공황장애 환자와 비공황 불안장애 환자의 심리적 특성 비교 -MMPI와 로르샤하 반응 특성을 중심으로-

이정은,이현수 한국임상심리학회 2009 Korean Journal of Clinical Psychology Vol.28 No.2

The purpose of this study was to investigate the psychological differences in between panic disorder and non-panic anxiety disorder patients and to explore more effective ways of treating patients with panic disorder. The MMPI and the Rorschach test were administered to 77 patients with panic disorders and 72 patients with non-panic anxiety disorders. The Rorschach was administered, scored and analyzed in accordance with the Comprehensive System developed by Exner(1993). Rorschach variables were classified in terms of five clusters(Capacity for Control and Stress Tolerance, Cognition, Affect, Self-perception, Interpersonal Perception). Various additional qualitative features were also analyzed. The results showed that the two groups of patients shared a similar pattern of self-recognition of symptoms, both groups were weak in managing resources and modulating affect, and each group demonstrated negative self- perceptions. However, some interesting differences emerged in the thought contents, thought processes, and coping strategies of the two groups. Firstly, patients in the panic disorder group showed higher stress due to affective constraints, efforts in cognitive control, and the poor management of resources. Secondly, while patients with non-panic anxiety disorders exhibited greater levels of social anxiety, patients with panic disorder displayed more negative ideas about their physical functioning. This finding illustrates an important point of contrast between the two groups. The non-panic anxiety patients held negative cognitions about their social functioning, but, for the panic disorder patients, the loss of objectivity occurred in relation to their catastrophic and unrealistic cognitions about their physical functioning. A logistic regression analysis indicated that self-awareness of symptoms, negative self-perception, and focusing on physical symptoms were important features discriminating between the two groups. These findings suggest that therapy for panic disorder patients could be more effective if patients are encouraged to adopt a more realistic set of beliefs and can be made more aware of their defensiveness, affective constraint, and excessive focus on physical symptoms.

공황장애의 평가

김정범 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.2

The four general areas to be evaluated in cases of panic disorder are (1) medical status, (2) phenomenology and history of panic auld agoraphobia, (3) comorbidity and history of other psychiatric disorders, and (4) predisposing and precipitating factors for panic attacks and factors maintaining the panic disorder. The assessment also involves information about how panic-disordered individuals behave on the five major response systems and their interaction: cognitive, behavioral, affective, physiological, and social. In order to tap into these different areas and response systems, clinicians should use a variety of measurement techniques: clinical interviews, self-report scales, self-monitoring, behavioral observation, psychophysiological monitoring. The use of a simple, psychometrically sound instrument such as Panic Disorder Severity Scale(PDSS), which considers all of the essential domains of panic disorder, will provide clinicians with an appropriate measure for diagnosing and monitoring patients. The application of this more comprehensive scale for monitoring patient should alert clinicians to reemergence of associated symptoms of panic disorder and allow for the rapid modification of treatment. All of the investigators who conduct any study of panic disorder should consider the essential, recommended, optional measures agreed in Consensus Development Conference on the treatment of panic disorder in 1992 and implement them in their research. Then the results of study from different laboratories will be easier to compare.

Orbito-Frontal Cortex Volumes in Panic Disorder

Murad Atmaca,Hanefi Yildirim,M. Gurkan Gurok,Muammer Akyol 대한신경정신의학회 2012 PSYCHIATRY INVESTIGATION Vol.9 No.4

