본문 바로가기
KERD
논문KCI 등재

우울장애 환자에서 양극성 기분성향에 따른 불안민감성과 공황증상 비교

Comparison of Anxiety Sensitivity and Panic-Related Symptoms between Depressive Patients with and without Bipolarity

이영민|최윤미|박영민|정희정|이병대|강태욱|박제민|문은수|임종길
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2017.10|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제23권 제3호|pp. 230-239|DOI 10.22802/jksbtp.2017.23.3.230

0

조회

0

다운로드

1

인용

0

참고문헌

키워드

공황증상·불안민감성·양극성 성향· 양극성범주장애·기분장애 설문지.Panic symptom · Anxiety sensitivity · Bipolarity · Bipolar spectrum disorder · MDQ.
주제분류정신과학

초록

Objectives：A few studies have shown that some anxiety disorders, especially panic disorder, are more related with bipolar than with unipolar depressive disorder. However, there is lack of evidence on the different patterns of anxiety sensitivity and panic-related symptoms, depending on bipolarity in patients with depression. This study was aimed at comparing anxiety sensitivity and panic-related symptoms between patients with depression with and without bipolarity. Methods：We recruited 158 patients who experiencing depressive disorders. Bipolarity was evaluated with the Mood Disorder Questionnaire(MDQ). Panic-related symptoms and anxiety sensitivity were measured with the Anxiety Sensitivity Index-Revised(ASI-R), Acute Panic Inventory(API) and Korea Albany Panic and Phobia Questionnaire(K-APPQ). Anxiety sensitivity and panic-related symptoms were compared between patients with depression with positive and negative screen in the MDQ using independent t-test and analysis of covariance(ANCOVA). Results：Patients with depression who had a positive screen on the MDQ had higher ASI-R total and subscales scores(total score, p=0.012; fear of publicly observable anxiety reactions, p=0.002; fear of cognitive dyscontrol, p= 0.009), API score(p=0.005), rate of API score with more than 20 points(p=0.021) than those with negative results on the MDQ. After adjust for age and Beck Depression Inventory(BDI) score, the differences between the two groups remained significant(ASI-R total score, p=0.012 ; ASI-R fear of publicly observable anxiety reactions, p=0.008 ; ASI-R fear of cognitive dyscontrol, p=0.012; API score, p=0.017). Additionally, a significant difference in the ASI-R subscale, fear of cardiovascular symptoms appeared between the two groups after adjusting for age and BDI score(p=0.042). Conclusion：The results suggested that the presence of bipolarity in patients with depression may be related to the frequency of panic symptoms and high anxiety sensitivity. The presence of bipolarity may need to be considered in treating comorbid panic disorder in patients with depression.

Abstract

Objectives：A few studies have shown that some anxiety disorders, especially panic disorder, are more related with bipolar than with unipolar depressive disorder. However, there is lack of evidence on the different patterns of anxiety sensitivity and panic-related symptoms, depending on bipolarity in patients with depression. This study was aimed at comparing anxiety sensitivity and panic-related symptoms between patients with depression with and without bipolarity. Methods：We recruited 158 patients who experiencing depressive disorders. Bipolarity was evaluated with the Mood Disorder Questionnaire(MDQ). Panic-related symptoms and anxiety sensitivity were measured with the Anxiety Sensitivity Index-Revised(ASI-R), Acute Panic Inventory(API) and Korea Albany Panic and Phobia Questionnaire(K-APPQ). Anxiety sensitivity and panic-related symptoms were compared between patients with depression with positive and negative screen in the MDQ using independent t-test and analysis of covariance(ANCOVA). Results：Patients with depression who had a positive screen on the MDQ had higher ASI-R total and subscales scores(total score, p=0.012; fear of publicly observable anxiety reactions, p=0.002; fear of cognitive dyscontrol, p= 0.009), API score(p=0.005), rate of API score with more than 20 points(p=0.021) than those with negative results on the MDQ. After adjust for age and Beck Depression Inventory(BDI) score, the differences between the two groups remained significant(ASI-R total score, p=0.012 ; ASI-R fear of publicly observable anxiety reactions, p=0.008 ; ASI-R fear of cognitive dyscontrol, p=0.012; API score, p=0.017). Additionally, a significant difference in the ASI-R subscale, fear of cardiovascular symptoms appeared between the two groups after adjusting for age and BDI score(p=0.042). Conclusion：The results suggested that the presence of bipolarity in patients with depression may be related to the frequency of panic symptoms and high anxiety sensitivity. The presence of bipolarity may need to be considered in treating comorbid panic disorder in patients with depression.

