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February 1993, Vol 50, No. 2 >
Article | February 1993

Suicide Attempts in Patients With Panic Disorder

J. P. Lepine, MD; J. M. Chignon, MD; M. Teherani, MS
[+] Author Affiliations

Accepted for publication February 8, 1992.

Reprint requests to the Psychiatry Department, Hôpital Louis Mourier, 178, Rue des Renouillers, 92701 Paris cedex France (Dr Chignon).


Arch Gen Psychiatry. 1993;50(2):144-149. doi:10.1001/archpsyc.1993.01820140070008
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• In a clinical sample of 100 outpatients with panic disorder, 42% had a history of suicide attempt. Female sex and being single, divorced, or widowed were associated with an increased risk of suicide attempt. Thirty-one (73.8%) of the suicide attempts occurred after the first panic attack and 27 (64.3%) after the onset of panic disorder. Eighty-eight of these patients met DSM-III-R criteria for at least one other diagnosis in addition to panic disorder. Moreover, 52% had a history of major depressive episode and 31% had a lifetime diagnosis of alcohol and/or other substance abuse. Compared with those who did not attempt suicide, those who attempted suicide were significantly more likely to have suffered from major depressive episode and alcohol or other substance abuse in their lifetime. Among the 35 patients with no comorbidity with either major depression or addictive behaviors, 17.1 % had a history of suicide attempt. All had suffered from depressive symptoms and/or a personality disorder. The same association was found in four of 19 patients suffering from panic disorder only with or without agoraphobia.

REFERENCES

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American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Third Edition . Washington, DC: American Psychiatric Association; 1980;.
2 +
American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987;.
3 +
Von Korff MR, Eaton WW, Keyl PM.  The epidemiology of panic attacks and panic disorder . Am J Epidemiol . 1985;;122:970-981.
4 +
Zitrin CM, Klein DF, Woermer MG.  Behavior therapy, supportive psychotherapy, imipramine and phobias . Arch Gen Psychiatry . 1978;;35:307-321.
5 +
Hoehn-Saric R.  Comparison of generalized anxiety disorder with panic disorder patients . Psychopharmacol Bull . 1982;;18:104-108.
6 +
Torgerssen S.  Childhood and family characteristics in panic and generalized anxiety disorders . Am J Psychiatry . 1986;;143:630-632.
7 +
Breier A, Charney DS, Heninger GR.  The diagnostic validity of anxiety disorder and their relationship to depressive illness . Am J Psychiatry . 1985;;142:787-797.
8 +
Sheehan DV, Carr DB, Fishman SM, Walsh MM, Peltier-Saxe D.  Lactate infusion in anxiety research: its evolution and practice . J Clin Psychiatry . 1985;;46:158-165.
9 +
Cloninger CR, Martin RL, Clayton P, Guze SB.  A blind follow-up and family study of anxiety neurosis: preliminary results of the St Louis 500 . In: Klein DF, Rabtkin J, eds. Anxiety: New Research and Changing Concepts . New York, NY: Raven Press; 1981;.
10 +
Coryell W, Endicott J, Andreasen NC, Keller MB, Clayton PJ, Hirschfeld RMA, Scheftner WA, Winokur G.  Depression and panic attacks: the significance of overlap as reflected in follow-up and family data . Am J Psychiatry . 1988;;145:293-300.
11 +
Stein MB, Uhde TW.  Panic disorder and major depression: a tale of two syndromes . Psychiatr Clin North Am . 1988;;11:441-461.
12 +
Breier A, Charney DS, Heninger GR.  Major depression in patients with agoraphobia and panic disorder . Arch Gen Psychiatry . 1984;;41:983-989.
13 +
Lesser IM, Rubin RI, Pecknold JC, Rifkin A, Swinson RP, Lydiard RB, Burrows GD, Noyes R, Du Pont RL.  Secondary depression in panic disorder and agoraphobia . Arch Gen Psychiatry . 1988;;45:437-443.