Objective Given the association between the pathophysiology of panic disorder and prefrontal cortex function, we aimed to perform a volumetric MRI study in patients with panic disorder and healthy controls focusing on the in vivo neuroanatomy of the OFC. Methods Twenty right-handed patients with panic disorder and 20 right-handed healthy control subjects were studied. The volumes of whole brain, total white and gray matters, and OFC were measured by using T1-weighted coronal MRI images, with 1.5-mm-thick slices, at 1.5T. In addition, for psychological valuation, Hamilton Depression Rating (HDRS) and Panic Agoraphobia Scales (PAS) were administered. ResultsaaUnadjusted mean volumes of the whole brain volume, total white and gray matter were not different between the patients and healthy controls while the patient group had significantly smaller left (t=-6.70, p<0.0001) and right (t=-5.86, p<0.0001) OFC volumes compared with healthy controls. Conclusion Our findings indicate an alteration of OFC morphology in the panic disorder and suggest that OFC abnormalities may be involved in the pathophysiology of panic disorder. Objective Given the association between the pathophysiology of panic disorder and prefrontal cortex function, we aimed to perform a volumetric MRI study in patients with panic disorder and healthy controls focusing on the in vivo neuroanatomy of the OFC. Methods Twenty right-handed patients with panic disorder and 20 right-handed healthy control subjects were studied. The volumes of whole brain, total white and gray matters, and OFC were measured by using T1-weighted coronal MRI images, with 1.5-mm-thick slices, at 1.5T. In addition, for psychological valuation, Hamilton Depression Rating (HDRS) and Panic Agoraphobia Scales (PAS) were administered. ResultsaaUnadjusted mean volumes of the whole brain volume, total white and gray matter were not different between the patients and healthy controls while the patient group had significantly smaller left (t=-6.70, p<0.0001) and right (t=-5.86, p<0.0001) OFC volumes compared with healthy controls. Conclusion Our findings indicate an alteration of OFC morphology in the panic disorder and suggest that OFC abnormalities may be involved in the pathophysiology of panic disorder.

아이젱크 성격검사와 한국판 성격장애 검사를 이용한 공황장애 환자의 성격특성및 임상증상과의 관계

김의정,김영철 梨花女子大學校 醫科大學 醫科學硏究所 1998 EMJ (Ewha medical journal) Vol.21 No.1

공황장애환자에서의 성격특성을 조사하고 공황장애의 임상척도와 성격특성간의 상관관계를 알아보기 위하여 DSM-Ⅳ 진단기준을 만족시키는 공황장애 환자군 36명과 대조군 36명을 대상으로 자기보고형 성격검사 도구인 PDQ-R과 EPQ의 각 성격검사항목의 상관관계를 분석하였다. 연구결과는 다음과 같았다. 1) 환자군과 대조군에서 나이, 성별, 결혼여부, 고용상태, 교육정동서의 유의한 차이가 없었으며, 환자군에서 공황장애의 초발연령은 평균 33.6±17.9세, 이환기간은 4.65±5.7년, 공황발작 빈도는 한달에 8.2±9.9회, 공황증상 심각도는 27.6±11.0이었다. 2) PDQ-R검사를 이용한 성격특성 비교에서는 회피성(p<0.05). 강박성(p<0.01). 경계성(p<0.001). 연극성(p<0.01). 편집성(p<0.05). 인격장애와 PDQ-R 총점(p<0.01). B형(p<0.001). C형(p<0.01) 인격장애 집단의 점수가 환자군에서 유의하게 높았고 EPQ검사에서는 N척도가 환자군에서 유의하게 높았으며(p<0.001) E척도는 환자군에서 유의하게 낮았다(p<0.05). 3) 성격특성과 공황장애 임상척도의 상관관계 조사에서는 공황발작 빈도와 A형 인격장애 집단(r=0.3596, p<0.05). 공황증상 심각도와 분열형 인격장애 사이(r=0.4947, p<0.01)에서 유의한 상관관계를 보였다. 결론적으로 공황장애 환자에서는 회피성, 강박성, 경계성, 연극성, 편집성 인격장애 및 성향이 흔히 동반되며 내향적이고 정서적(신경증적)인 경향이 보인다. 또한 이러한 특성중 일부는 공황증상의 심각도나 공황발작 빈도와 상관관계가 있는 것으로 나타나 공황장애와 인격장애는 서로 연관성이 있다는 기존의 연구들을 뒷받침해주고 있으며 앞으로 그 연관성의 본질에 대한 추후 연구에 대한 필요성을 제시하고 있다. Objectives : This study was performed to examine personailty characteristics in patients with panic disorder and to assess the links between personailty characteristics and duration, frequency, and severity of panic symptoms. Methods : Thirty-six patients meeting DSM-Ⅳ criteria for panic disorder(patient group) and thirty-six normal controls were assessed by the PDQ-R and EPQ. Results : 1) Panic parients were more likley to show avoidant(p<0.05), obsessive-compulsive(p<0.01), histrionic(p<0.01), borderline(p<0.001) and paranoid(p<0.05) personality scales than controls. The scores of total PDQ-R(p<0.01), cluster B(p<0.001) and cluster C(p<0.01) personality disorder and traits in panic patients were significantly higher than controls. 2) Panic patients showed significantly higher scores than controls on the EPQ factors of N(p<0.01) and significantly lower scores than controls on the EPQ factors of E(p<0.05). 3) The frequency of panic attack and severity of panic symptoms in panic patients were sinificantly correlated with cluster A personality disorder(p<0.05) and schizotypal personaity disorder(p<0.01), respectively. Conclusion : The above results revealed that panic patients were more avoidant, obsessive-compulsive, histrionic, borderline, and paranoid than controls. The author also noted that panic patients were more introverted and neurotic than controls. Some clinical features of panic support the previous findings that where was a possible kink between panic disorder and personality disorder.