참고문헌 (49)

  1. Association AP, "DSM 5" (2013), American Psychiatric Association
  2. Association AP, "Practice guideline for the treatment of patients with panic disorder" (2009), American Psychiatric Association
  3. Taylor S, "Anxiety sensitivity: Theoretical perspectives and recent findings", Behav Res Ther, 33, pp.243~258 (1995)
  4. Reiss S, "Expectancy model of fear, anxiety, and panic", Clin Psychol Rev, 11, pp.141~153 (1991)
  5. Reiss S, "Theoretical issues in behavior therapy inside" (1985), Academic Press
  6. clinical psychiatry, "Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences", pp.2011, Sadock BJ
  7. Wittchen HU, "Why do people with anxiety disorders become depressed? A prospective-longitudinal community study", Act Psychiatr Scand, 102, pp.14~23 (2000)
  8. Zimmerman M, "Major depressive disorder and axis I diagnostic comorbidity", J Clin Psychiatry, 63, pp.187~193 (2002)
  9. Grunhaus L, "Clinical and Psychobiological Characteristics", Am J Psychiatry, 145, pp.1214~1221 (1988)
  10. Rudd MD, "Diagnostic comorbidity in persons with suicidal ideation and behavior", Am J Psychiatry, 150, pp.928~934 (1993)
  11. Fawcett J, "Suicide risk factors in depressive disorders and in panic disorder", J Clin Psychiatry, 53, pp.9~13 (1992)
  12. Goodwin RD, "Bipolar–panic comorbidity in the general population: prevalence and associated morbidity", J Affect Disord, 70, pp.27~33 (2002)
  13. Chen Y-W, "Comorbidity of panic disorder in bipolar illness", Am J psychiatry, 152, pp.280~283 (1995)
  14. Frank E, "Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder", Arch Gen Psychiatry, 59, pp.905~911 (2002)
  15. Simon NM, "Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression", J Psychiatr Res, 37, pp.187~192 (2003)
  16. Ghaemi SN, "'Cade’s disease' and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder", Can J Psychiatry, 47, pp.125~134 (2002)
  17. Goodwin FK, "Understanding manic-depressive illness", Arch Gen Psychiatry, 55, pp.23~25 (1998)
  18. Hirschfeld RM, "Development and validation of a screening instrument for bipolar spectrum disorder:the Mood Disorder Questionnaire", Am J Psychiatry, 157, pp.1873~1875 (2000)
  19. Zimmermann P, "Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity", Arch Gen Psychiatry, 66, pp.1341~1352 (2009)
  20. Sasdelli A, "Screening for bipolar disorder symptoms in depressed primary care attenders: comparison between Mood Disorder Questionnaire and Hypomania Checklist(HCL-32)", Psychiatry J, 2013 (2013)
  21. Erbauch J, "An inventory for measuring depression", Arch Gen Psychiatry, 562, pp.53~63 (1961)
  22. Lee M, "A standardization study of beck depression inventory(I):Korean version(K-BDI): reliability land factor analysis", Korean J Psychopathol, 4, pp.77~95 (1995)
  23. Miller CJ, "Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder", J Affect Disord, 81, pp.167~171 (2004)
  24. Hirschfeld RM, "Screening for bipolar disorder in patients treated for depression in a family medicine clinic", J Am Board Fam Pract, 18, pp.233~239 (2005)
  25. Hirschfeld R, "The Mood Disorder Questionnaire: a simple, patient-rated screening instrument for bipolar disorder", Prim Care Companion J Clin Psychiatry, 4, pp.9~11 (2002)
  26. Jon DI, "Validity and reliability of the Korean version of the Mood Disorder Questionnaire", Compr Psychiatry, 50, pp.286~291 (2009)
