Abstract
Purpose
Panic Disorder (PD) is a classic example of a disease where symptom remission may be achieved, yet patient quality of life (QOL) remains low, providing further support for the need to measure QOL as an additional outcome in patient care. The objectives of this review are to examine the substantial QOL impairments in PD and to determine whether modern treatments for PD, which have been proven to achieve symptom remission, have been shown to restore QOL.
Methods
We identified studies on QOL in PD from 1980 to 2010 by searching MEDLINE, PsycINFO, and PubMed databases.
Results
The literature reveals substantial QOL impairments in PD, often resulting in poor sense of health, frequent utilization of medical services, occupational deficiency, financial dependency, and marital strife. Modern therapies have been demonstrated to achieve symptom remission and improve QOL in PD; however, post-treatment QOL is still significantly lower than community averages.
Conclusions
QOL needs to be added as an essential outcome measure in patient care. Further research should be conducted to better understand the nature of comorbidities in PD as well as to determine whether additional interventions that have been studied in other psychiatric disorders, such as exercise, meditation, yoga, humor, massage, and nutritional supplements, can be utilized to improve QOL in PD to normal community levels.
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Abbreviations
- PD:
-
Panic disorder
- QOL:
-
Quality of life
- CBT:
-
Cognitive behavioral therapy
References
Frances, A., Miele, G. M., Widiger, T. A., Pincus, H. A., Manning, D., & Davis, W. W. (1993). The classification of panic disorders: From Freud to DSM-IV. The Journal of Psychiatric Research, 27(Suppl 1), 3–10.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn, Text Revision) (DSM-IV-TR). Washington, DC: American Psychiatric Association.
National Institute of Mental Health (2009). Panic disorder. Retrieved from http://www.nimh.nih.gov/health/publications/anxiety-disorders/panic-disorder.shtml.
Kessler, R. C., & Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115–129.
Kessler, R. C., McGonagle, K. A., Zhao, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the national comorbidity survey. Archives of General Psychiatry, 51, 8–19.
Chou, K. L. (2010). Panic disorder in older adults: Evidence from the national epidemiologic survey on alcohol and related conditions. International Journal of Geriatric Psychiatry, 25, 822–832.
Edlund, M. J., Swann, A. C. (1987). The economic and social costs of panic disorder. Hospital and Community Psychiatry, 38(12), 1277–1279, 1288.
Ettigi, P., Meyerhoff, A. S., Chirban, J. T., et al. (1997). The quality of life and employment in panic disorder. Journal of Nervous and Mental Disease, 185(6), 368–372.
Kroenke, K., Spitzer, R. L., Williams, J. B., et al. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.
Markowitz, J. S., Weissman, M. M., Ouellette, R., et al. (1989). Quality of life in panic disorder. Archives of General Psychiatry, 46(11), 984–992.
Massion, A. O., Warshaw, M. G., & Keller, M. B. (1993). Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. American Journal of Psychiatry, 150(4), 600–607.
Reilly, M. C., Zbrozek, A. S., & Dukes, E. M. (1993). The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics, 4, 353–365.
Rubin, H. C., Rapaport, M. H., Levine, B., et al. (2000). Quality of well being in panic disorder: The assessment of psychiatric and general disability. Journal of Affective Disorders, 57(1–3), 217–221.
Saarni, S. I., & Suvisaari, J. (2007). Impact of psychiatric disorders on health-related quality of life: General population survey. British Journal of Psychiatry, 190, 326–332.
Simon, G., & Von Korff, M. (1991). Somatization and psychiatric disorder in the Epidemiologic Catchment Area study. American Journal of Psychiatry, 148, 1494–1500.
Constitution of the World Health Organization. (1946). American Journal of Public Health and the Nations Health, 36(11), 1315–1323.
Beard, C., Weisberg, R. B., & Keller, M. B. (2010). Health-related quality of life across the anxiety disorders: Findings from a sample of primary care patients. Journal of Anxiety Disorders, 24, 559–564.
