공황장애에서 단기약물치료가 불안민감도와 삶의 질 및 기능장애에 미치는 영향

Effect of Short-Term Pharmacotherapy on Anxiety Sensitivity, Quality of Life and Functional Disability in Panic Disorder Patients

  • 오윤혜 (성균관대학교 의과대학 정신건강의학교실) ;
  • 최관우 (성균관대학교 의과대학 정신건강의학교실) ;
  • 김보라 (성균관대학교 의과대학 정신건강의학교실) ;
  • 허정윤 (성균관대학교 의과대학 정신건강의학교실) ;
  • 유범희 (성균관대학교 의과대학 정신건강의학교실)
  • Oh, Yun-Hye (Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Kwan-Woo (Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Bora (Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Heo, Jung-Yoon (Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yu, Bum-Hee (Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2013.03.04
  • 심사 : 2013.04.17
  • 발행 : 2013.04.30

초록

공황장애 환자에서 12주간의 escitalopram 약물치료 결과, 공황장애 증상은 관해 상태에 이르렀고, 높은 불안민감도와 삶의 질 저하 및 기능장애가 모두 유의하게 호전되었다. 하지만 공황장애 환자들은 약물치료 후에도 여전히 상대적으로 높은 불안민감도와 삶의 질 저하 및 기능장애를 보여서 이의 회복을 위해서는 장기간의 약물치료가 필요할 수 있겠다.

Objective : Panic disorder is a chroni, debilitating illness, and has been known to be affected by high anxiety sensitivity and a poor quality of life. We examined if 12 weeks of pharmacotherapy with escitalopram could affect anxiety sensitivity, quality of life, and general disability in patients with panic disorder. Method : We enrolled 27 patients who met the DSM-IV-TR criteria for panic disorder, with or without agoraphobia, and completed 12 weeks of escitalopram treatment. We enrolled 29 normal control subjects who were matched for age and sex compared with the panic patients. All subjects were assessed using the Hamilton Rating Scale for depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), WHO quality of life assessment (WHO-QOL) and Sheehan Disability Scale (SDS) before and after 12 weeks of treatment. Result : Panic disorder patients had a higher Anxiety sensitivity, a poorer Quality of life, and significant disability than normal control subjects at baseline. After the treatment, Panic disorder patients showed significant improvement in the severity of panic symptoms in terms of the HAM-A p<0.001), HAM-D (p<0.001) in addition, the reached a remission state in terms of the PDSS score. They also showed significant improvement in the ASI-R (p<0.001), WHO-QOL (p<0.001) and SDS (p<0.001), but mean scores of the ASI-R, WHO-QOL and SDS in panic disorder patients were did not reach normal levels. Conclusion : This study suggests that 12 weeks of pharmacotherapy with escitalopram could improve anxiety sensitivity, quality of life, and disability in panic disorder patients, although their anxiety sensitivity, quality of life and disability were not yet normalized after short-term pharmacotherapy. Thus, long-term pharmacotherapy may be necessary for panic disorder patients in order to get an optimal clinical response in terms of anxiety sensitivity, quality of life, and general disability.