  27. Taylor S, "An expanded anxiety sensitivity index:evidence for a hierarchic structure in a clinical sample", J Anxiety Disord, 12, pp.463~483 (1998)
  28. 김지혜, "한국어 확장판 불안 민감도 지수의 타당화 연구", 신경정신의학, 43(1), pp.54~61 (2004), 대한신경정신의학회
  29. Dillon DJ, "Measurement of lactate-induced panic and anxiety", Psychiatry Res, 20, pp.97~105 (1987)
  30. Cao HZ, "Significance of plasma brain-derived neurotrophic factor in patients with panic disorder", pp.2006
  31. Rapee RM, "Assessment instrument for panic disorder that includes fear of sensation-producing activities: The albany panic and phobia questionnaire", Anxiety, 1, pp.114~122 (1994)
  32. 김지혜, "한국판 알마니 공황-공포 질문지 타당화 연구", 신경정신의학, 43(3), pp.329~336 (2004), 대한신경정신의학회
  33. Simon NM, "Panic disorder and bipolar disorder: anxiety sensitivity as a potential mediator of panic during manic states", J Affect Disord, 87, pp.101~105 (2005)
  34. Perugi G, "The soft bipolar spectrum redefined:focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions", The Psychiatr Clin North Am, 25, pp.713~737 (2002)
  35. Asmundson GJ, "Anxiety sensitivity and its relationship to spontaneous and cued panic attacks in college students", Behav Res Ther, 31, pp.199~201 (1993)
  36. Maller RG, "Anxiety sensitivity in 1984 and panic attacks in 1987", J Anxiety Disord, 6, pp.241~247 (1992)
  37. Donnell CD, "Anxiety sensitivity and history of panic as predictors of response to hyperventilation", Behav Res Ther, 27, pp.325~332 (1989)
  38. Sakai Y, "Cerebral glucose metabolism associated with a fear network in panic disorder", Neuroreport, 16, pp.927~931 (2005)
  39. Massana G, "Amygdalar atrophy in panic disorder patients detected by volumetric magnetic resonance imaging", Neuroimage, 19, pp.80~90 (2003)
  40. Drevets WC, "Neuroimaging abnormalities in the amygdala in mood disorders", Ann N Y Acad Sci, 985, pp.420~444 (2003)
  41. Blumberg HP, "Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder", Arch Gen Psychiatry, 60, pp.1201~1208 (2003)
  42. MacKinnon DF, "Carbon dioxide provocation of anxiety and respiratory response in bipolar disorder", J Affect Disord, 99, pp.45~49 (2007)
  43. Doughty CJ, "Bipolar-panic disorder comorbidity within bipolar disorder families: a study of siblings", Bipolar Disord, 6, pp.245~252 (2004)
  44. MacKinnon DF, "Bipolar disorder and panic disorder in families: an analysis of chromosome 18 data", Am J Psychiatry, 155, pp.829~831 (1998)
  45. Brown TA, "A psychometric reanalysis of the Albany Panic and Phobia Questionnaire", Behav Res Ther, 43, pp.337~355 (2005)
  46. Telch MJ, "Role of cognitive appraisal in panic-related avoidance", Behav Res Ther, 27, pp.373~383 (1989)
  47. Craske MG, "A review of the relationship between panic and avoidance", Clin Psychol Rev, 8, pp.667~685 (1988)
  48. Bader CD, "Bipolar disorder not otherwise specified in relation to the bipolar spectrum", Bipolar Disord, 9, pp.860~867 (2007)
  49. Brodie HKH, "Bipolar depression-A comparative study of patient characteristics", Am J Psychiatry, 127, pp.1086~1090 (1971)

이 간행물의 다른 논문 (13건)

정신약물에 의한 피부 부작용원승희, 임효덕, 이승재, 김병수, 장성만, 우정민pp. 121-126밈 이론의 관점에서 본 정신 질환의 이해주연우, 이승복, 손정우pp. 127-137운동이 기분 및 우울증에 미치는 영향 및 임상적 적용 : 신경가소성의 관점에서민유선, 김병수pp. 138-146인지기능장애가 있는 지역사회 거주노인에서 삶의 질의 관련인자김성완, 김남준, 신일선, 김재민, 윤진상, 신희영pp. 147-154양극성 장애, 조증 삽화 입원 환자에서 조증 증상 경과 예측과 관련있는 임상 변인 연구박진완, 한상우, 이연정, 백두현, 우성일, 황재욱, 김채리pp. 155-163
원문 보기