14 +
Van Valkenburg C, Akiskal HS, Puzantian V, Rosenthal T.  Anxious depressions: clinical, family history and naturalistic outcome: comparisons with panic and major depressive episode . J Affect Disord . 1984;;6:67-82.
15 +
Munjack M, Moss HB.  Affective disorder and alcoholism in family of agoraphobics . Arch Gen Psychiatry . 1981;;38:869-871.
16 +
Clancy J, Noyes R, Hoenk PR, Slymen DJ.  Secondary depression in anxiety neurosis . J Nerv Ment Dis . 1978;;166:846-850.
17 +
Woodruff RA Jr, Guze SB, Clayton PJ.  Anxiety neuroses among psychiatric outpatients . Compr Psychiatry . 1972;;13:165-170.
18 +
Aronson TA, Logne CM.  On the longitudinal course of panic disorder: developmental history and predictors of phobia complications . Compr Psychiatry . 1987;;28:344-355.
19 +
Charney DS, Heninger GR, Price LH, Breier A.  Major depression and panic disorder: diagnostic and neurobiological relationship . Psychopharmacol Bull . 1986;;22:503-511.
20 +
Uhde TW, Boulenger JP, Roy-Burne PP, Vittone BJ.  Longitudinal course of panic disorder: clinical and biological considerations . Prog Neuropsychopharmacol Biol Psychiatry . 1985;;9:39-51.
21 +
Stein MB, Tancer ME, Uhde TW.  Major depression in patients with panic disorder: factors associated with course and recurrence . J Affect Disord . 1990;;19:287-296.
22 +
Vollrath M, Koch R, Angst J.  The Zurich Study, IX: panic disorder and sporadic panic: symptoms, diagnosis, prevalence and overlap with depression . Eur Arch Psychiatry Neurol Sci . 1990;;239:221-230.
23 +
Wittchen HU.  Natural history and spontaneous remissions of untreated anxiety disorders: results of the Munich Follow-up Study (MFS) . In: Hand I, Wittchen HU, eds. Panic and Phobias 2. Treatment and Variables Affecting Course and Outcome . New York, NY: Springer-Verlag NY Inc; 1988;.
24 +
Leckman JF, Weissman MM, Merikangas KR, Pauls DL, Prusoff BA.  Panic disorder increases the risk of major depression, alcoholism, panic and phobic disorders in affectively ill families . Arch Gen Psychiatry . 1983;;41:845-852.
25 +
Cox BJ, Norton R, Dorward J, Fergusson PA.  The relationship between panic attacks and chemical dependencies . Addict Behav . 1989;;14:53-60.
26 +
Kushner MG, Kenneth JS, Beitman BD.  The relation between alcohol problems and the anxiety disorders . Am J Psychiatry . 1990;;147:685-695.
27 +
George DT, Nutt DJ, Dwyer BA, Linnoila M.  Alcoholism and panic disorder: is the comorbidity more than a coincidence? Acta Psychiatr Scand . 1990;;81:97-107.
28 +
Burke JD, Wittchen HU, Regier DA, Sartorius N.  Extracting information from diagnostic interviews on co-occurrence of symptoms of anxiety and depression . In: Maser JD, Cloninger CR, eds. Comorbidity of Mood and Anxiety Disorders . Washington, DC: American Psychiatric Association Press; 1990;:649-667.
29 +
Roy A, Linnoila M.  Alcoholism and suicide . Suicide Life Threat Behav . 1986;;16:244-273.
30 +
Roy A. Suicide. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry . 5th ed. Baltimore, Md: Williams & Wilkins; 1989;;2.
31 +
Ennis J, Barnes RA, Kennedy S, Trachtenberg DD.  Depression in selfharm patients . Br J Psychiatry . 1989;;154:41-47.
32 +
Roy A, Lamparski D, Dejong J, Moore V, Linnoila M.  Characteristics of alcoholics who attempt suicide . Am J Psychiatry . 1990;;147:761-765.
