Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-19T04:00:28.461Z Has data issue: false hasContentIssue false
  • English
  • Français

A latent class approach to the external validation of respiratory and non-respiratory panic subtypes

Published online by Cambridge University Press:  16 August 2011

R. Roberson-Nay ,
S. J. Latendresse  and
K. S. Kendler
R. Roberson-Nay*
Affiliation:
Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, P.O. Box 980489, Richmond, VA 23298, USA
S. J. Latendresse
Affiliation:
Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, P.O. Box 980489, Richmond, VA 23298, USA
K. S. Kendler
Affiliation:
Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, P.O. Box 980489, Richmond, VA 23298, USA
*
*Address for correspondence: R. Roberson-Nay, Ph.D., Department of Psychiatry, Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, P.O. Box 980489, Richmond, VA 23298, USA. (Email: rrobersonnay@vcu.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The phenotypic variance observed in panic disorder (PD) appears to be best captured by a respiratory and non-respiratory panic subtype. We compared respiratory and non-respiratory panic subtypes across a series of external validators (temporal stability, psychiatric co-morbidity, treatment response) to determine whether subtypes are best conceptualized as differing: (1) only on their symptom profiles with no other differences between them; (2) on a quantitative (i.e. severity) dimension only; or (3) qualitatively from one another.

Method

Data from a large epidemiological survey (National Epidemiologic Survey on Alcohol and Related Conditions) and a clinical trial (Cross-National Collaborative Panic Study) were used. All analytic comparisons were examined within a latent class framework.

Results

High temporal stability of panic subtypes was observed, particularly among females. Respiratory panic was associated with greater odds of lifetime major depression and a range of anxiety disorders as well as increased treatment utilization, but no demographic differences. Treatment outcome data did not suggest that the two PD subtypes were associated with differential response to either imipramine or alprazolam.

Conclusions

These data suggest that respiratory and non-respiratory panic represent valid subtypes along the PD continuum, with the respiratory variant representing a more severe form of the disorder.

Keywords

External validationlatent classpanic disorderrespiratorystabilitysubtypes
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 3 , March 2012 , pp. 461 - 474
Copyright
Copyright © Cambridge University Press 2011

