Abstract
Background and objective: Dissociative experiences are widespread among patients with panic disorder and have a negative impact on cognitive-behavioural therapy. In this study we aimed to investigate whether or not dissociative experiences affect response to drug treatment for panic disorder.
Methods: Thirty-five patients, 20 women and 15 men, with a mean age of 35.4 years and a diagnosis of panic disorder, were enrolled in the study. Paroxetine 20 mg/day was administered over 6 weeks. Patients were assessed on the Dissociative Experience Scale (DES) and Panic and Agoraphobia Scale (PAS) at the commencement of therapy, and on the PAS again after therapy.
Results: The average DES score was determined as 30.3. Agoraphobia was identified in 34.3% of patients. DES scores were higher in patients with agoraphobia than in those without agoraphobia. Agoraphobia scores were higher in patients with high DES scores. When patients were divided into those with low DES scores (<30) and those with high DES scores (>30), a decrease in PAS scores with treatment was observed in both groups, but the decrease was greater in those with low DES scores (18.8 ± 6.8 vs 5.7 ± 5.7 in the high-DES score group; Z = 4.486, p = 0.00000053). Similarly, while a decrease in PAS scores with treatment was observed both in patients with agoraphobia (p < 0.05) and in those without agoraphobia, PAS scores decreased more in non-agoraphobic patients (16.7 ± 7.5 vs 4.8 ± 6.6 in patients with agoraphobia; Z = 3.799, p = 0.000047). In addition, the decrease in PAS scores was significantly correlated with baseline DES score (β = 0.706, T = 5.727, p = 0.0000022).
Conclusion: This study shows that dissociative experiences reduce the response to drug therapy in patients with panic disorder.
Similar content being viewed by others
References
Roy-Byrne PP, Russo J, Cowley DS, et al. Unemployment and emergency room visits predict poor treatment outcome in primary care panic disorder. J Clin Psychiatry. 2003; 64;(4): 383–9
Roy-Byrne PP, Russo J, Cowley DS, et al. Panic disorder in public sector primary care: clinical characteristics and illness severity compared with ‘mainstream’ primary care panic disorder. Depress Anxiety 2003; 17(2): 51–7
Roy-Byrne P, Sherbourne C, Miranda J, et al. Poverty and response to treatment among panic disorder patients in primary care. Am J Psychiatry2006; 163(8): 1419–25
Roy-Byrne P, Stein MB, Russo J, et al. Medical illness and response to treatment in primary care panic disorder. Gen Hosp Psychiatry 2005; 27(4): 237–43
Michelson L, June K, Vives A, et al. The role of trauma and dissociation in cognitive-behavioral psychotherapy outcome and maintenance for panic disorder with agoraphobia. Behav Res Ther 1998; 36: 1011–50
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association, 1994
Holmes EA, Brown RJ, Mansell W, et al. Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clin Psychol Rev 2005; 25: 1–23
Spitzer C, Barnow S, Freyberger HJ, et al. Recent developments in the theory of dissociation. World Psychiatry 2006; 5(2): 82–6
Halligan SL, Yehuda R. Assessing dissociation as a risk factor for posttraumatic stress disorder: a study of adult offspring of Holocaust survivors. J Nerv Ment Dis2002; 190: 429–36
Cassano GB, Petracca A, Perugi G, et al. Derealization and panic attacks: a clinical evaluation on 150 patients with panic disorder/agoraphobia. Compr Psychiatry 1989; 30: 5–12
Ball S, Robinson A, Shekhar A, et al. Dissociative symptoms in panic disorder. J Nerv Ment Dis 1997; 185(12): 755–60
Sierra M, Gomez J, Molina JJ, et al. Depersonalization in psychiatric patients: a transcultural study. J Nerv Ment Dis 2006; 194: 356–61
Muris P, Merckelbach H, Peeters E. The links between the Adolescent Dissociative Experiences Scale (A-DES), fantasy proneness, and anxiety symptoms. J Nerv Ment Dis 2003,191; 18–24
