Published online Jun 19, 2021. doi: 10.5498/wjp.v11.i6.242
Peer-review started: February 24, 2021
First decision: April 21, 2021
Revised: May 6, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: June 19, 2021
Panic disorders frequently occur with affective disorders, particularly bipolar disorder. The lifetime prevalence of panic disorder is about 21% of bipolar disorder, much higher than about 10% of major depressive disorder. Patients with panic disorder and bipolar disorder are more likely to present with a severe course of disorder, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.
Patients who suffer from both panic disorder and bipolar disorder have a poorer prognosis than patients who suffer from only one disorder. So, it is crucial to predict a bipolarity of a patient who is diagnosed with panic disorder at early phase of disease course to select a proper treatment for the patients. However, there is no standard evaluation tool to predict a bipolarity of panic disorder patients.
In this study, we tried to identify the specific symptoms of patients with panic disorder that indicate bipolarity to establish a proper treatment plan.
A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) were diagnosed with panic disorder. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests included the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between panic disorder and bipolarity. Our collected data was not normally distributed. So, for statistical analysis, we used Mann-Whitney test to compare continuous variables between two groups, and Spearman’s rank correlation to find the relationship between the MDQ scores and other variables.
Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, n = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, n = 126). The BP+ group were more likely to be unmarried (single 56.2% vs 44.4%, P = 0.008) and younger (30.78 ± 0.59 vs 37.11 ± 3.21, P < 0.001). Moreover, the BP+ group had significantly higher scores on some psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, MMPI (depression), MMPI (paranoia), and age were negatively associated; however, MMPI (Ma) and STAI (trait) were positively associated with the BP+ group (K-MDQ score ≥ 7). In addition, BP+ was positively associated with current manic symptoms (1.080, P = 0.000) and trait anxiety (1.062, P = 0.006), and negatively associated with current depressive symptoms.
The result of this study suggests that MMPI, TCI and STAI can be used to predict the bipolarity of panic disorder patients. These psychological assessments can be considered to performed in clinics to establish proper treatment plans for a better prognosis.
Further investigations should aim to assess the validity of specific psychological factors to be used to detect bipolarity in panic patients prospectively.