Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: The role of adult separation anxiety

• Published in: Journal of affective disorders Vol. 136; no. 3; pp. 675 - 679
• Main Authors: Miniati, M, Calugi, S, Rucci, P, Shear, M.K, Benvenuti, A, Santoro, D, Mauri, M, Cassano, G.B
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01-02-2012; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Agoraphobia - complications; Agoraphobia - drug therapy; Anxiety disorders. Neuroses; Anxiety, Separation - complications; Biological and medical sciences; Cognitive Therapy; Female; Follow-Up Studies; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Mood disorders; Naturalistic follow-up; Panic disorder; Panic Disorder - complications; Panic Disorder - drug therapy; Panic–agoraphobic spectrum; Prognosis; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Remission; Remission Induction; Separation anxiety; Treatment Outcome; Remission; Naturalistic follow-up; Panic–agoraphobic spectrum; Panic disorder; Separation anxiety; Human; Panic; Agoraphobia; Panic-agoraphobic spectrum; Separation anxiety disorder; Anxiety disorder; Treatment; Follow up study; Adult; Predictive factor
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2011.10.008

Abstract Background Efficacy of treatments for panic disorder is well established, but not all patients respond. Adult separation anxiety has been found to predict poorer response to CBT, but its effect on response to medication has not been previously explored. Study aim The aim of this study is to investigate if panic–agoraphobic spectrum factors, including ‘ separation anxiety ’ factor predict treatment outcome in patients with panic disorder. Study sample Participants who met criteria for PD (n = 57) completed baseline assessment and 12 months follow-up. Patients were administered the Panic Agoraphobic Spectrum Self-Report (PAS-SR, Lifetime and Last-Month Versions), and the Panic Disorder Severity Scale (PDSS). We examined patients who met the following criteria at baseline: 1) PDSS total score > 7; 2) no current Axis I comorbidity with major depression; 3) no lifetime or current bipolar disorder. All patients were treated with evidence-based psychopharmacological treatment for panic disorder during the 12-month observation period. Results Twenty eight patients (48.1%) achieved remission during the follow-up period. In a logistic regression model, controlling for baseline severity, gender and age, only the last-month PAS-SR ‘ separation anxiety ’ factor was associated with a lower likelihood of remission. Conclusions Signs and symptoms of separation anxiety in adulthood, as assessed with the PAS-SR Last Month version, are predictors of poor treatment outcome in patients with PD. We submit that the assessment of panic–agoraphobic spectrum features, including adult separation anxiety, should become routine of clinical assessment of patients with PD. It is likely that a better psychopathological characterization of patients may inform treatment selection, and result in better treatment outcome.