33 +
Coryell W, Noyes R Jr, Clancy J.  Excess mortality in panic disorders: a comparison with primary unipolar depression . Arch Gen Psychiatry . 1982;;39:701-703.
34 +
Weissman MM, Klerman GL, Markowitz JS, Ouellette R.  Suicidal ideation and suicide attempts in panic disorder and attacks . N Engl J Med . 1989;;321:1209-1241.
35 +
Fyer AJ, Endicott J, Manuzza S, Klein DF. Schedule for Affective Disorders and Schizophrenia-Lifetime Version (Modified for the Study of Anxiety Disorders) . New York, NY: Anxiety Disorders Clinic, New York State Psychiatric Institute; 1985;.
36 +
Mannuzza S, Fyer AJ, Martin LY, Gallops MS, Endicott J, Gorman JM, Liebowitz MR, Klein DF.  Reliability of anxiety assessment, I: diagnostic agreement . Arch Gen Psychiatry . 1989;;46:1093-1102.
37 +
Johnson J, Weissman MM, Klerman GL.  Panic disorder, comorbidity, and suicide attempts . Arch Gen Psychiatry . 1990;;47:805-808.
38 +
Boyd JH, Burke JD, Grünberg E, Holzer CE, Rae DS, George LK, Karno M, Stolzman R, McEvoy L, Nestadt G.  Exclusion criteria of DSM-III . Arch Gen Psychiatry . 1984;;41:983-989.
39 +
Weissman MM, Leckman JF, Merikangas KR, Gammon GD, Prusoff BA.  Depressive and anxiety disorder in parents and children . Arch Gen Psychiatry . 1984;;40:1055-1060.
40 +
Weissman MM.  The epidemiology of suicide attempts, 1960 to 1971 . Arch Gen Psychiatry . 1974;;30:737-746.
41 +
Klein DF.  Endogenomorphic depression . Arch Gen Psychiatry . 1974;;31:447-454.
42 +
Angst J.  Reccurrent brief depression: a new concept of mild depression: Abstracts of the XVIth Collegium Internationale NeuroPsychopharmacologicum Congress, Munich, 1988 . Psychopharmacology . 1988;;96( (suppl) ):123.
43 +
Abbar M, Chignon JM, Amadéo S, Schenk L, Picot MC, Castelnau D.  Panic disorder in suicide attempters . Clin Neuropharmacol . 1992;;15( (suppl 1) ):57B. Abstract.
44 +
Coryell W.  Mortality after thirty to forty years: panic disorder compared with other psychiatric illnesses . In: Grinspoon L, ed. Psychiatry Update Vol III . Washington, DC: American Psychiatric Association; 1984;: 460-467.
45 +
Allgulander C, Lavori PW.  Excess mortality among 3302 patients with 'pure'n anxiety neurosis . Arch Gen Psychiatry . In press.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Third Edition . Washington, DC: American Psychiatric Association; 1980;.
2 +
American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987;.
3 +
Von Korff MR, Eaton WW, Keyl PM.  The epidemiology of panic attacks and panic disorder . Am J Epidemiol . 1985;;122:970-981.
4 +
Zitrin CM, Klein DF, Woermer MG.  Behavior therapy, supportive psychotherapy, imipramine and phobias . Arch Gen Psychiatry . 1978;;35:307-321.
5 +
Hoehn-Saric R.  Comparison of generalized anxiety disorder with panic disorder patients . Psychopharmacol Bull . 1982;;18:104-108.
6 +
Torgerssen S.  Childhood and family characteristics in panic and generalized anxiety disorders . Am J Psychiatry . 1986;;143:630-632.
7 +
Breier A, Charney DS, Heninger GR.  The diagnostic validity of anxiety disorder and their relationship to depressive illness . Am J Psychiatry . 1985;;142:787-797.
8 +
Sheehan DV, Carr DB, Fishman SM, Walsh MM, Peltier-Saxe D.  Lactate infusion in anxiety research: its evolution and practice . J Clin Psychiatry . 1985;;46:158-165.