공황장애 환자의 증상에 영향을 미치는 성격 및 방어기제 인자

최호동,천은진,이준엽,송신호,정성훈,구본훈 한국정신분석학회 2012 精神分析 (Psychoanalysis) Vol.23 No.2

Objectives: There are several studies about the prevalence of comorbid personality in the patients with panic disorder, and the comparison of defense mechanisms between patients with panic disorder and those with normal controls. The purpose of this study is to investigate specific factors of personality and defense mechanisms that affect symptoms in panic disorder patients. Methods: We recruited 38 patients with panic disorder according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorder, 4th edition. We investigated specific factors of personality and defense mechanisms affecting symptoms in the patients using the Symptom Checklist-90-Revised (SCL-90-R), the Personality Disorder Questionnaire-4+,and the Defense Style Questionnaire. Results: The defense style turned out to be more primitive as the positive symptom distress level of SCL-90R increased. The factors of personality affecting panic disorder were dependence, avoidance, degree of depress and negativistic personality, while the factors of defense mechanism that influence symptoms of panic disorder were maladaptive defense style, acting out and somatization. In contrast, the symptomatic factor of panic disorder that affects maladaptive defense style was interpersonal sensitivity of SCL-90R. Conclusion: The finding suggests that the level of maturity in defense mechanism is negatively correlated with the severity of symptoms in panic disorder. Interpersonal themes, such as dependence and avoidant personality, can worsen the symptoms of panic disorder.

상황인식 기반의 공황장애 증상 관리 시스템

최동운,맹환,강윤정 한국엔터테인먼트산업학회 2019 한국엔터테인먼트산업학회논문지 Vol.13 No.4

We extract the symptom of panic disorder from the context awareness environment. It extracts body context information through natural movement that exists in everyday life and uses a component of panic disorder. The ontology theory can be used to provide information on the degree of symptoms of panic disorder through inference process. For the components of panic disorder to the information processing based on ontology are defined as Classes. Panic disorder index is expressed through ontology modeling so that the condition of panic disorder can be known. The derivation of panic disorder component and panic disorder index will enable context awareness based information service for panic disorder. The context information is periodically synchronized with the context awareness on based device. Panic disorder can be used to improve the lifestyle of panic disorder.

공황장애환자에서 광장공포증 동반여부에 따른 스트레스대처방식의 차이

최은영,제영묘,이대수,정영인 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.1

In an attempt to know the factors affecting the development of agoraphobia following panic attacks, the author investigated whether there are differences between coping strategies of panic disorder with and without ago-raphobia. Thirty-seven patients meeting the criteria of DSM-IV panic disorder were divided into 2 subgroups, one group with agoraphobia, another without agoraphobia. Questionaires for the severity of panic symptoms, and of anticipating anxiety for panic attacks, multidimensional coping scale for stress were administered to panic subjects. The results were summarized as follows. 1) Group of panic disorder with agoraphobia complaints trembling or shaking more than group of panic disorder without agoraphobia. 2) There was no differences of degree for the severity of anticipating anxiety between two groups. 3) Group of Panic disorder with agoraphobia had higher score on BDI than Group of panic disorder without agoraphobia. 4) Group of panic disorder with agoraphobia had lower score on active coping, positive interpretation, acceptance than group of panic disorder without agoraphobia, and the differences of these strategies between two groups were not correlated with the score on BDI at the time of investigation. In conclusion, these results suggest that the coping strategies for stress may be a predictor of agoraphobia in patients with panic disorder.