Miller PP, Brown TA, Di Nardo PA, et al. The experimental induction of depersonalization and derealization in panic disorder and nonanxious subjects. Behav Res Ther 1994; 32: 511–9
Rufer M, Held D, Cremer J, et al. Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessivecompulsive disorder. Psychother Psychosom 2006; 75(1): 40–6
Martenyi F, Brown EB, Zhang H, et al. Fluoxetine versus placebo in posttraumatic stress disorder. J Clin Psychiatry 2002; 63(3): 199–206
First MB, Spitzer RL, Gibbon M, et al. Structured clinical interview for DSM-IV clinical version (SCID-I/CD). Washington, DC: American Psychiatric Press, 1997
Pollack MH, Doyle AC. Treatment of panic disorder: focus on paroxetine. Psychopharmacol Bull 2003; 37Suppl. 1: 53–63
Bandelow B. Assessing the efficacy of treatments for panic disorder and agoraphobia: II. The Panic and Agoraphobia Scale. Int Clin Psychopharmacol 1995; 10: 73–81
Tural U, Fidaner H, Alkin T, et al. Validity and reliability of the Turkish version of the Panic and Agoraphobia Scale. Turkish J Psychiatry 2000; 11: 29–39
Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986; 174: 727–35
Sar V, Kiziltan E, Kundakci T. The validity and reliability of Dissociative Experience Scale in Turkish sample. National Psychiatry Congress Book, Antalya 1997: 64
Atesci FC, Karadag F, Amuk T, et al. Suicidal ideations in panic disorder. Anatol J Psychiatry2003; 4(2): 81–6
Ozkan M, Ozen S, Ertunc N. The role of traumatic life events on forming axis-1 disorders in comorbid panic disorder. Turk J Psychiatry 2005; 8(2): 53–9
Shinoda N, Kodama K, Sakamoto T, et al. Predictors of 1-year outcome for patients with panic disorder. Compr Psychiatry 1999; 40: 39–43
Keller MB, Yonkers KA, Warshaw MG, et al. Remission and relapse in subjects with panic disorder and panic with agoraphobia: a prospective short-interval naturalistic follow-up.J Nerv Ment Dis 1994; 182: 290–6
Carpiniello B, Baita A, Carta MG, et al. Clinical and psychosocial outcome of patients affected by panic disorder with or without agoraphobia: results from a naturalistic followup study. Eur Psychiatry 2002; 17: 394–8
Goodwin RD, Lieb R, Hoefler M, et al. Panic attack as a risk factor for severe psychopathology. Am J Psychiatry 2004; 161: 2207–14
Onur E, Alkin T, Monkul ES, et al. Panic-agoraphobic spectrum. Turk J Psychiatry 2004; 15(3): 215–23
Albert U, Maina G, Bergesio C, et al. Axis I and II comorbidities in subjects with and without nocturnal panic. Depress Anxiety 2006; 23: 422–8
Rosenbaum JF. Treatment-resistant panic disorder. J Clin Psychiatry 1997; 58Suppl. 2: v61–4
Mathew SJ, Coplan JD, Gorman JM. Management of treatmentrefractory panic disorder. Psychopharmacol Bull 2001; 35(2): 97–110
Yargic LI, Tutken H, Sar V. Childhood traumatic life events and adulthood dissociative symptoms. National Psychiatry Congress book. Turkey: Lilly Corp., 1994: 397
Doruk A, Yetkin S, Tiirkbay T, et al. The childhood traumatic events and psychiatric disorders in patients with posttraumatic stress disorder. Gulhane Med J 2001; 43(2): 141–7
Evren C, Ogel K. Dissociative symptoms among alcohol and substance dependents and its relationships with childhood trauma history, depression, anxiety, and alcohol/substance use. Anatol J Psychiatry 2003; 4: 30–7
Marshall RD, Schneier FR, Lin SH, et al. Childhood trauma and dissociative symptoms in panic disorder. Am J Psychiatry 2000; 157: 451–3
Acknowledgements
No sources of funding were used to assist in the preparation of this study. The authors have no potential conflicts of interest that are directly relevant to the content of this article. Written consent was obtained from patients for publication of their details.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gulsun, M., Doruk, A., Uzun, O. et al. Effect of Dissociative Experiences on Drug Treatment of Panic Disorder. Clin. Drug Investig. 27, 583–550 (2007). https://doi.org/10.2165/00044011-200727080-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00044011-200727080-00007