Background: Anxious-depressive attack (ADA) is a proposed novel symptom complex associated with anxiety and mood disorders. Its main features are (1) sudden intense distressing emotions with no direct psychological cause, (2) intrusive memories of various negative events, (3) worry and agitation about the details of the rumination and (4) various coping behaviors, including acting out. The author has reported five previous cases of ADA. The present study investigates the clinical significance of ADA.
Method: First, to compare clinical characteristics between subjects with and without ADA, 331 consecutive new outpatients were examined (Study I). Second, because of the similarities between ADA and panic attack, the characteristics of ADA were examined in 65 panic disorder (PD) patients (Study II).
Results: The overall incidence of ADA was 43.2%. In PD and social anxiety disorder patients, those exhibiting ADA were significantly younger and had significantly more severe depression and social anxiety than those without ADA (Study I). In PD patients with ADA, ADA preceded panic attacks, and ADA frequency was correlated with the severity of depression and social anxiety but not with panic symptoms (Study II). ADA was often managed with acting out behavior (Study II).
Conclusion: ADA appears to be relatively common among people with anxiety and mood disorders. We found that ADA was correlated with the severity of social anxiety, but not PD. PD patients exhibited a “seesaw” phenomenon between ADA and panic attacks. ADA may be a core symptom complex of a severe form of anxious depression.
パニック症の症状評価尺度である患者用Panic and Agoraphobia Scale（PAS）の日本語版を作成し，その信頼性および妥当性を検討した。DSM-IV-TR（APA, 2000）でパニック症あるいは広場恐怖と診断された外来患者を対象とし，初回面談時，その3日後および4週間後にPAS（患者用）を実施した。その結果，特に未治療の患者に対して，症状の理解が十分でない場合，患者に対して心理士による心理教育を行い，症状の理解を深めてもらうことで，PAS（患者用）は十分な信頼性を有することが示された。しかしながら，妥当性評価では，PAS（患者用）合計点の変化量とPatient Global Impression-Improvementスコアの間に，医師評価ほどの相関関係は認められなかった。そのため，臨床試験等の研究で使用する場合，PAS（患者用）は副次評価とすることが適切と考えられた。