DOI QR코드

DOI QR Code

Impairment of Working Memory in Patients with Panic Disorder

공황장애 환자에서의 작업기억 장애

  • Chae, Seung-Hui (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Young-Chul (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Dong-Won (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Oh, Kang-Seob (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jeon, Sang-Won (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Cho, Sung Joon (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 채승희 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 신영철 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 신동원 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 오강섭 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 전상원 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 조성준 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실)
  • Received : 2021.03.02
  • Accepted : 2021.04.19
  • Published : 2021.04.30

Abstract

Objective : The purpose of this study was to investigate the impairment of working memory in patients with panic disorder through neuropsychological examination. Methods : A total of 38 patients who met the DSM-5 criteria for panic disorder and 40 healthy controls were recruited in this study. Controls and patients were matched for age, sex, and education. The Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale (HAMD), and the Panic Disorder Severity Scale (PDSS) were used to evaluate the severities of anxiety, depression, and panic disorder. Further, the digit span task was performed to assess working memory. In addition, a sub-analysis was performed after excluding participants with clinical depressive symptoms. Finally, a sub-analysis by the education level was performed. Results : The HAMA, HAMD, and PDSS scores were significantly higher for patients with panic disorder compared to controls. The scores of digit span forward, digit span backward, digit span sequencing, and total digit span were significantly lower for patients with panic disorder compared to controls. In the sub-analyses excluding patients with depression and by education level, the score of total digit span was significantly lower for patients with panic disorder compared to controls. Conclusion : In this study, patients with panic disorder had deficits in working memory compared to healthy controls.

