Scientific literature has highlighted the link between autism spectrum disorder (ASD) and anxiety disorders, but few studies have delved into the relationship between ASD and panic-agoraphobic disorders. The aim of this study is to investigate the relationship between autism spectrum and panic-agoraphobic symptoms, examining whether and which autistic domains are predictive of the presence of specific panic-agoraphobic symptoms.

Forty-five adult subjects with ASD and 50 healthy controls (HCs) were evaluated through the Structured Clinical Interview for DSM-5, Research Version and assessed with the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Panic-Agoraphobic – Short Version (PAS-SV) questionnaires. Statistical analyses included Mann–Whitney U test, chi-square test, and a set of linear and logistic regression analyses.

The PAS-SV total and domain scores were significantly higher in the ASD group than in the HC group. A higher AdAS total score appeared to be predictive of a higher PAS-SV total score. The AdAS domain Restricted Interests and Rumination would increase the risk of obtaining higher PAS-SV total and domain scores. Conversely, the AdAS Spectrum domain Inflexibility and Adherence to Routine would predict lower total PAS-SV score.

This study revealed a greater representation of panic-agoraphobic symptoms in adults with ASD, as well as an increased risk of showing such symptoms in the presence of significant autistic traits. Restricted interests and ruminative thinking emerged as predominant risk factors for panic-agoraphobic manifestations.

The COVID-19 pandemic brought many new challenges that people had to overcome with ingenuity. However, many patients already suffering with psychiatric diseases saw their access to conventional health care limited, aggravating their statuses. E-Medicine is the branch of health care that provides access through the Internet, and it has been growing in the last few years. During the COVID-19 pandemic, many health care workers shifted towards E-Medicine, aiming to provide support to patients, especially with the social distance policies that were implemented worldwide.

Provide an example of how e-Medicine can be a tool in establishing a therapeutic alliance, and patient follow-up

Case report with a brief literature review on the subject

RG is a 19-year-old female that contacts her family doctor through e-mail, expressing concerns over not being able to leave her house for over a year, also manifesting anxiety and depressed humor. This started in April 2020 and was slowly worsening throughout the year, culminating in a panic attack. RG started counselling and follow-up appointments via Internet and started treatment with vortioxetine. Three months later, improvements were stated, namely decreased anxiety, better sleep patterns, and leaving the house for small periods.

Without E-Medicine, RG wouldn’t be as able to reach out to her family doctor, and follow-up would be much more arduous since the patient avoided leaving her house, and telephone appointments lack the visual aspect of the clinical interview. E-Medicine is a valid alternative to conventional Medicine, providing a safe environment for patients concerned with public space.

No significant relationships.

Cognitive behavioural therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PDA). However, implementation of some of the procedures involved, particularly in vivo exposure, can be time consuming and taxing for routine health care services. CBT with exposure taking place in virtual reality (VR-CBT) is a more time-efficient option and has shown promising results in the treatment of PDA. However, VR-CBT requires expensive equipment and appropriate virtual environments, which historically has been costly and cumbersome to produce. Thus, access to VR-CBT has been sparse in regular care environments.

The aim of this study was to investigate whether VR-CBT using filmed virtual environments produced with a low-cost 360-degree film camera can be a feasible and acceptable treatment for PDA when implemented in a primary care context.

This was an open feasibility trial with a within-group design, with assessments conducted at pre-test, post-test, and 6-month follow-up. Participants (n = 12) received a 10–12 week treatment programme of VR-CBT and PDA-related symptoms were assessed by the primary outcome measure The Mobility Inventory for Agoraphobia (MIA) and the Panic-Disorder Severity Scale-Self Rated (PDSS-SR).

The results showed that treatment satisfaction was high and participants were significantly improved on PDA-related measures at post-treatment and at 6-month follow-up with large effect sizes (Cohen’s d range = 1.46–2.82). All 12 participants completed the treatment.

These findings suggest that VR-CBT with 360-degree video virtual environments delivered to primary care patients with PDA is feasible, acceptable, and potentially efficacious.