9 +
Cloninger CR, Martin RL, Clayton P, Guze SB.  A blind follow-up and family study of anxiety neurosis: preliminary results of the St Louis 500 . In: Klein DF, Rabtkin J, eds. Anxiety: New Research and Changing Concepts . New York, NY: Raven Press; 1981;.
10 +
Coryell W, Endicott J, Andreasen NC, Keller MB, Clayton PJ, Hirschfeld RMA, Scheftner WA, Winokur G.  Depression and panic attacks: the significance of overlap as reflected in follow-up and family data . Am J Psychiatry . 1988;;145:293-300.
11 +
Stein MB, Uhde TW.  Panic disorder and major depression: a tale of two syndromes . Psychiatr Clin North Am . 1988;;11:441-461.
12 +
Breier A, Charney DS, Heninger GR.  Major depression in patients with agoraphobia and panic disorder . Arch Gen Psychiatry . 1984;;41:983-989.
13 +
Lesser IM, Rubin RI, Pecknold JC, Rifkin A, Swinson RP, Lydiard RB, Burrows GD, Noyes R, Du Pont RL.  Secondary depression in panic disorder and agoraphobia . Arch Gen Psychiatry . 1988;;45:437-443.
14 +
Van Valkenburg C, Akiskal HS, Puzantian V, Rosenthal T.  Anxious depressions: clinical, family history and naturalistic outcome: comparisons with panic and major depressive episode . J Affect Disord . 1984;;6:67-82.
15 +
Munjack M, Moss HB.  Affective disorder and alcoholism in family of agoraphobics . Arch Gen Psychiatry . 1981;;38:869-871.
16 +
Clancy J, Noyes R, Hoenk PR, Slymen DJ.  Secondary depression in anxiety neurosis . J Nerv Ment Dis . 1978;;166:846-850.
17 +
Woodruff RA Jr, Guze SB, Clayton PJ.  Anxiety neuroses among psychiatric outpatients . Compr Psychiatry . 1972;;13:165-170.
18 +
Aronson TA, Logne CM.  On the longitudinal course of panic disorder: developmental history and predictors of phobia complications . Compr Psychiatry . 1987;;28:344-355.
19 +
Charney DS, Heninger GR, Price LH, Breier A.  Major depression and panic disorder: diagnostic and neurobiological relationship . Psychopharmacol Bull . 1986;;22:503-511.
20 +
Uhde TW, Boulenger JP, Roy-Burne PP, Vittone BJ.  Longitudinal course of panic disorder: clinical and biological considerations . Prog Neuropsychopharmacol Biol Psychiatry . 1985;;9:39-51.
21 +
Stein MB, Tancer ME, Uhde TW.  Major depression in patients with panic disorder: factors associated with course and recurrence . J Affect Disord . 1990;;19:287-296.
22 +
Vollrath M, Koch R, Angst J.  The Zurich Study, IX: panic disorder and sporadic panic: symptoms, diagnosis, prevalence and overlap with depression . Eur Arch Psychiatry Neurol Sci . 1990;;239:221-230.
23 +
Wittchen HU.  Natural history and spontaneous remissions of untreated anxiety disorders: results of the Munich Follow-up Study (MFS) . In: Hand I, Wittchen HU, eds. Panic and Phobias 2. Treatment and Variables Affecting Course and Outcome . New York, NY: Springer-Verlag NY Inc; 1988;.
24 +
Leckman JF, Weissman MM, Merikangas KR, Pauls DL, Prusoff BA.  Panic disorder increases the risk of major depression, alcoholism, panic and phobic disorders in affectively ill families . Arch Gen Psychiatry . 1983;;41:845-852.
25 +
Cox BJ, Norton R, Dorward J, Fergusson PA.  The relationship between panic attacks and chemical dependencies . Addict Behav . 1989;;14:53-60.
26 +
Kushner MG, Kenneth JS, Beitman BD.  The relation between alcohol problems and the anxiety disorders . Am J Psychiatry . 1990;;147:685-695.
