Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Childhood Trauma and Pharmacotherapy Retention among Outpatients with Panic Disorder

공황장애 외래 환자의 아동기 외상과 약물치료 유지

  • Kim, Dong Joo (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Kim, Daeho (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Lee, Jinbok (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Kim, Yaeseul (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Sohn, Sujin (Department of Psychiatry, Hanyang University College of Medicine)
  • 김동주 (한양대학교 의과대학 정신건강의학과교실) ;
  • 김대호 (한양대학교 의과대학 정신건강의학과교실) ;
  • 이진복 (한양대학교 의과대학 정신건강의학과교실) ;
  • 김예슬 (한양대학교 의과대학 정신건강의학과교실) ;
  • 손수진 (한양대학교 의과대학 정신건강의학과교실)
  • Received : 2020.04.23
  • Accepted : 2020.06.01
  • Published : 2020.06.30
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Abstract

Objectives : This study investigated lifetime experiences of trauma, treatment retention, and psychiatric symptoms among outpatients with panic disorder after initiation of pharmacotherapy. Our research hypothesis was that panic patients with childhood trauma would display more severe symptoms and less treatment retention compared to those without such history. Methods : A total of 135 first-visit outpatients with DSM-IV panic disorder were approached during the period from March 2012 to August 2016. Fifty-three patients (39%) either refused or returned incomplete questionnaires, leading to a final sample size of 82. Participants completed the Trauma History Screen, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Abbreviated PTSD checklist. Results : The number of lifetime trauma was significantly correlated with treatment retention (rho=-0.269, p=0.015). Among subtypes of trauma, only childhood physical abuse was significantly correlated with treatment retention (rho=-0.298, p=0.007). Conclusions : Our results indicated that psychological trauma, particularly of an interpersonal nature from childhood, can affect pharmacotherapy treatment retention in panic disorder. This may be mediated by poor patient-doctor relationships originating from trust issues among childhood trauma survivors or lack of perceived improvement due to the more severe symptoms and unfavorable course experienced by those with childhood trauma. Further studies are needed to explore the reasons for poor treatment adherence in this population.

연구목적 최근 공황장애와 초기 외상 사건에 대한 연구결과가 축적되는데, 아직까지 공황장애의 경과나 치료와 아동기 외상 연구는 드문 실정이다. 이 연구는 공황장애 외래 환자에서 아동기 외상 병력과 약물치료 유지 기간 사이의 상관 관계를 조사하였다. 방 법 이 횡단적 연구는 한 대학병원 정신건강의학과 외래를 방문한 공황장애 환자를 대상으로 일생의 외상력, 우울, 불안 및 외상후 스트레스 증상과 약물치료 기간을 조사하였다. 2012년 3월~2016년 2월까지 총 135명의 공황장애 외래 초진 환자를 대상으로 설문지 연구를 실행하였으며 이중 53명(39%)이 거절하거나 불완전한 설문을 작성하여 나머지 82명의 자료를 분석하였다. 설문지에는 외상력 선별 검사(Trauma History Screen), 벡우울척도, 벡불안척도, 간편 외상후 스트레스 장애 체크리스트 설문지가 포함되었다. 결 과 일생 동안 경험한 외상 종류의 수와 치료기간은 음의 상관관계를 나타내었다(rho=-0.269, p=0.015). 외상의 아형을 볼 때는 아동기 신체 학대와 치료 기간 사이에 유의한 부정 상관 결과를 보였다(rho=-0.298, p=0.007). 결 론 이 연구의 결과는 심리적 외상, 특히 아동기의 대인관계적 외상이 공황장애의 치료 유지에 영향을 줄 수 있는 것을 시사한다. 향후 연구에서는 아동기 외상과 불량한 치료 유지를 중재하는 요인, 예를 들어 치료 관계나 치료에 대한 기대 부족 등에 대한 연구가 필요하다.