Depersonalization during panic attacks may be a feature of a subgroup of Panic disorder. Several studies suggest that such subgroup corresponds to a more clinically severe form of Panic Disorder, with earlier onset and a higher rate of comorbidity with other psychiatric disorders, such as obsessive-compulsive disorder and generalized anxiety disorder. It is also hypothesized that depersonalization during panic attacks may lead Panic disorder to evolve into Agoraphobia.

To present the case report of a patient with severe Agoraphobia, whose only symptom of Panic disorder was depersonalization.

Description of a case report.

We describe the case of a 20-year-old woman who developed Agoraphobia after a single panic attack, during a physical education class, at the age of 13, with depersonalization symptoms only. After the attack, the patient stopped playing sports and engaging in any kind of activity in the absence of a trusted person. At the age of 20, the patient will only travel alone in the immediacies of her home, sometimes missing classes, because she cannot get a ride from trusted acquaintances. She justifies such avoidances with her fear of feeling depersonalized again. Over the course of her illness, she denied having experienced any other symptoms of a panic attack. She was treated with Paroxetine 40mg daily and cognitive behavioral therapy, having improved.

We believe this case provides good insight into depersonalization in panic attacks, supporting the view that Panic disorder with depersonalization may be a distinct and more severe subgroup of Panic Disorder.

Disease trajectories of patients with anxiety disorders are highly diverse and approximately 60% remain chronically ill. The ability to predict disease course in individual patients would enable personalized management of these patients. This study aimed to predict recovery from anxiety disorders within 2 years applying a machine learning approach.

In total, 887 patients with anxiety disorders (panic disorder, generalized anxiety disorder, agoraphobia, or social phobia) were selected from a naturalistic cohort study. A wide array of baseline predictors (N = 569) from five domains (clinical, psychological, sociodemographic, biological, lifestyle) were used to predict recovery from anxiety disorders and recovery from all common mental disorders (CMDs: anxiety disorders, major depressive disorder, dysthymia, or alcohol dependency) at 2-year follow-up using random forest classifiers (RFCs).

At follow-up, 484 patients (54.6%) had recovered from anxiety disorders. RFCs achieved a cross-validated area-under-the-receiving-operator-characteristic-curve (AUC) of 0.67 when using the combination of all predictor domains (sensitivity: 62.0%, specificity 62.8%) for predicting recovery from anxiety disorders. Classification of recovery from CMDs yielded an AUC of 0.70 (sensitivity: 64.6%, specificity: 62.3%) when using all domains. In both cases, the clinical domain alone provided comparable performances. Feature analysis showed that prediction of recovery from anxiety disorders was primarily driven by anxiety features, whereas recovery from CMDs was primarily driven by depression features.

The current study showed moderate performance in predicting recovery from anxiety disorders over a 2-year follow-up for individual patients and indicates that anxiety features are most indicative for anxiety improvement and depression features for improvement in general.

Panic disorder (PD) is generally regarded as a chronic condition with considerable variation in severity of symptoms.

To describe the long-term outcome of naturalistically treated PD.

Fifty-five outpatients with PD, who participated in a placebo-controlled drug trial of the efficacy of alprazolam and imipramine 15 years ago were reassessed with the same instruments used in the original study.

Complete recovery (no panic attacks and no longer on medication during the last 10 years) was seen in 18% of patients, and an additional 13% recovered but were still on medication. Fifty-one percent experienced recurrent anxiety attacks whereas 18% still met diagnostic criteria for PD. The incidence of agoraphobia decreased from 69% to 20%. Patients with agoraphobia at admission tended to have a poorer long-term outcome according to daily functioning compared with patients without agoraphobia at admission, although both groups reported improved daily functioning at follow-up. Maintenance medication was common. No benzodiazepine abuse was reported.

PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.

The aim of this study was to ascertain predictors of work insufficiency in patients with panic disorder (PD) with agoraphobia (AG).

