Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-16T10:51:28.185Z Has data issue: false hasContentIssue false
  • English
  • Français

Diurnal Rhythms and Symptom Severity in Panic Disorder

A Preliminary Study of 24–Hour Changes in Panic Attacks, Generalised Anxiety, and Avoidance Behaviour

Published online by Cambridge University Press:  02 January 2018

Marilla F. Geraci  and
Thomas W. Uhde
Marilla F. Geraci
Affiliation:
Mental Health Clinic, MHAN & A Nursing Service, Clinical Center Nursing Department, National Institutes of Health, Bethesda, Maryland
Thomas W. Uhde*
Affiliation:
Section on Anxiety and Affective Disorders, Biological Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, USA
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

Diurnal changes in the frequency of panic attacks and symptoms of generalised anxiety, phobic anxiety and phobic avoidance in 34 panic-disorder patients and 40 normal controls were evaluated. The panic-disorder patients had significant diurnal changes in generalised and phobic anxiety, but not phobic avoidance. Increased severity of symptoms and prominent diurnal changes were most evident in the panic-disorder patients with a history of depression. Although panic attacks were distributed throughout the 24–hour period, patients with a current episode or history of depression tended to have more frequent panic attacks in the morning or early afternoon. These observations challenge the traditional belief that ‘anxious neurotic’ patients are relatively asymptomatic upon awakening in the morning and then develop more severe symptoms of anxiety later in the day.

Type
Papers
Information
The British Journal of Psychiatry , Volume 161 , Issue 4 , October 1992 , pp. 512 - 516
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abe, K. & Suzuki, T. (1985) Age trends of early awakening and feeling worse in the morning than in the evening in apparently normal people. Journal of Nervous and Mental Disease, 173, 495–498.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Bunney, W. E. Jr. & Hamburg, D. A. (1963) Method for reliable longitudinal observation of behavior. Archives of General Psychiatry, 9, 280–294.Google Scholar
Cameron, O. G., Lee, M. A., Kotun, J., et al (1986) Circadian symptom fluctuations in people with anxiety disorders. Journal of Affective Disorders, 11, 213–218.Google Scholar
Davidson, J. & Turnbull, C. D. (1986) Diagnostic significance of vegetative symptoms in depression. British Journal of Psychiatry, 148, 442–446.Google Scholar
Fyer, A. J., Endicott, J., Mannuzza, S., et al (1985) Schedule for Affective Disorders and Schizophrenia: Lifetime Version (Modified for the Study of Anxiety Disorders). New York: Anxiety Disorders Clinic, New York State Psychiatric Institute.Google Scholar
Mannuzza, S., Fyer, A. J., Klein, D. F., et al (1986) Schedule for Affective Disorders and Schizophrenia - Lifetime Version (Modified for the study of anxiety disorders): Rationale and conceptual development. Journal of Psychiatric Research, 20, 317–325.Google Scholar
Roth, M. (1960) Depressive states and their borderlands: classification, diagnosis and treatment. Comprehensive Psychiatry, 1, 135–155.Google Scholar
Roth, M., Gurney, C., Garside, R. F., et al (1972) Studies in the classification of affective disorders: The relationship between anxiety states and affective illness – I. British Journal of Psychiatry, 121, 147–161.Google Scholar
Spielberger, C. D., Gorsuch, R. L. & Lushene, R. E. (1970) State-Trait Anxiety (STAI) Manual. Palo Alto, California: Consulting Psychologists Press.Google Scholar
Stein, M. B. & Uhde, T. W. (1988) Panic disorder and major depression: a tale of two syndromes. Psychiatric Clinics of North America, 11, 441–461.CrossRefGoogle ScholarPubMed
Uhde, T. W. (1990) Caffeine provocation of panic: a focus on biological mechanisms. In Neurobiology of Panic Disorder (ed. Ballenger, J. C.), pp. 219–242. New York: Alan R. Liss.Google Scholar
Uhde, T. W., Boulenger, J. P., Roy-Byrne, P. P., et al (1985) Longitudinal course of panic disorder; clinical and biological considerations. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 9, 39–51.Google Scholar
Uhde, T. W. & Nemiah, J. C. (1989) Panic and generalized anxiety disorder. In Comprehensive Textbook of Psychiatry, vol. I (5th edn) (eds J. H. Kaplan & B. J. Sadock). Baltimore: Williams & Williams.Google Scholar
Wehr, T. A. & Goodwin, F. K. (1981) Biological rhythms and psychiatry. In American Handbook of Psychiatry, Vol. VII; Advances and New Directions (2nd edn), (eds S. Arieti & H. K. H. Brodie). New York: Basic Books.Google Scholar
Zung, W. W. K. (1971) A rating instrument for anxiety disorders. Psychosomatics, 12, 371–379.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.