불안 민감성에 대한 이요인 이론의 제안과 그 타당화: 공황장애 집단과 신체형 장애 집단을 중심으로

황성훈,이훈진,이수현 한국임상심리학회 2006 Korean Journal of Clinical Psychology Vol.25 No.3

The purpose of this study was to test the hypothesis that the anxiety sensitivity known as a major mechanism of panic disorder may be divided into dual factors, one being somatic sensitivity, the other being catastrophic interpretation. For this purpose, we modified the anxiety sensitivity index-revised(ASI-R) into two-step rating, somatic sensitivity in the first step and cognitive interpretation in the second step, that can reflect the dual factors. In study 1, we compared panic group and somatization group with control group(each 30 subjects) selected from 500 college students. As predicted from dual factor hypothesis, in the first step rating of somatic sensation, the somatization group exceeded the panic group. However in the second rating(catastrophizing), the panic group did not exceed the somatization group. In study 2, panic patients and somatoform disorder patients(each 30 patients) were compared with 30 normal controls. In the somatic sensation factor, the result of study 1 was replicated, and in the catastrophic interpretation factor, the predicted difference was revealed. That is, in the catastrophic interpretation the panic patients were higher than somatoform disorder patients. These findings support the validity of dual factor hypothesis which says that although panic disorder and somatoform disorder share two-factor structure, panic disorder may be dominant in catastrophic interpretation and somatoform disorder may be prominent in somatic sensation. The dual factor theory may build a conceptual bridge between anxiety sensitivity research and Clark's cognitive model of panic disorder. In clinical settings, it will also contribute to the differential diagnosis and therapy of panic disorders.

한국형 공황장애 약물치료 알고리듬 2008:초기치료전략

양종철,김민숙,유범희,윤세창,이상혁,서호석,김찬형 대한정신약물학회 2009 대한정신약물학회지 Vol.20 No.1

Objective:The Korean Association of Anxiety Disorders developed a Korean treatment algorithm for panic disorder to help clinicians make treatment decisions. This study investigated a consensus about initial treatment strategies as part of developing a medication algorithm for panic disorders in Korea. Methods Based on current treatment algorithms published by the American Psychiatric Association, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association, we developed questionnaires about initial treatment strategies for patients with panic disorder. Fifty-four experts in panic disorder answered the questionnaires. We classified expert opinions into three categories (first-, second-, and third-line treatment strategies) by χ2 tests. Results:Antidepressants and anxiolytics were recommended as first-line strategies for the initial treatment of panic disorder. A combination of medical treatment and cognitive-behavioral therapy was also recommended for more severe cases. Paroxetine, escitalopram, alprazolam, and clonazepam were preferred from among many anti-panic drugs. The mean starting dose of anti-panic drugs in the initial treatment for panic disorder was relatively lower than that for such other psychiatric illnesses as major depressive disorder. Conclusion:These results, reflecting recent studies and clinical experiences, may provide guidelines about initial treatment strategies for panic disorder.

갱년기 증후군을 나타낸 공황장애 환자 치험 1례

김철수,송호림,이용현,김형준,황정선,임세영,유상민,조윤철 대한한방부인과학회 2004 大韓韓方婦人科學會誌 Vol.17 No.3

Panic disorder is that suffering panic accompany severe symptoms, such as dyspnea, feeling of chocking, palpitation, chest discomfort or pain, sweating, feeling of dizzy, trembling of shaking, abdominal disorder, numbness or tingling sensations, chills or hot flushes, fear of dying, fear of losing control or going crazy, yet there is no real indisposition. The women in climacteric, they may suffer from palpitation, feeling of ascending fever, feeling of anxiety, which are similar to the symptom of panic disorder. If the women, who are under panic disorder, get going with the menopause, they will feel more painful. This case is that of a woman in her late fifties who are diagnosed as panic disorder 10 years ago. She suffered the climacteric while treated with panic disorder and the respective symptoms got worse. However, her symptoms became much better after oriental herb treatment for them for five months. During the treatment, a favorable turn of the menopausal hormone was shown in the lab tests and on the sheets for diagnosing panic disorder.