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Clinical Significance of Lifetime Panic Spectrum Symptoms in the Treatment of Patients With Bipolar I Disorder
Ellen Frank, PhD;
Jill M. Cyranowski, PhD;
Paola Rucci, DStat;
M. Katherine Shear, MD;
Andrea Fagiolini, MD;
Michael E. Thase, MD;
Giovanni B. Cassano, MD, FRCPsych;
Victoria J. Grochocinski, PhD;
Bryan Kostelnik, BA;
David J. Kupfer, MD
Arch Gen Psychiatry. 2002;59:905-911.
Background Given the observed association between panic disorder and bipolar disorder
and the potential negative influence of panic symptoms on the course of bipolar
illness, we were interested in the effects of what we have defined as "panic
spectrum" conditions on the clinical course and treatment outcome in patients
with bipolar I (BPI) disorder. We hypothesized that lifetime panic spectrum
features would be associated with higher levels of suicidal ideation and a
poorer response to acute treatment of the index mood episode in this patient
population.
Methods A sample of 66 patients with BPI disorder completed a self-report measure
of lifetime panic-agoraphobic spectrum symptoms. Patients falling above and
below a predefined clinical threshold for panic spectrum were compared for
clinical characteristics, the presence of suicidal ideation during acute treatment,
and acute treatment response.
Results Half of this outpatient sample reported panic spectrum features above
the predefined threshold. These lifetime features were associated with more
prior depressive episodes, higher levels of depressive symptoms, and greater
suicidal ideation during the acute-treatment phase. Patients with BPI disorder
who reported high lifetime panic-agoraphobic spectrum symptom scores took
27 weeks longer than those who reported low scores to remit with acute treatment
(44 vs 17 weeks, respectively).
Conclusions The presence of lifetime panic spectrum symptoms in this sample of patients
with BPI disorder was associated with greater levels of depression, more suicidal
ideation, and a marked (6-month) delay in time to remission with acute treatment.
Alternate treatment strategies are needed for patients with BPI disorder who
endorse lifetime panic spectrum features.
From the Department of Psychiatry, Western Psychiatric Institute and
Clinic (Drs Frank, Cyranowski, Rucci, Shear, Fagiolini, Thase, Grochocinski,
and Kupfer), and the Department of Psychology (Dr Frank and Mr Kostelnik),
University of Pittsburgh, Pittsburgh, Pa; and the Departments of Psychiatry,
Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa, Italy
(Drs Rucci and Cassano).
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