Study results suggest that the lifetime presence of recurrent panic attacks may differentiate between subgroups of patients with mood disorders, especially in those with bipolar disorder.

To elucidate the relationship between the comorbidity of panic and affective disorders, UK researchers compared lifetime clinical illness characteristics and items of symptomatology in 290 patients with bipolar I disorder (BPI) and 335 patients with major depressive disorder (MDDR) according to the lifetime presence of recurrent panic attacks.

Nick Craddock (Cardiff University) and co-authors found that 47% and 58% of patients with BPI and MDDR, respectively, had a lifetime history of panic attacks.

A higher score on the Beck Depression Inventory was significantly associated with the lifetime presence of panic attacks in patients with BPI and MDDR (odds ratio [OR]=1.05), as did a younger age at the baseline interview in patients with BPI (OR=0.97).

Compared with patients with BPI and without a lifetime history of recurrent panic attacks, those with a history of panic attacks were significantly more likely to experience suicidal behavior, more severe impairment during the worst depressive episode (as rated using the Global Assessment Scale), and more frequent and severe depressive episodes (according to the Bipolar Affective Disorder Dimension Scale [BADDS]) with corresponding odds ratios (ORs) of 1.82, 0.97, and 1.02.

Patients with MDDR and a positive history of recurrent panic attacks were twice as likely to have had inpatient treatment at least once in their lifetime as their counterparts without a panic attack history, and scored higher on the BADDS (OR=1.03).

The researchers also looked at items of psychopathology in BPI and MDDR patients using the Operational Criteria symptom checklist. They found that patients with BPI and a history of panic attacks were approximately twice as likely to experience diurnal variation, slowed activity, and insomnia, and almost four times more likely to early-morning waking and agitated activity compared with BPI patients without panic attacks.

Furthermore, MDDR patients with a panic attack history were approximately twice as likely to experience suicidal ideation and slowed activity as MDDR patients without this history.

The authors note that no association was seen between the lifetime presence of panic attacks and clinical characteristics of illness relating to mania.

“The presence of recurrent panic attacks in bipolar and unipolar disorder may be indicative of a course of illness associated with a greater depressive morbidity,” conclude the authors in the journal Bipolar Disorders.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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