Keywords

Acknowledgement

본 연구를 설계해주신 고(故) 임세원 교수님께 감사합니다. 저자들은 본 연구에 기여한 고(故) 임세원 교수님의 열정과 정신을 기립니다.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (dsm-5). 5th ed. Arlington, VA: American Psychiatric Association;2017.
  2. Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, et al. The epidemiology of dsm-iv panic disorder and agoraphobia in the united states: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2006;67:363-374. https://doi.org/10.4088/JCP.v67n0305
  3. Suh HS, Lee JH, Gim MS, Kim MK. Korean guidelines for the treatment of panic disorder. J Korean Med Assoc 2018;61:493-499. https://doi.org/10.5124/jkma.2018.61.8.493
  4. Roy-Byrne PP, Cowley DS. Course and outcome in panic disorder: a review of recent follow-up studies. Anxiety 1994;1:151-160. https://doi.org/10.1002/anxi.3070010402
  5. Pollack MH, Otto MW. Long-term course and outcome of panic disorder. J Clin Psychiatry 1997;58 Suppl 2:57-60.
  6. Leon AC, Portera L, Weissman MM. The social costs of anxiety disorders. Br J Psychiatry Suppl 1995:19-22.
  7. Ferreri F, Lapp LK, Peretti CS. Current research on cognitive aspects of anxiety disorders. Current Opinion in Psychiatry 2011;24:49-54. https://doi.org/10.1097/YCO.0b013e32833f5585
  8. O'Sullivan K, Newman EF. Neuropsychological impairments in panic disorder: a systematic review. J Affect Disord 2014;167:268-284. https://doi.org/10.1016/j.jad.2014.06.024
  9. Airaksinen E, Larsson M, Forsell Y. Neuropsychological functions in anxiety disorders in population-based samples: Evidence of episodic memory dysfunction. J Psychiatr Res 2005;39:207-214. https://doi.org/10.1016/j.jpsychires.2004.06.001
  10. Castaneda AE, Tuulio-Henriksson A, Marttunen M, Suvisaari J, Lonnqvist J. A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. Journal of Affective Disorders 2008;106:1-27. https://doi.org/10.1016/j.jad.2007.06.006
  11. Di Giorgio LM, Velasques BB, Ribeiro P, Nardi AE, de Carvalho MR. Evoked potential in panic disorder patients: a systematic review. CNS Neurol Disord Drug Targets 2015;14:863-871. https://doi.org/10.2174/1871527314666150303164539
  12. Asmundson GJ, Stein MB, Larsen DK, Walker JR. Neurocognitive function in panic disorder and social phobia patients. Anxiety 1994;1:201-207.
  13. Alves MR, Pereira VM, Machado S, Nardi AE, Oliveira e Silva AC. Cognitive functions in patients with panic disorder: a literature review. Braz J Psychiatry 2013;35:193-200. https://doi.org/10.1590/1516-4446-2012-1000
  14. Lautenbacher S, Spernal J, Krieg JC. Divided and selective attention in panic disorder. A comparative study of patients with panic disorder, major depression and healthy controls. Eur Arch Psychiatry Clin Neurosci 2002;252:210-213. https://doi.org/10.1007/s00406-002-0382-5
  15. Kaplan JS, Erickson K, Luckenbaugh DA, Weiland-Fiedler P, Geraci M, Sahakian BJ, et al. Differential performance on tasks of affective processing and decision-making in patients with panic disorder and panic disorder with comorbid major depressive disorder. J Affect Disord 2006;95:165-171. https://doi.org/10.1016/j.jad.2006.04.016
  16. Harber L, Hamidian R, Bani-Fatemi A, Wang KZ, Dada O, Messina G, et al. Meta-analysis of neuropsychological studies in panic disorder patients: Evidence of impaired performance during the emotional stroop task. Neuropsychobiology 2019;78:7-13. https://doi.org/10.1159/000496623
  17. Simone AN, Marks DJ, Bedard AC, Halperin JM. Low working memory rather than adhd symptoms predicts poor academic achievement in school-aged children. Journal of Abnormal Child Psychology 2018;46:277-290. https://doi.org/10.1007/s10802-017-0288-3
  18. Friso-van den Bos I, van de Weijer-Bergsma E. Classroom versus individual working memory assessment: Predicting academic achievement and the role of attention and response inhibition. Memory 2020;28:70-82. https://doi.org/10.1080/09658211.2019.1682170
  19. Alloway TP. Working memory, but not iq, predicts subsequent learning in children with learning difficulties. European Journal of Psychological Assessment 2009;25:92-98. https://doi.org/10.1027/1015-5759.25.2.92
  20. Fitri FI, Fithrie A, Rambe AS. Association between working memory impairment and activities of daily living in post-stroke patients. Med Glas (Zenica) 2020;17:433-438.
  21. Memel M, Woolverton CB, Bourassa K, Glisky EL. Working memory predicts subsequent episodic memory decline during healthy cognitive aging: Evidence from a cross-lagged panel design. Aging, Neuropsychology, and Cognition 2019;26:711-730. https://doi.org/10.1080/13825585.2018.1521507
  22. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The mini-international neuropsychiatric interview (m.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for dsm-iv and icd-10. J Clin Psychiatry 1998;59 Suppl 20:22-57.
  23. 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
  24. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62. https://doi.org/10.1136/jnnp.23.1.56
  25. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the hamilton depression rating scale. J Affect Disord 2013;150:384-388. https://doi.org/10.1016/j.jad.2013.04.028