키워드

참고문헌

  1. Yates WR. Phenomenology and epidemiology of panic disorder. Ann Clin Psychiatry 2009;21:95-102.
  2. Pollack MH, Smoller JW. The longitudinal course and outcome of panic disorder. Psychiatr Clin North Am 1995;18:785-801.
  3. Rubin HC, Rapaport MH, Levine B, Gladsjo JK, Rabin A, Auerbach M, et al. Quality of well being in panic disorder: the assessment of psychiatric and general disability. J Affect Disord 2000;57:217-221. https://doi.org/10.1016/S0165-0327(99)00030-0
  4. Klerman GL, Weissman MM, Ouellette R, Johnson J, Greenwald S. Panic attacks in the community. Social morbidity and health care utilization. JAMA 1991;265:742-746. https://doi.org/10.1001/jama.1991.03460060074027
  5. Markowitz JS, Weissman MM, Ouellette R, Lish JD, Klerman GL. Quality of life in panic disorder. Arch Gen Psychiatry 1989;46:984-992. https://doi.org/10.1001/archpsyc.1989.01810110026004
  6. Noyes R Jr, Clancy J, Woodman C, Holt CS, Suelzer M, Christiansen J, et al. Environmental factors related to the outcome of panic disorder. A seven-year follow-up study. J Nerv Ment Dis 1993;181:529-538. https://doi.org/10.1097/00005053-199309000-00001
  7. Katerndahl DA, Realini JP. Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder. J Clin Psychiatry 1997;58:153-158. https://doi.org/10.4088/JCP.v58n0403
  8. Hollifield M, Katon W, Skipper B, Chapman T, Ballenger JC, Mannuzza S, et al. Panic disorder and quality of life: variables predictive of functional impairment. Am J Psychiatry 1997;154:766-772. https://doi.org/10.1176/ajp.154.6.766
  9. Bonacchi A, Miccinesi G, Guazzini M, Rossi A, Bacci S, Toccafondi A, et al. Temperament and character traits associated with health-related quality of life in cancer patients. Tumori 2012;98:377-384. https://doi.org/10.1177/030089161209800316
  10. Reiss S, McNally RJ. The expectancy model of fear. In: Reiss S, Bootzin RR, editors. Theoretical issues in behavior therapy. New York: Academic Press;1985. p.107-121.
  11. Reiss S. Expectancy model of fear, anxiety, and panic. Clin Psychol Rev 1991;11:141-153. https://doi.org/10.1016/0272-7358(91)90092-9
  12. Taylor S, Cox BJ. An expanded anxiety sensitivity index: evidence for a hierarchic structure in a clinical sample. J Anxiety Disord 1998; 12:463-483. https://doi.org/10.1016/S0887-6185(98)00028-0
  13. Ehlers A. A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance. J Abnorm Psychol 1995; 104:164-172. https://doi.org/10.1037/0021-843X.104.1.164
  14. Schmidt NB, Zvolensky MJ, Maner JK. Anxiety sensitivity: prospective prediction of panic attacks and Axis I pathology. J Psychiatr Res 2006;40:691-699. https://doi.org/10.1016/j.jpsychires.2006.07.009
  15. Park HJ, Kim EJ, Ku JI, Woo JM, Lee SH, Chung SK, et al. Psychological characteristics of early remitters in patients with panic disorder. Psychiatry Res 2012;197:237-241. https://doi.org/10.1016/j.psychres.2011.11.001
  16. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62. https://doi.org/10.1136/jnnp.23.1.56
  17. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50-55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
  18. Shear MK, Clark D, Feske U. The road to recovery in panic disorder: response, remission, and relapse. J Clin Psychiatry 1998;59 Suppl 8: 4-8; discussion 9-10.
  19. Kim JH, Yu BH, Oh KS, Yang JC, Kim Y, Lee SY, et al. A Validation Study of Korean Anxiety Sensitivity Index-Revised (ASI-R). J Korean Neuropsychiatr Assoc 2004;43:54-61.
  20. Min SK, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean version of WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF). J Korean Neuropsychiatr Assoc 2000;39:571-579.
  21. Park JY, Kim JH. Korean version of the Sheehan Disability Scale (SDS): Reliability and Validity. Korean J Clin Psychol 2010;29:73-81. https://doi.org/10.15842/kjcp.2010.29.1.005
  22. Barrera TL, Hiatt EL, Dunn NJ, Teng EJ. Impact of panic disorder on quality of life among veterans in a primary care pilot study. Compr Psychiatry 2013;54:256-261. https://doi.org/10.1016/j.comppsych.2012.09.001
  23. Candilis PJ, McLean RY, Otto MW, Manfro GG, Worthington JJ, 3rd, Penava SJ, et al. Quality of life in patients with panic disorder. J Nerv Ment Dis 1999;187:429-434. https://doi.org/10.1097/00005053-199907000-00006
  24. Bandelow B, Stein DJ, Dolberg OT, Andersen HF, Baldwin DS. Improvement of quality of life in panic disorder with escitalopram, citalopram, or placebo. Pharmacopsychiatry 2007;40:152-156. https://doi.org/10.1055/s-2007-984398
  25. Hazen AL, Walker JR, Eldridge GD. Anxiety sensitivity and treatment outcome in panic disorder. Anxiety 1996;2:34-39. https://doi.org/10.1002/(SICI)1522-7154(1996)2:1<34::AID-ANXI5>3.0.CO;2-D
  26. Davidoff J, Christensen S, Khalili DN, Nguyen J, IsHak WW. Quality of life in panic disorder: looking beyond symptom remission. Qual Life Res 2012;21:945-959. https://doi.org/10.1007/s11136-011-0020-7
  27. Steven Reiss. Expectancy theory of fear, anxiety, and panic. Clin Psychol Rev 1991;11:141-153. https://doi.org/10.1016/0272-7358(91)90092-9
  28. Hayward C, Killen JD, Kraemer HC, Taylor CB. Predictors of panic attacks in adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39:207-214. https://doi.org/10.1097/00004583-200002000-00021
  29. Schmidt NB, Lerew DR, Jackson RJ. The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. J Abnorm Psychol 1997;106:355-364. https://doi.org/10.1037/0021-843X.106.3.355
  30. Scholten WD, Batelaan NM, van Balkom AJ, Wjh Penninx B, Smit JH, van Oppen P. Recurrence of anxiety disorders and its predictors. J Affect Disord 2013;147:180-185. https://doi.org/10.1016/j.jad.2012.10.031
  31. McNally RJ. Anxiety sensitivity and panic disorder. Biol Psychiatry 2002;52:938-946. https://doi.org/10.1016/S0006-3223(02)01475-0
  32. Avallone KM, McLeish AC, Luberto CM, Bernstein JA. Anxiety sensitivity, asthma control, and quality of life in adults with asthma. J Asthma 2012;49:57-62. https://doi.org/10.3109/02770903.2011.641048
  33. Mahrer NE, Montano Z, Gold JI. Relations between anxiety sensitivity, somatization, and health-related quality of life in children with chronic pain. J Pediatr Psychol 2012;37:808-816. https://doi.org/10.1093/jpepsy/jss054