanted to find out if the attacks affected the fetuses. They reviewed the medical records of 25 Caucasian and middle-to-upper class mothers with panic disorders. These were compared to the records of 33 mothers (similar demographics) with no lifetime history of anxiety disorders or other major psychopathology. The women also completed questionnaires for demographic information and life stresses. Women who reported alcohol or drug abuse, or used these during pregnancy, were excluded from the study as well as women whose children had experienced a major medical problem, trauma, or abuse. Women with maternal diabetes were also excluded. The Family Inventory of Life Events was used to measure stress. The newborn baby's age at birth, or gestational age in weeks, was calculated from the mother's last menstrual period. Without an LMP date, ultrasonography was used. If neither of these were available, the gestational age was taken from the delivery record and calculated.

Results indicate that mothers with panic disorder continued to have panic attacks throughout their pregnancies. Only 8% also had symptoms of depression during pregnancy. Between them and the control group, no significant differences were found in terms of maternal age, race, socioeconomic status, primiparous status, smoking during pregnancy, or psychotropic medications taken during pregnancy. Panic disorder mothers had higher blood pressures and were more likely to report eating disorders, but no significant differences were found in the gestational ages of their babies and mothers in the control group; however, PD mothers had babies with significantly lower birth weights. Their infants were not born earlier, but they were smaller; however, although the birth weights were significantly smaller, they were not below normal. A statistical analysis allowed the researchers to conclude that other variables, such as smoking and high stress, were not responsible for the finding of low birth rate in PD mothers. They do point out that if PD risk were combined with other risk factors, this could spell problems for the child. They admit that causes of low-birth weight may not have been completely determined and some of their analytic methods could have affected their findings. The use of Caucasian, middle-to-upper class women meant the sample was not representative of the entire population.

In "Effects of Prenatal Anxiety Disorders in Children at High Risk for Panic Disorder: A Controlled Study" (Biederman, Petty, et al., 2006), the researchers wanted to test the hypothesis that anxiety disorders "breed true in offspring" (p. 191). They assessed participants using structured diagnostic interviews. Although anxiety disorder and panic disorder are two different diseases, they frequently occur together, and children of parents with panic disorder are at higher risk for anxiety disorders, including agoraphobia, generalized anxiety, obsessive-compulsive disorder, social phobia, and separation anxiety disorder. The purpose of the study was to examine the association between anxiety disorders in parents and children at risk for panic disorder with the hope that a better understanding of how these disorders are transmitted could result eventually in prevention and early intervention.

The researchers chose children at high risk for panic disorder from a previous longitudinal study. Parents with panic disorder and depression were recruited. Only patients with a positive lifetime diagnosis of panic disorder or major depression were included.

Parents in the control group were free of anxiety disorders and mood disorders. A committee of mental health specialists, blind to the participant's history, had to reach a consensus in order to establish a positive diagnosis. Researchers then conducted a statistical analysis of the data. For each disorder that was elevated in the offspring, the researchers tried to determine if the disorder could be accounted for by the presence in the parent of panic disorder, an identical disorder, or by parental major depression. The researchers accounted for social phobia and separation anxiety in the offspring by the same disorder in the parent. Parental panic disorder, on the other hand, conferred a risk of agoraphobia and obsessive-compulsive disorder in their offspring. These findings imply that risk factors differ. The authors argue that separation anxiety disorder is limited to a subgroup of children with familial separation anxiety disorder, but they could not state if these children are at higher risk for panic disorder. They found that social phobia in children is more clearly associated with social phobia in the parent than with PD or MD. Social phobia in the parent breeds true in the offspring. Panic disorder in a parent confers a risk of agoraphobia in the children. PD in the parent also increases the risk of OCD in the children. They conclude, "These finding shed light on the nature of transmission of anxiety disorders between parents and their high-risk offspring and suggest that differing risk factors underlie the expression of individual anxiety disorder" (p. 196). Again, a larger percentage of the participants in this study were Caucasions with higher levels of social class, and thus are not truly representative of the general population and the results cannot be generalized.

In "Childhood Abuse and Familial Violence and the Risk of Panic Attacks and Panic Disorder in Young Adulthood" (Goodwin, Fergusson, & Horwood, 2004), researchers examined links between childhood abuse and familial violence with the development of panic attacks and panic disorder.