  26. Katherine Shear M, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, et al. Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry 1997;154:1571-1575. https://doi.org/10.1176/ajp.154.11.1571
  27. Lee EH, Kim JH, Yu BH. Reliability and validity of the self-report version of the panic disorder severity scale in korea. Depress Anxiety 2009;26:E120-123. https://doi.org/10.1002/da.20461
  28. GrEGoire J, Van Der Linden M. Effect of age on forward and backward digit spans. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 1997;4:140-149. https://doi.org/10.1080/13825589708256642
  29. Dobbs AR, Rule BG. Adult age differences in working memory. Psychol Aging 1989;4:500-503. https://doi.org/10.1037/0882-7974.4.4.500
  30. Hilbert S, Nakagawa TT, Puci P, Zech A, Buhner M. The digit span backwards task. Eur J Psychol Assess 2015;31:174-180. https://doi.org/10.1027/1015-5759/a000223
  31. Roy-Byrne PP, Stein MB, Russo J, Mercier E, Thomas R, McQuaid J, et al. Panic disorder in the primary care setting: Comorbidity, disability, service utilization, and treatment. J Clin Psychiatry 1999; 60:492-500. https://doi.org/10.4088/JCP.v60n0713
  32. Mineka S, and DW, Clark LA. Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol 1998;49:377-412. https://doi.org/10.1146/annurev.psych.49.1.377
  33. Breier A, Charney DS, Heninger GR. Major depression in patients with agoraphobia and panic disorder. Arch Gen Psychiatry 1984;41:1129-1135. https://doi.org/10.1001/archpsyc.1984.01790230015002
  34. Tsourtos G, Thompson JC, Stough C. Evidence of an early information processing speed deficit in unipolar major depression. Psychol Med 2002;32:259-265. https://doi.org/10.1017/S0033291701005001
  35. Channon S, Baker JE, Robertson MM. Effects of structure and clustering on recall and recognition memory in clinical depression. J Abnorm Psychol 1993;102:323-326. https://doi.org/10.1037/0021-843X.102.2.323
  36. Dratcu L, Bond A. Panic patients in the non-panic state: physiological and cognitive dysfunction. Eur Psychiatry 1998;13:18-25. https://doi.org/10.1016/S0924-9338(97)86747-8
  37. Zhou Z, Ni D. Impairment of working memory, decision-making, and executive function in the first-degree relatives of people with panic disorder: a pilot study. Front Psychiatry 2017;8:219. https://doi.org/10.3389/fpsyt.2017.00219
  38. Galderisi S, Mancuso F, Mucci A, Garramone S, Zamboli R, Maj M. Alexithymia and cognitive dysfunctions in patients with panic disorder. Psychother Psychosom 2008;77:182-188. https://doi.org/10.1159/000119738
  39. Gelernter J, Cubells JF, Kidd JR, Pakstis AJ, Kidd KK. Population studies of polymorphisms of the serotonin transporter protein gene. Am J Med Genet 1999;88:61-66. https://doi.org/10.1002/(SICI)1096-8628(19990205)88:1<61::AID-AJMG11>3.0.CO;2-K
  40. Roy-Byrne PP, Perera P, Pitts CD, Christi JA. Paroxetine response and tolerability among ethnic minority patients with mood or anxiety disorders: a pooled analysis. J Clin Psychiatry 2005;66:1228-1233. https://doi.org/10.4088/JCP.v66n1004
  41. Volpe U, Merlotti E, Mucci A, Galderisi S. The contribution of brain imaging to the study of panic disorder. Epidemiol Psichiatr Soc 2004;13:237-248. https://doi.org/10.1017/S1121189X00001755
  42. Nordahl TE, Semple WE, Gross M, Mellman TA, Stein MB, Goyer P, et al. Cerebral glucose metabolic differences in patients with panic disorder. Neuropsychopharmacology 1990;3:261-272. https://doi.org/10.1016/0924-977X(93)90061-P
  43. Fischer H, Andersson JL, Furmark T, Fredrikson M. Brain correlates of an unexpected panic attack: a human positron emission tomographic study. Neurosci Lett 1998;251:137-140. https://doi.org/10.1016/S0304-3940(98)00503-5
  44. Kent JM, Coplan JD, Mawlawi O, Martinez JM, Browne ST, Slifstein M, et al. Prediction of panic response to a respiratory stimulant by reduced orbitofrontal cerebral blood flow in panic disorder. Am J Psychiatry 2005;162:1379-1381. https://doi.org/10.1176/appi.ajp.162.7.1379
  45. Chang C, Crottaz-Herbette S, Menon V. Temporal dynamics of basal ganglia response and connectivity during verbal working memory. Neuroimage 2007;34:1253-1269. https://doi.org/10.1016/j.neuroimage.2006.08.056
  46. McNab F, Klingberg T. Prefrontal cortex and basal ganglia control access to working memory. Nat Neurosci 2008;11:103-107. https://doi.org/10.1038/nn2024
  47. Luerding R, Weigand T, Bogdahn U, Schmidt-Wilcke T. Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients: Structural correlates of pain-cognition interaction. Brain 2008;131:3222-3231. https://doi.org/10.1093/brain/awn229
  48. Luna B, Minshew N, Garver K, Lazar N, Thulborn K, Eddy W, et al. Neocortical system abnormalities in autism: an fmri study of spatial working memory. Neurology 2002;59:834-840. https://doi.org/10.1212/WNL.59.6.834
  49. Deckersbach T, Moshier SJ, Tuschen-Caffier B, Otto MW. Memory dysfunction in panic disorder: an investigation of the role of chronic benzodiazepine use. Depress Anxiety 2011;28:999-1007. https://doi.org/10.1002/da.20891
  50. Gladsjo JA, Rapaport MH, McKinney R, Lucas JA, Rabin A, Oliver T, et al. A neuropsychological study of panic disorder: negative findings. J Affect Disord 1998;49:123-131. https://doi.org/10.1016/S0165-0327(98)00006-8