Keywords

References

  1. Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, Huang B, Saha TD. The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006;67:363-374. https://doi.org/10.4088/JCP.v67n0305
  2. Cho MJ, Seong SJ, Park JE, Chung IW, Lee YM, Bae A, Ahn JH, Lee DW, Bae JN, Cho SJ, Park JI, Son J, Chang SM, Hahm BJ, Lee JY, Sohn JH, Kim JS, Hong JP. Prevalence and correlates of DSM-IV mental disorders in South Korean Adults: the Korean Epidemiologic Catchment Area Study 2011. Psychiatry Investig 2015;12:164-170. https://doi.org/10.4306/pi.2015.12.2.164
  3. Health Insurance Review and Assessment Service. Statistics of Diseases, 2010-2016. Seoul: Health Insurance Review and Assessment Service;2017.
  4. Katon W. Panic disorder: epidemiology, diagnosis, and treatment in primary care. J Clin Psychiatry 1986;47 Suppl:21-30.
  5. Zaubler TS, Katon W. Panic disorder in the general medical setting. J Psychosom Res 1998;44:25-42. https://doi.org/10.1016/S0022-3999(97)00134-7
  6. Brown GW, Harris TO. Aetiology of anxiety and depressive disorders in an inner-city population. 1. Early adversity. Psychol Med 1993;23:143-154. https://doi.org/10.1017/S0033291700038939
  7. Safren SA, Gershuny BS, Marzol P, Otto MW, Pollack MH. History of childhood abuse in panic disorder, social phobia, and generalized anxiety disorder. J Nerv Ment Dis 2002;190:453-456. https://doi.org/10.1097/00005053-200207000-00005
  8. Cougle JR, Timpano KR, Sachs-Ericsson N, Keough ME, Riccardi CJ. Examining t he u nique relationships b etween anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Res 2010;177:150-155. https://doi.org/10.1016/j.psychres.2009.03.008
  9. Goodwin RD, Fergusson DM, Horwood LJ. Childhood abuse and familial violence and the risk of panic attacks and panic disorder in young adulthood. Psychol Med 2005;35:881-890. https://doi.org/10.1017/S0033291704003265
  10. De Venter M, Van Den Eede F, Pattyn T, Wouters K, Veltman DJ, Penninx B, Sabbe B. Impact of childhood trauma on course of panic disorder: contribution of clinical and personality characteristics. Acta Psychiatr Scand 2017;135:554-563. https://doi.org/10.1111/acps.12726
  11. Marchesi C, Cantoni A, Fonto S, Giannelli MR, Maggini C. Predictors of symptom resolution in panic disorder after one year of pharmacological treatment: a naturalistic study. Pharmacopsychiatry 2006;39:60-65. https://doi.org/10.1055/s-2006-931543
  12. Nay W, Brown R, Roberson-Nay R. Longitudinal course of panic disorder with and without agoraphobia using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychiatry Res 2013;208:54-61. https://doi.org/10.1016/j.psychres.2013.03.006
  13. Roy-Byrne PP, Cowley DS. Course and outcome in panic disorder: a review of recent follow-up studies. Anxiety 1994;1:151-160. https://doi.org/10.1002/anxi.3070010402
  14. Batelaan NM, de Graaf R, Penninx BW, van Balkom AJ, Vollebergh WA, Beekman AT. The 2-year prognosis of panic episodes in the general population. Psychol Med 2010;40:147-157. https://doi.org/10.1017/s0033291709005625
  15. Imai H, Tajika A, Chen P, Pompoli A, Furukawa TA. Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database Syst Rev 2016;10:CD011170.
  16. Mitte K. A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 2005;88:27-45. https://doi.org/10.1016/j.jad.2005.05.003
  17. Mukherjee S, Sullivan G, Perry D, Verdugo B, Means-Christensen A, Schraufnagel T, Sherbourne CD, Stein MB, Craske MG, Roy-Byrne PP. Adherence to treatment among economically disadvantaged patients with panic disorder. Psychiatr Serv 2006;57:1745-1750. https://doi.org/10.1176/appi.ps.57.12.1745
  18. Marchesi C. Pharmacological management of panic disorder. Neuropsychiatr Dis Treat 2008;4:93-106. https://doi.org/10.2147/NDT.S1557
  19. Roy-Byrne PP, Craske MG, Stein MB. Panic disorder. Lancet 2006;368:1023-1032. https://doi.org/10.1016/S0140-6736(06)69418-X
  20. Otto MW, Tuby KS, Gould RA, McLean RY, Pollack MH. An effect-size analysis of the relative efficacy and tolerability of serotonin selective reuptake inhibitors for panic disorder. Am J Psychiatry 2001;158:1989-1992. https://doi.org/10.1176/appi.ajp.158.12.1989
  21. Perna G, Alciati A, Riva A, Micieli W, Caldirola D. Longterm pharmacological treatments of anxiety disorders: an updated systematic review. Curr Psychiatry Rep 2016;18:23. https://doi.org/10.1007/s11920-016-0668-3
  22. Baeza-Velasco C, Olie E, Beziat S, Guillaume S, Courtet P. Determinants of suboptimal medication adherence in patients with a major depressive episode. Depress Anxiety 2019;36:244-251. https://doi.org/10.1002/da.22852
