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THE MORBIDITY RISK for panic disorder (PD) is known to be significantly higher in first-degree relatives of probands with PD.1 The symptomatological characteristics, however, of the PD patients with first-degree family history (FH) of PD remain unclear. In order to clarify the specific symptoms in PD patients with putative genetic factor, we examined the association between the FH in PD and the first panic attack (PA) symptoms.

Three hundred and fifty-six unrelated patients with PD with or without agoraphobia diagnosed according to the criteria in the DSM-IV-TR participated in this study after having provided written informed consent. This study was approved by the institutional ethical committees of the Mie University School of Medicine and the Warakukai Nagoya Mental Clinic. Interviews were conducted with the PD patients to investigate a first-degree FH of PD. In the present study the PD proband with the first-degree FH of PD was defined as PD patient with a first-degree relative who has a history of treatment at a psychiatric hospital or clinic, and who has been diagnosed with and treated for PD. First PA symptoms were confirmed by means of a questionnaire at the patient's first visit.

The number of PD patients with a first-degree FH of PD was 20 (5.62%). PD patients have experienced 5.83 ± 2.51 symptoms on average at first PA (range: 1–13). PD patients with a first-degree FH of PD were significantly younger at onset (age: 24.30 ± 12.35 years vs 29.81 ± 9.75 years), had experienced more symptoms (mean total no. first PA symptoms: 6.95 ± 2.51 vs 5.75 ± 2.19), and more frequently had experienced paresthesia (60.0% vs 25.3%) and chills or hot flashes (55.0% vs 29.5%) at first PA compared to those without a first-degree FH of PD, while there were no differences in mean age, sex ratio, and frequency of comorbidity in agoraphobia or mood disorder.

These results suggest that PD patients with putative genetic factors might have an onset early in life,2 and show more severe symptoms of PD. The frequency of parasthesia and chills or hot flashes is relatively low among the 13 PA symptoms in all PD patients as a whole. These results suggest that the high-frequency symptoms in PA, such as palpitation and smothering, are commonly observed symptoms in PD patients regardless of FH, and in addition, only PD patients with a first-degree FH of PD specifically experience these two symptoms. The hypothesized shared neurocircuit model in PA and hot flashes involves several regions such as the hypothalamus, brainstem, insula, and cingulate cortex.3 The present results suggest that there is dysregulation of these regions in PD patients with putative genetic factors. Further study is needed to confirm the identification of PA symptoms in the multiplex PD family.

Received 18 June 2008; revised 29 September 2008; accepted 3 November 2008.

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