Candilis, P. J., McLean, R. Y. S., Otto, M. W., et al. (1999). Quality of life in patients with panic disorder. Journal of Nervous and Mental Disease, 187(7), 429–434.
Cramer, V., Svenn, T., Kringlen, E., et al. (2005). Quality of life and anxiety disorders: A population study. Journal of Nervous and Mental Disease, 193(3), 196–202.
Hung, C. I., Wang, S. J., Yang, C. H., et al. (2008). The impacts of migraine, anxiety disorders, and chronic depression on quality of life in psychiatric outpatients with major depressive disorder. Journal of Psychosomatic Research, 65(2), 135–142.
Luciano, J. V., Bertsch, J., Salvador-Carulla, L., et al. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample. Journal of Evaluation in Clinical Practice, 16, 895–901.jep
Luo, N., Fones, C. S. L., Thumboo, J., et al. (2004). Factors influencing health-related quality of life of Asians with anxiety disorders in Singapore. Quality of Life Research: An International Journal of Quality of Life, 13(2), 557–565.
Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005). Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162(6), 1171–1178.
Sanderson, K., & Andrews, G. (2002). Prevalence and severity of mental health-related disability and relationship to diagnosis. Psychiatric Services, 53(1), 80–86.
Schonfeld, W. H., Verboncoeur, C. J., & Fifer, S. K. (1997). The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. Journal of Affective Disorders, 43, 105–119.
Sherbourne, C., Sullivan, G., Craske, M. G., et al. (2010). Functioning and disability levels in primary care outpatients with one or more anxiety disorders. Psychological Medicine, 40(12), 2059–2068.
Sherbourne, C. D., Wells, K. B., & Judd, L. L. (1996). Functioning and well-being of patients with panic disorder. American Journal of Psychiatry, 153(2), 213–218.
Simon, N. M., Otto, M. W., Korbly, N. B., et al. (2002). Quality of life in social anxiety disorder compared with panic disorder and the general population. Psychiatric Services, 53(6), 714–718.
Carrera, M., Herran, A., Ayuso-Mateos, J. L., et al. (2006). Quality of life in early phases of panic disorder: Predictive factors. Journal of Affective Disorders, 94(1–3), 127–134.
Dammen, T., Ekeberg, O., Arnesen, H., et al. (2008). Health-related quality of life in non-cardiac chest pain patients with and without panic disorder. International Journal of Psychiatry in Medicine, 38(3), 271–286.
Fyer, A. J., Katon, W., Hollifield, M., et al. (1996). DSM-IV panic disorder field trial: Panic attack frequency and functional disability. Anxiety, 2(4), 157–166.
Hollifield, M., Katon, W., Skipper, B., et al. (1997). Panic disorder and quality of life: Variables predictive of functional impairment. American Journal of Psychiatry, 154(6), 766–772.
Katon, W., Hollifield, M., Chapman, T., et al. (1995). Infrequent panic attacks: Psychiatric comorbidity, personality characteristics and functional disability. Journal of Psychiatric Research, 29(2), 121–131.
Pollack, M. H., Otto, M. W., Worthington, J. J., et al. (1998). Sertraline in the treatment of panic disorder. A flexible-dose multicenter trial. Archives of General Psychiatry, 55, 1010–1016.
Rufer, M., Albrecht, R., Schmidt, O., et al. (2009). Changes in quality of life following cognitive-behavioral group therapy for panic disorder. European Psychiatry: Electronic publication ahead of print.
Spitzer, R. L., Kroenke, K., Linzer, M., et al. (1995). Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD study. Journal of American Medical Association, 274, 1511–1517.
Stahl, S. M., Gergel, I., & Li, D. (2003). Escitalopram in the treatment of panic disorder: A randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 64(11), 1322–1327.
Bringager, C. B., Friis, S., Arnesen, H., et al. (2008). Nine-year follow-up of panic disorder in chest pain patients: Clinical course and predictors of outcome. General Hospital Psychiatry, 30(2), 138–146.
Muller-Tasch, T., Frankenstein, L., Holzapfela, N., et al. (2008). Panic disorder in patients with chronic heart failure. Journal of Psychosomatic Research, 64(3), 299–303.
