Vladan Starcevic

Pathological worry in major depression: a preliminary report

Forty-nine Ss with the DSM-III-R generalized anxiety disorder (GAD) and 32 Ss with the DSM-III-R major depressive episode (MDE) were administered the Penn State Worry Questionnaire (PSWQ) in order to assess the frequency and severity of worrying. The PSWQ scores were almost equally elevated in Ss with GAD and MDE, indicating that high PSWQ scores may not be specific for the diagnosis of GAD. This finding also suggests that except for the uncontrollability of worry, which was not measured by the PSWQ, there may be no difference in the process of pathological worrying between Ss with GAD and MDE. The domains of worry may or may not be similar in Ss with GAD and MDE, but the experiences associated with them are likely to be different, due to different cognitive schemata in anxiety and depression. Finally, the phenomenological presentation of pathological worry may also differ in these two conditions, which calls for further research in this area.

The phenomenology of panic attacks in panic disorder with and without agoraphobia

The frequency of symptoms during panic attacks and anticipation of the panic consequences were compared in patients with the subtypes of panic disorder (PD). Patients with moderate and severe agoraphobic avoidance reported that they had experienced more symptoms than patients with an uncomplicated PD (without agoraphobia [AG]); they also experienced almost all of the symptoms more frequently, with the difference being significant for a quarter of the examined panic symptoms. Panic patients with moderate and severe AG were also significantly more concerned about the loss of control and social and physical consequences of panic attacks. Taken together, these findings suggest that the severity of panic attacks, defined as the number of panic symptoms, along with a variety of anticipatory fears about the consequences of the attacks may contribute to the development of AG in panic patients.

Panic disorder and hypochondriacal fears and beliefs

The purpose of this study was to examine correlates of hypochondriacal fears and beliefs in patients with panic disorder (PD) (n = 54). They were evaluated using the structured diagnostic interviews for axis I and axis II disorders (SCID-UP-R and SCID-II). They were administered the Illness Attitudes Scales (IAS) as a measure of hypochondriacal fears and beliefs, the Hopkins Symptom Checklist 90 (HSCL), and the Fear Questionnaire (FQ). One half of the patients rated themselves as having substantial hypochondriacal fears and beliefs. The sample was divided into groups of patients seeking predominantly treatment or relief from symptoms (treatment-oriented), and those who were searching for a cause of their illness (explanation-seeking): the latter had significantly more hypochondriacal concerns. Avoidant, histrionic, and borderline personalities were more common in the hypochondriacal group. The results of several analyses suggest that patients with PD who are also agoraphobic, fear physical disease more and have more false beliefs of having a disease than PD patients without agoraphobia.

Generalized Anxiety Disorder, Worries about Illness, and Hypochondriacal Fears and Beliefs

In order to compare hypochondriacal phenomena in patients with generalized anxiety disorder (GAD) and panic disorder (PD), and in order to examine the relationship between worries about illness on one hand, and disease fears/phobias and hypochondriacal beliefs on the other, the authors administered the Illness Attitudes Scales to patients with both GAD and PD, and determined the spheres of worry in patients with GAD. Patients with GAD were significantly less hypochondriacal than PD patients. A specific relationship between GAD and hypochondriasis was not found because worries about illness, which characterize some GAD patients, were largely independent from disease fears/phobias and hypochondriacal beliefs, which are a hallmark of hypochondriasis.

Comorbidity rates do not support distinction between panic disorder and generalized anxiety disorder

Groups of patients with principal diagnosis of panic disorder (n = 54) and generalized anxiety disorder (n = 49) were compared on the basis of their comorbidity with other mental disorders. The rates and patterns of comorbidity were similar, except for comorbid simple phobia and past drug abuse. This finding was interpreted as failing to support a notion that there is essential distinction between panic disorder and generalized anxiety disorder.

Comparison of primary and secondary panic disorder: a preliminary report

We examined the onsets of comorbid psychiatric disorders in patients with panic disorder (PD) (N = 54). In 42 patients (77.8%), PD was preceded by another psychiatric condition (secondary PD group), while in 12 patients (22.2%), PD occurred first or was the only diagnosed mental disorder (primary PD group). Patients with primary and secondary PD did not differ with respect to demographic variables, mean ages of onset of PD, mean duration of PD, number of patients with a personality disorder, and number of patients with different DSM-III-R subtypes of PD. Except for the anger and sleep scales of the Hopkins Symptom Checklist 90, patients with primary PD had significantly less self-rated psychopathology; they also displayed less extensive phobic avoidance, and had a lower rate of current psychiatric comorbidity. These findings are discussed in light of the value of the concepts of comorbidity and primary/secondary dichotomy.