27 +
George DT, Nutt DJ, Dwyer BA, Linnoila M.  Alcoholism and panic disorder: is the comorbidity more than a coincidence? Acta Psychiatr Scand . 1990;;81:97-107.
28 +
Burke JD, Wittchen HU, Regier DA, Sartorius N.  Extracting information from diagnostic interviews on co-occurrence of symptoms of anxiety and depression . In: Maser JD, Cloninger CR, eds. Comorbidity of Mood and Anxiety Disorders . Washington, DC: American Psychiatric Association Press; 1990;:649-667.
29 +
Roy A, Linnoila M.  Alcoholism and suicide . Suicide Life Threat Behav . 1986;;16:244-273.
30 +
Roy A. Suicide. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry . 5th ed. Baltimore, Md: Williams & Wilkins; 1989;;2.
31 +
Ennis J, Barnes RA, Kennedy S, Trachtenberg DD.  Depression in selfharm patients . Br J Psychiatry . 1989;;154:41-47.
32 +
Roy A, Lamparski D, Dejong J, Moore V, Linnoila M.  Characteristics of alcoholics who attempt suicide . Am J Psychiatry . 1990;;147:761-765.
33 +
Coryell W, Noyes R Jr, Clancy J.  Excess mortality in panic disorders: a comparison with primary unipolar depression . Arch Gen Psychiatry . 1982;;39:701-703.
34 +
Weissman MM, Klerman GL, Markowitz JS, Ouellette R.  Suicidal ideation and suicide attempts in panic disorder and attacks . N Engl J Med . 1989;;321:1209-1241.
35 +
Fyer AJ, Endicott J, Manuzza S, Klein DF. Schedule for Affective Disorders and Schizophrenia-Lifetime Version (Modified for the Study of Anxiety Disorders) . New York, NY: Anxiety Disorders Clinic, New York State Psychiatric Institute; 1985;.
36 +
Mannuzza S, Fyer AJ, Martin LY, Gallops MS, Endicott J, Gorman JM, Liebowitz MR, Klein DF.  Reliability of anxiety assessment, I: diagnostic agreement . Arch Gen Psychiatry . 1989;;46:1093-1102.
37 +
Johnson J, Weissman MM, Klerman GL.  Panic disorder, comorbidity, and suicide attempts . Arch Gen Psychiatry . 1990;;47:805-808.
38 +
Boyd JH, Burke JD, Grünberg E, Holzer CE, Rae DS, George LK, Karno M, Stolzman R, McEvoy L, Nestadt G.  Exclusion criteria of DSM-III . Arch Gen Psychiatry . 1984;;41:983-989.
39 +
Weissman MM, Leckman JF, Merikangas KR, Gammon GD, Prusoff BA.  Depressive and anxiety disorder in parents and children . Arch Gen Psychiatry . 1984;;40:1055-1060.
40 +
Weissman MM.  The epidemiology of suicide attempts, 1960 to 1971 . Arch Gen Psychiatry . 1974;;30:737-746.
41 +
Klein DF.  Endogenomorphic depression . Arch Gen Psychiatry . 1974;;31:447-454.
42 +
Angst J.  Reccurrent brief depression: a new concept of mild depression: Abstracts of the XVIth Collegium Internationale NeuroPsychopharmacologicum Congress, Munich, 1988 . Psychopharmacology . 1988;;96( (suppl) ):123.
43 +
Abbar M, Chignon JM, Amadéo S, Schenk L, Picot MC, Castelnau D.  Panic disorder in suicide attempters . Clin Neuropharmacol . 1992;;15( (suppl 1) ):57B. Abstract.
44 +
Coryell W.  Mortality after thirty to forty years: panic disorder compared with other psychiatric illnesses . In: Grinspoon L, ed. Psychiatry Update Vol III . Washington, DC: American Psychiatric Association; 1984;: 460-467.
45 +
Allgulander C, Lavori PW.  Excess mortality among 3302 patients with 'pure'n anxiety neurosis . Arch Gen Psychiatry . In press.

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