July 31, 2007 / 4:35 PM / 10 years ago

Panic with agoraphobia linked to alcohol abuse

NEW YORK (Reuters Health) - People who have panic disorder with agoraphobia often develop an alcohol use disorder, and visa versa -- each condition may directly contribute to the development of the other, according to a report in the Journal of Clinical Psychiatry.

Alcohol use disorders and panic disorder with or without agoraphobia tend to occur within the same individual," Dr. Eric J. L. Griez, of Maastricht University, the Netherlands, and colleagues write.

Agoraphobia is the abnormal, obsessive, intense fear of open places or open areas. People with agoraphobia may become anxious by just thinking about a situation where it might be difficult to leave, and they will avoid the situations that trigger anxiety or panic, even if it means confinement to the home.

The cause of this agoraphobia-panic condition is controversial, the researchers note. Three explanations have been offered to explain these behaviors.

The first suggests that panic disorder with agoraphobia promotes excessive alcohol use as self-medication. Second, chronic alcohol abuse and alcohol withdrawal induce neurochemical changes that promote panic. The third possibility is the some people are genetically predisposed to developing both disorders.

The researchers conducted a review of epidemiological, family, and laboratory studies on alcohol and panic disorders. A total of 20 studies were included in the analysis.

Based on their analysis of the data, the investigators found that in patients with panic disorder with agoraphobia, alcohol appears to decrease the level of anxiety, which reduces the likelihood of panic.

In alcohol abusers, they found that alcohol increases carbon dioxide sensitivity, thereby promoting panic.

A clear pattern of family transmission was also found to contribute to the occurrence of both panic and alcohol use disorders.

"As far as panic disorder with agoraphobia patients are concerned, the 'self-medication' hypothesis appears to be valid," Griez and colleagues conclude. "In the case of alcoholic patients, the hypothesis that alcohol may trigger the onset of panic is most likely."

The investigators would like to see of the same relationship exists between panic disorder and other substances of abuse. "In general, increasing the knowledge on panic and substance abuse should guarantee that more instruments are used in clinical practice to treat patients, prevent complications, and improve their quality of life."

SOURCE: Journal of Clinical Psychiatry, June 2007.

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