  23. Kim C, Jeong Y, Kim EK, Park SC, Jo HY, Kim D. Childhood trauma and treatment Implications in major depressive disorder in South Korea: comparison with medical outpatients and two-year follow-up. Mood Emot 2019;17.
  24. Lee K, Kim D, Cho Y. Exploratory Factor Analysis of the Beck Anxiety Inventory and the Beck Depression Inventory-II in a Psychiatric Outpatient Population. J Korean Med Sci 2018;33:e128. https://doi.org/10.3346/jkms.2018.33.e128
  25. Carlson EB, Smith SR, Palmieri PA, Dalenberg C, Ruzek JI, Kimerling R, Burling TA, Spain DA. Development and validation of a brief self-report measure of trauma exposure: the Trauma History Screen. Psychol Assess 2011;23:463-477. https://doi.org/10.1037/a0022294
  26. Derogatis LR, Rickels K, Rock AF. T he SCL-90 a nd the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry 1976;128:280-289. https://doi.org/10.1192/bjp.128.3.280
  27. Kim K, Kim J, Won H. Korean manual of symptom checklist-90-revision. Seoul: Jung Ang Juk Sung Publisher 1984:8-10.
  28. Beck AT, Steer RA, Brown G. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
  29. Sung HM, Kim JB, Park YN, Bai DS, Lee SH, Ahn HN. A study on the reliability and the validity of Korean version of the Beck Depression Inventory-II (BDI-II). J Korean Soc Biol Ther Psychiatry 2008;14.
  30. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893-897. https://doi.org/10.1037/0022-006X.56.6.893
  31. Yook S, Kim Z. A clinical study on the Korean version of Beck Anxiety Inventory: comparative study of patient and non-patient. Korean J Clin Psychol 1997;16:185-197.
  32. Liu Y, Sareen J, Bolton J, Wang J. Development and validation of a risk-prediction algorithm for the recurrence of panic disorder. Depress Anxiety 2015;32:341-348. https://doi.org/10.1002/da.22359
  33. Cowley DS, Ha EH, Roy-Byrne PP. Determinants of pharmacologic treatment failure in panic disorder. J Clin Psychiatry 1997;58:555-561;quiz 562-553. https://doi.org/10.4088/JCP.v58n1208
  34. Yonkers KA, Ellison JM, Shera DM, Pratt LA, Cole JO, Fierman E, Keller MB, Lavori PW. Description of antipanic therapy in a prospective longitudinal study. J Clin Psychopharmacol 1996;16:223-232. https://doi.org/10.1097/00004714-199606000-00006
  35. Teicher MH, Samson JA. Childhood maltreatment and psychopathology: a case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. Am J Psychiatry 2013;170:1114-1133. https://doi.org/10.1176/appi.ajp.2013.12070957
  36. Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry 2003;160:1453-1460. https://doi.org/10.1176/appi.ajp.160.8.1453
  37. Bandelow B, Spath C, Tichauer GA, Broocks A, Hajak G, Ruther E. Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Compr Psychiatry 2002;43:269-278. https://doi.org/10.1053/comp.2002.33492
  38. Grilo CM, Money R, Barlow DH, Goddard AW, Gorman JM, Hofmann SG, Papp LA, Shear MK, Woods SW. Pretreatment patient factors predicting attrition from a multicenter randomized controlled treatment study for panic disorder. Compr Psychiatry 1998;39:323-332. https://doi.org/10.1016/S0010-440X(98)90043-8
  39. White KS, Allen LB, Barlow DH, Gorman JM, Shear MK, Woods SW. Attrition in a multicenter clinical trial for panic disorder. J Nerv Ment Dis 2010;198:665-671. https://doi.org/10.1097/NMD.0b013e3181ef3627
  40. Miniati M, Rucci P, Benvenuti A, Frank E, Buttenfield J, Giorgi G, Cassano GB. Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse. J Psychiatr Res 2010;44:302-309. https://doi.org/10.1016/j.jpsychires.2009.09.008
  41. Hung CI. Factors predicting adherence to antidepressant treatment. Curr Opin Psychiatry 2014;27:344-349. https://doi.org/10.1097/YCO.0000000000000086
  42. Lecomte T, Spidel A, Leclerc C, MacEwan GW, Greaves C, Bentall RP. Predictors and profiles of t reatment non-adherence and engagement in services problems in early psychosis. Schizophr Res 2008;102:295-302. https://doi.org/10.1016/j.schres.2008.01.024
  43. Carter JC, Bewell C, Blackmore E, Woodside DB. The impact of childhood sexual abuse in anorexia nervosa. Child Abuse Negl 2006;30:257-269. https://doi.org/10.1016/j.chiabu.2005.09.004
  44. Keller SM, Zoellner LA, Feeny NC. Understanding factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support. J Consult Clin Psychol 2010;78:974-979. https://doi.org/10.1037/a0020758
  45. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSMIV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-627. https://doi.org/10.1001/archpsyc.62.6.617