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

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., revised. American Psychiatric Association: Washington, DC.Google Scholar
Briggs, AC, Stretch, DD, Brandon, S (1993). Subtyping of panic disorder by symptom profile. British Journal of Psychiatry 163, 201–209.CrossRefGoogle ScholarPubMed
Brown, TA, Antony, MM, Barlow, DH (1995). Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment. Journal of Consulting and Clinical Psychology 63, 408–418.CrossRefGoogle ScholarPubMed
Brown, TA, Barlow, DH (1992). Comorbidity among anxiety disorders: implications for treatment and DSM-IV. Journal of Consulting and Clinical Psychology 60, 835–844.CrossRefGoogle ScholarPubMed
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585–599.CrossRefGoogle Scholar
Cross-National Collaborative Panic Study, Second Phase Investigators (1992). Drug treatment of panic disorder: comparative efficacy of alprazolam, imipramine, and placebo. British Journal of Psychiatry 160, 191–202.CrossRefGoogle Scholar
Domschke, K, Freitag, CM, Kuhlenbaumer, G, Schirmacher, A, Sand, P, Nyhuis, P, Jacob, C, Fritze, J, Franke, P, Rietschel, M, Garritsen, HS, Fimmers, R, Nothen, MM, Lesch, KP, Stogbauer, F, Deckert, J (2004). Association of the functional V158M catechol-O-methyl-transferase polymorphism with panic disorder in women. International Journal of Neuropsychopharmacology 7, 183–188.CrossRefGoogle ScholarPubMed
Eaton, WW, Kessler, RC, Wittchen, HU, Magee, WJ (1994). Panic and panic disorder in the United States. American Journal of Psychiatry 151, 413–420.Google ScholarPubMed
Goodman, LA (2007). On the assignment of individuals to latent classes. Sociological Methodology 37, 1–22.CrossRefGoogle Scholar
Grant, BF, Hasin, DS, Stinson, FS, Dawson, DA, Goldstein, RB, Smith, S, Huang, B, Saha, TD (2006). The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 67, 363–374.Google Scholar
Hamilton, SP, Slager, SL, Heiman, GA, Deng, Z, Haghighi, F, Klein, DF, Hodge, SE, Weissman, MM, Fyer, AJ, Knowles, JA (2002). Evidence for a susceptibility locus for panic disorder near the catechol-O-methyltransferase gene on chromosome 22. Biological Psychiatry 51, 591–601.CrossRefGoogle ScholarPubMed
Klein, DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Archives of General Psychiatry 50, 306–317.Google Scholar
Klerman, GL (1988). Overview of the Cross-National Collaborative Panic Study. Archives of General Psychiatry 45, 407–412.CrossRefGoogle ScholarPubMed
McHugh, RK, Smits, JA, Otto, MW (2009). Empirically supported treatments for panic disorder. Psychiatric Clinics of North America 32, 593–610.CrossRefGoogle ScholarPubMed
Muthen, LK, Muthen, BO (2007). Mplus: Statistical Analysis with Latent Variables. Muthen and Muthen: Los Angeles, CA.Google Scholar
Regier, DA, Narrow, WE, Rae, DS (1990). The epidemiology of anxiety disorders: The Epidemiologic Catchment Area (ECA) experience. Journal of Psychiatric Research 24, 3–14.CrossRefGoogle ScholarPubMed
Roberson-Nay, R, Kendler, KS (in press). Panic disorder and its subtypes: a comprehensive analysis of panic symptom heterogeneity using epidemiological and treatment seeking samples. Psychological Medicine.Google Scholar
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–987.CrossRefGoogle ScholarPubMed
Rothe, C, Koszycki, D, Bradwejn, J, King, N, Deluca, V, Tharmalingam, S, Macciardi, F, Deckert, J, Kennedy, JL (2006). Association of the Val158Met catechol O-methyltransferase genetic polymorphism with panic disorder. Neuropsychopharmacology 31, 2237–2242.Google Scholar
Sanderson, WC, Di Nardo, PA, Rapee, RM, Barlow, DH (1990). Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder. Journal of Abnormal Psychology 99, 308–312.Google Scholar
Schneier, FR, Fyer, AJ, Martin, LY (1991). A comparison of phobic subtypes within panic disorder. Journal of Anxiety Disorders 5, 65–75.CrossRefGoogle Scholar
Starcevic, V, Uhlenhuth, H, Kellner, R (1992). Patterns of comorbidity in panic disorder and agoraphobia. Psychiatry Research 42, 171–183.CrossRefGoogle ScholarPubMed
Tsao, JCI, Lewin, MR, Craske, MG (1998). The effects of cognitive-behavior therapy for panic disorder on comorbid conditions. Journal of Anxiety Disorders 12, 357–371.CrossRefGoogle ScholarPubMed
Tsao, JCI, Mystkowski, JL, Zucker, BG, Craske, MG (2002). Effects of cognitive-behavior therapy for panic disorder on comorbid conditions: replication and extension. Behavior Therapy 33, 493–509.CrossRefGoogle Scholar
Uhlenhuth, EH, Leon, AC, Matuzas, W (2006). Psychopathology of panic attacks in panic disorder. Journal of Affective Disorders 92, 55–62.CrossRefGoogle ScholarPubMed
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, H, Joyce, PR, Karam, EG, Lee, C, Lellouch, J, Lépine, J, Newman, SC, Oakley-Browne, MA, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, H, Yeh, E (1997). The cross-national epidemiology of panic disorder. Archives of General Psychiatry 54, 305–309.CrossRefGoogle ScholarPubMed
Williams, JB, Gibbon, M, First, MB, Spitzer, RL, Davies, M, Borus, J, Howes, MJ, Kane, J, Pope, HG, Rounsaville, B, Wittchen, H (1992). The Structured Clinical Interview for DSM-III-R(SCID): II. Multisite test-retest reliability. Archives of General Psychiatry 49, 630–636.CrossRefGoogle Scholar
Woo, JM, Yoon, KS, Yu, BH (2002). Catechol O-methyltransferase genetic polymorphism in panic disorder. American Journal of Psychiatry 159, 1785–1787.CrossRefGoogle ScholarPubMed