Worthington, J. J., Pollack, M. H., Otto, M. W., et al. (1997). Panic disorder in emergency ward patients with chest pain. Journal of Nervous and Mental Disease, 185(4), 274–276.
Dammen, T., Bringager, C. B., & Arnesen, H. (2006). A 1-year follow-up study of chest-pain patients with and without panic disorder. General Hospital Psychiatry, 28, 516–524.
Hegel, M. T., Unützer, J., Tang, L., et al. (2005). Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. American Journal of Geriatric Psychiatry, 13(1), 48–58.
Barrera, T. L., & Norton, P. J. (2009). Quality of life impairment in generalized anxiety disorder, social phobia and panic disorder. Journal of Anxiety Disorders, 23, 1086–1090.
Afari, N., Schmaling, K. B., Barnhart, S., et al. (2001). Psychiatric comorbidity and functional status in adult patients with asthma. Clinical Psychology in Medical Settings, 8(4), 245–252.
Creed, F., Ratcliffe, J., Fernandes, L., et al. (2005). Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders. British Journal of Psychiatry, 186, 507–515.
Epstein, S. A., Kay, G., Clauw, D., et al. (1999). Psychiatric disorders in patients with fibromyalgia. A multicenter investigation. Psychosomatics, 40(1), 57–63.
Roy-Byrne, P. P., Russo, J., Dugdale, D. C., et al. (2002). Undertreatment of panic disorder in primary care: Role of patient and physician characteristics. Journal of American Board of Family Practice, 15, 443–450.
Kessler, R. C., & Frank, R. G. (1997). The impact of psychiatric disorders on work-loss days. Psychological Medicine, 27, 861–873.
Mittal, D., Fortney, J. C., Pyne, J. M., et al. (2006). Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder. Psychiatric Services, 57(12), 1731–1737.
Supina, A. L., Johnson, J. A., Patten, S. B., et al. (2007). The usefulness of the EQ-5D in differentiating among persons with major depressive episode and anxiety. Quality of Life Research Journal, 16(5), 749–754.
Katerndahl, D. A., Realini, J. P., et al. (1997). Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder. Journal of Clinical Psychiatry, 58(4), 153–158.
Sareen, J., Jacobi, F., Cox, B. J., et al. (2006). Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Archives of Internal Medicine, 166(19), 2109–2116.
Jacobs, R. J., Davidson, J. R., Gupta, S., & Meyerhoff, A. S. (1997). The effects of clonazepam on quality of life and work productivity in panic disorder. American Journal of Managed Care, 3(8), 1187–1196.
Mavissakalian, M. R., Perel, J. M., Talbott-Green, M., & Sloan, C. (1998). Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia. Biological Psychiatry, 43, 848–854.
Pohl, R. B., Wolkow, R. M., & Clary, C. M. (1998). Sertraline in the treatment of panic disorder: A double-blind multicenter trial. American Journal of Psychiatry, 155(9), 1189–1195.
Simon, N. M., Kaufman, R. E., Hoge, E. A., et al. (2009). Open-label support for Duloxetine for the treatment of panic disorder. CNS Neuroscience and Therapeutics, 15, 19–23.
Food and Drug Administration. (2009). Approval package: Savella (Milnacipran HCI) Tablets. January 14, 2009. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000TOC.cfm. Accessed January 15, 2011.
Blaya, C., Seganfredo, A. C., Dornelles, M., et al. (2007). The efficacy of milnacipran in panic disorder: An open trial. International Clinical Psychopharmacology, 22(3), 153–158.
Heldt, E., Blaya, C., Isolan, L., et al. (2006). Quality of life and treatment outcome in panic disorder: Cognitive behavior group therapy effects in patients refractory to medication treatment. Psychotherapy and Psychosomatics, 75(3), 183–186.
Telch, M. J., Schmidt, N. B., Jaimez, T. L., et al. (1995). Impact of cognitive-behavioral treatment on quality of life in panic disorder patients. Journal of Consulting and Clinical Psychology, 63(5), 823–830.
