Deirdre Sierra-Biddle

Personality traits in early phases of panic disorder: implications on the presence of agoraphobia, clinical severity and short‐term outcome

Objective:  To explore the relations between personality traits using the Big Five model and presence of agoraphobia, clinical severity and short‐term outcome in an unbiased clinical sample of never‐treated panic disorder patients.

Can personality traits help us explain disability in chronic schizophrenia

Abstract  Psychotic features have been considered the main determinant of psychosocial function in schizophrenia. However, other variables are likely to affect dysfunction in these patients. The authors’ hypothesis is that personality traits in outpatients with chronic schizophrenia differ from traits found in the healthy population and may be associated with disability in this disorder. A total of 62 patients with schizophrenia were evaluated with the Eysenck Personality Questionnaire (EPQ) and the Tridimensional Personality Questionnaire (TPQ). Psychotic features were measured with the help of the Positive and Negative Syndrome Scale (PANSS). Disability was assessed with the Disability Assessment Schedule (DAS). A total of 43 healthy subjects were used as controls for personality measurements. Normative data for the study population was also used to evaluate results in patients. Patients with schizophrenia had higher levels of neuroticism (median in percentile 65) and lower levels of extraversion (median in percentile 25) than the healthy population. Results of the TPQ showed higher harm avoidance and lower reward dependence levels compared to the healthy population. After multiple regression tests, negative symptoms were the strongest predictor of disability in patients with schizophrenia. Neuroticism contributed independently to the DAS overall behavior and global judgement subscales scores (more negative symptoms and higher neuroticism resulted in worse functioning), but not to the social role subscale. Outpatients with chronic schizophrenia showed high levels of neuroticism, harm avoidance, and introversion. Neuroticism significantly contributes to the long‐term deficits found in patients with schizophrenia.

The acute phase response in panic disorder.

An acute-phase response (APR), manifested as an increase of acute-phase proteins has been shown in major depression. Panic disorder (PD) may share some aetiopathogenic mechanisms with depression, but APR has not been studied in this disorder. Forty-one panic patients in the first stages of their illness were compared with 32 healthy subjects of comparable sex, age, and body mass index. Clinical diagnosis was established with the mini international neuropsychiatric interview, and severity with the panic disorder severity scale and the CGI scale. Laboratory determinations included four acute phase proteins (APPs) [albumin, gammaglobulins, fibrinogen, C-reactive-protein (CRP)] and basal cortisol level. Patients were studied after 8-wk follow-up taking selective serotonin reuptake inhibitors (SSRIs) to assess the evolution of the APPs. Gammaglobulin levels were lower, and both cortisol and CRP levels were higher in PD patients than in controls. APP did not differ between patients with or without agoraphobia. At follow-up, patients who responded to SSRIs presented a decrease in albumin levels, and a trend towards a decrease in cortisol and CRP compared with levels at intake. The conclusions of this study are that there is an APR in patients suffering from PD, and this APR tends to diminish after a successful treatment with SSRIs.

Diagnostic Accuracy in the First 5 minof a Psychiatric Interview

Background: There is little if any research on the explicit contents delivered by patients in the first minutes of a psychiatric interview. Methods: In order to study the impact of the first minutes of a psychiatric interview on final diagnosis, we gathered information from the speech during the first 5 min in 162 new psychiatric patients with a checklist including symptoms extracted from the SCAN interview. Results: The area reported most frequently was life events (51.2%). The average of psychiatric symptoms cited was 2.3. An initial suspected diagnosis was done in 126 patients, and in 73 patients (57.9% of those with a suspected diagnosis, 45.1% of the total sample) the initial diagnosis was coincident with the final diagnosis. The initial clinical impression was more accurate in adjustment and ‘neurotic’ disorders, and less in mood disorders. Those patients who cited more symptoms received a less accurate initial diagnosis. Conclusion: Psychiatric patients spontaneously report a low number of symptoms. The accuracy of psychiatric diagnosis in the first minutes of an interview is unacceptably low. However, the role of short psychiatric interviewing as a screening method deserves to be further investigated.

Panic disorder and the onset of agoraphobia

In a remarkable study, Kikuchi et al. have shown that the prevalence of agoraphobia (AG) is related to long duration of panic disorder (PD) and prevalence of generalized anxiety disorder using a transverse-design study in outpatients. 1 They suggest that further longitudinal studies using structured interviews are needed to determine the optimum strategies to prevent the development of AG in PD patients. In contrast, they suggest that a limitation of their study was that information given by the patients is subject to recall bias. Another possible shortcoming is the possible selection bias, given that patients with AG had a longer duration of illness and would have had more opportunity for previous psychiatric consultations. We recently organized a meeting in Santander, Spain, entitled ‘The Early Phases of Anxiety Disorders’ (Santander, Spain, 17–19 November 2005). Here, relevant European researchers in the field of anxiety disorders (mainly panic), analyzed factors related to the development of these disorders and the possibility of early intervention strategies, such as the ones recently adopted in the field of schizophrenia. The main problem in the case of PD is the difficulty of prospectively studying large cohorts of subjects, because prodromal symptoms of anxiety disorders are highly prevalent in the general population. This is not the case in psychotic disorders, where prodromal symptoms may be presented by some subjects (i.e. schizotypal patients, so on) but not by a large proportion of the population. In the case of anxiety disorders, even the study of highrisk cohorts (for instance, offspring) would be very costly, although some efforts have been made. 2 With this limitation in mind, the best strategy would be to recruit patients at the first stages of the illness, after the initial consultation with the Emergency services or with general practitioners. At least this approach would give us the opportunity to analyze patient clinical features before the start of treatment and to follow them prospectively. We are conducting a study of this kind, in the Panic Disorder Unit of Cantabria (PADUC), and lately presented some data. 3 In brief, panic patients recruited in the first stages of their illness were evaluated with the Mini International Neuropsychiatric Interview 4 in order to determine the DSM-IV diagnosis, and only those with PD with or without agoraphobia with recent onset and who were free of any comorbid psychiatric disorder were included in the study and prospectively followed up. Median time since the first panic attack was 8 months. With more than 200 patients now included in the study, we have found that only one patient with a 1-year follow-up evaluation (out of 75 with available data at this point) developed agoraphobia and did not suffer from it at baseline. This means that nearly 99% of agoraphobics at 1-year follow up had presented agoraphobic features also at intake. In fact, some authors have suggested that the large majority of panic patients (90%) suffer from mild phobic symptoms before the onset of panic attacks. 5 This contrasts with the findings reported by Kikuchi et al . because they showed that 69 out of the 170 patients (nearly 40%) with PD with AG manifested the agoraphobia more than 2 years after the onset of PD. 1