Linear regression was used to identify predictors of work insufficiency in a sample of 72 consecutive outpatients with PD with AG. Intensity of work insufficiency was ascertained from modified National Institute of Mental Health Panic Questionnaire (NIMH PQ). That represented dependent variable. Independent variables were demographic data, duration of illness, presence of comorbid current major depression episode, presence of any personality disorder and scores on the Panic and Agoraphobia Scale (PAS) subscales: panic attacks, AG (avoidance behavior), anticipatory anxiety and worries about health.

Patients reported severe work insufficiency. The best predict variable for the work insufficiency in patients with PD with AG was high score on the PAS dimension of AG.

Patients generally reported severe effects of PD with AG on work efficacy and the results suggested that the impaired work efficacy was the most associated with avoidance behavior. These results recommend that the treatment of PD with AG patients should be related to decreasing avoidance behavior in order to establish adequate work performance in patients.

We examined gender differences in the frequency of DSM-IV personality disorder diagnoses in a sample of patients with a diagnosis of panic disorder (PD).

One hundred and eighty-four outpatients with a principal diagnosis of PD (DSM-IV) were enrolled. All patients were evaluated with a semi-structured interview to collect demographic and clinical data and to generate Axis I and Axis II diagnoses in accordance with DSM-IV criteria.

Males were significantly more likely than females to meet diagnoses for schizoid and borderline personality disorder. Compared to males, females predominated in histrionic and cluster C diagnoses, particularly dependent personality disorder diagnoses. A significant interaction was found between female sex and agoraphobia on personality disorder (PD) distribution.

Male PD patients seem to be characterized by more severe personality disorders, while female PD patients, particularly with co-morbid agoraphobia, have higher co-morbidity rates with personality disorders belonging to the ‘anxious-fearful cluster’.

A clinical and psychosocial follow-up study of a cohort of 85 patients affected by panic disorder (PD) with or without agoraphobia was performed an average of 40 months after initial observation and following a mean duration of illness of 8 years.

Eighty-five out of 130 patients affected by PDs with or without agoraphobia according to DSM-III R criteria, examined between 1990 and 1995 at an outpatient clinic were re-examined in 1997/1998 using the same standardized clinical evaluation performed on admission. Patients also underwent a structured diagnostic interview (Mini International Neuropsychiatric Interview, MINI) and psychosocial evaluation (Scale of Sheehan’s Disability Scale, DISS, Baker and Intagliata’s Satisfaction with Life Domains Scale, SLDS).

At follow-up, the percentage of patients who had either improved or were in remission was considerably higher among those initially diagnosed as PD with respect to those diagnosed as panic disorder with agoraphobia (PDA): Thirty-eight percent of PD and 20.6% of PDA patients were in clinical remission. Mild panic symptoms and phobic avoidance were found in the majority of patients who were still symptomatic (respectively 71% and 57%). Approximately 60% of patients reported a significant difficulty in performing daily activities and 40% expressed dissatisfaction in at least 50% of life domains considered. Seventy-two percent of subjects examined were still undergoing pharmacological treatment at the time of follow-up.

The findings of the study are suggestive of a chronic illness with a significant impact on everyday quality of life of patients.

There is insufficient knowledge of the long-term course of panic disorder (PD).

To determine the long-term course and prognostic variables in patients diagnosed with PD.

Patients who were diagnosed of anxiety states between 1950 and 1961, were examined using a structured clinical interview (SCID-DSM-III-R) between 1984 and 1988 (n = 144). A re-examination was performed in the period 1997–2001 (N = 125). Mean length of follow-up from onset was 47 years.

PD tends to be chronic. Among those who recovered, 93% had done so already by the 1980s. Lack of regular treatment compliance, progression to agoraphobia and number of episodes of panic disorder were associated with worse outcome. Agoraphobia without panic attacks and somatization symptoms were the most prevalent clinical status at follow-up.

After several decades, participants improve with regard to number of panic attacks, though most continue to have residual symptoms.