Dow, M. T., Kenardy, J. A., Johnston, D. W., & Newman, M. (2007). Prognostic indices with brief and standard CBT for panic disorder: II. Moderators of outcome. Psychological Medicine, 37(10), 1503–1509.
Carlbring, P., Bohman, S., Brunt, S., et al. (2006). Remote treatment of panic disorder: A randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. American Journal of Psychiatry, 163(12), 2119–2125.
Ramnerö, J., & Ost, L. G. (2007). Panic and avoidance in panic disorder with agoraphobia: Clinical relevance of change in different aspects of the disorder. Journal of Behavior Therapy and Experimental Psychiatry, 38(1), 29–39.
Rollman, B. L., Belnap, B. H., Mazumdar, S., et al. (2005). A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care. Archives of General Psychiatry, 62(12), 1332–1341.
Roy-Byrne, P. P., Katon, W., Cowley, D. S., & Russo, J. (2001). A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Archives of General Psychiatry, 58(9), 869–876.
Roy-Byrne, P. P., Craske, M. G., Stein, M. B., et al. (2005). A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Archives of General Psychiatry, 62(3), 290–298.
Bandelow, B., Stein, D. J., Dolberg, O. T., et al. (2007). Improvement of quality of life in panic disorder with escitalopram, citalopram, or placebo. Pharmacopsychiatry, 40(4), 152–156.
Ware, J. E., Kosinski, M., & Keller, S. K. (1994). SF-36 ® physical and mental health summary scales: A user’s manual. Boston, MA: The Health Institute.
Acil, A. A., Dogan, S., & Dogan, O. (2008). The effects of physical exercises to mental state and quality of life in patients with schizophrenia. Journal of Psychiatric and Mental Health Nursing, 15(10), 808–815.
Larun, L., Nordheim, L. V., Ekeland, E., Hagen, K. B., Heian, F. (2006). Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Systems Review, 19(3), CD004691.
Nyklícek, I., & Kuijpers, K. F. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: Is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35(3), 331–340.
Hamre, H. J., Witt, C. M., Glockmann, A., Ziegler, R., Willich, S. N., & Kiene, H. (2007). Rhythmical massage therapy in chronic disease: A 4-year prospective cohort study. The Journal of Alternative and Complementary Medicine, 13(6), 635–642.
Marziali, E., McDonald, L., & Donahue, P. (2008). The role of coping humor in the physical and mental health of older adults. Aging and Mental Health, 12(6), 713–718.
Vilhauer, J. S., Young, S., Kealoha, C., et al. (2010). Treating major depression by creating positive expectations for the future: A pilot study for the effectiveness of future directed therapy (FDT) on symptom severity and quality of life. CNS Neuroscience & Therapeutics (in press).
Van der Watt, G., Laugharne, J., & Janca, A. (2008). Complementary and alternative medicine in the treatment of anxiety and depression. Current Opinion in Psychiatry, 21(1), 37–42.
Grossman, P., Kappos, L., Gensicke, H., et al. (2010). MS quality of life, depression, and fatigue improve after mindfulness training: A randomized trial. Neurology, 75(13), 1141–1149.
Eguchi, M., Noda, Y., Nakano, Y., et al. (2005). Quality of life and social role functioning in Japanese patients with panic disorder. Journal of Nervous and Mental Disease, 193(10), 686–689.
Yen, C. F., Kuo, C. Y., Tsai, P. T., et al. (2007). Correlations of quality of life with adverse effects of medication, social support, course of illness, psychopathology, and demographic characteristics in patients with panic disorder. Depression and Anxiety, 24(8), 563–570.
Teh, C. F., Morone, N. E., Karp, J. E., et al. (2009). Pain interference impacts response to treatment for anxiety disorders. Depression and Anxiety, 26(3), 222–228.
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Davidoff, J., Christensen, S., Khalili, D.N. et al. Quality of life in panic disorder: looking beyond symptom remission. Qual Life Res 21, 945–959 (2012). https://doi.org/10.1007/s11136-011-0020-7
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DOI: https://doi.org/10.1007/s11136-011-0020-7