A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.

myo-lnositol (mIns), a natural component of the human diet and essential precursor of several signalling pathways, including that of G protein-coupled receptors, has also been shown to be effective in the treatment of psychiatric disorders such as depression, obsessive compulsive disorder and panic disorder. Most likely since mlns is a simple isomer of glucose, no serious side effects have been reported with its use, even at high oral doses of mlns. Previous studies suggest that the therapeutic action of mlns may include reduced serotonin 5HTzA and muscarinic acetylcholine receptor function. An important signal transduction system that may possibly be involved in the mechanism of action of antidepressants is phosphoinositide (PI) turnover. In this signalling system PI-phospholipase C (PLCpl), that is implicated in the in the mechanism of action of antidepressants and anxiolytics, is activated. The mechanism of action of mlns, however, still remains elusive and needs further investigation. In this study a possible modulatory role of 24-hour pre-treatment of human neuroblastoma cell line (SH-SY5Y) with mlns on mRNA levels and protein expression of phospholipase C-p1 (PLCP1) and glycogen synthase kinase 3P (GSK3p) was investigated. The effects of mlns were also compared to that of other prototype antidepressants, such as fluoxetine (a selective serotonin reuptake inhibitor), imipramine (a tricyclic antidepressant), lithium and another drug with potential antidepressant effects, sildenafil (phosphodiesterase 5-type (PDE5) inhibitor). Real-time reverse transcription Polymerase Chain Reaction (RTPCR) was performed in order to investigate the mRNA levels, while protein expression in membranes and the cytosol fraction of cells were quantified with Western blots. The expression of PLCPl was decreased after pre-treatments with imipramine or myoinositol in combination with fluoxetine. In addition, sildenafil alone or in combination with myo-inositol, also decreased the expression of membrane-bound PLCp1. However, a 24- hour pre-treatment with lithium did not alter PLCPl expression significantly. Determined mRNA levels for the expression of PLCPl were consistent in these findings, except for the inhibition of the mRNA for the expression of PLCPl also after lithium treatment. The reduced PLCpl mRNA levels after lithium pre-treatment may suggest the involvement of posttranscriptional modification (or delayed translational effects) of PLCpl after lithium treatment. The data from the current study suggest that antidepressant action may include downregulation of PLCPl expression and that modulators of the nitric oxidecGMP pathway (e.g. sildenafil as a PDE5 inhibitor) may exhibit similar properties. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

myo-lnositol (mIns), a natural component of the human diet and essential precursor of several signalling pathways, including that of G protein-coupled receptors, has also been shown to be effective in the treatment of psychiatric disorders such as depression, obsessive compulsive disorder and panic disorder. Most likely since mlns is a simple isomer of glucose, no serious side effects have been reported with its use, even at high oral doses of mlns. Previous studies suggest that the therapeutic action of mlns may include reduced serotonin 5HTzA and muscarinic acetylcholine receptor function. An important signal transduction system that may possibly be involved in the mechanism of action of antidepressants is phosphoinositide (PI) turnover. In this signalling system PI-phospholipase C (PLCpl), that is implicated in the in the mechanism of action of antidepressants and anxiolytics, is activated. The mechanism of action of mlns, however, still remains elusive and needs further investigation. In this study a possible modulatory role of 24-hour pre-treatment of human neuroblastoma cell line (SH-SY5Y) with mlns on mRNA levels and protein expression of phospholipase C-p1 (PLCP1) and glycogen synthase kinase 3P (GSK3p) was investigated. The effects of mlns were also compared to that of other prototype antidepressants, such as fluoxetine (a selective serotonin reuptake inhibitor), imipramine (a tricyclic antidepressant), lithium and another drug with potential antidepressant effects, sildenafil (phosphodiesterase 5-type (PDE5) inhibitor). Real-time reverse transcription Polymerase Chain Reaction (RTPCR) was performed in order to investigate the mRNA levels, while protein expression in membranes and the cytosol fraction of cells were quantified with Western blots. The expression of PLCPl was decreased after pre-treatments with imipramine or myoinositol in combination with fluoxetine. In addition, sildenafil alone or in combination with myo-inositol, also decreased the expression of membrane-bound PLCp1. However, a 24- hour pre-treatment with lithium did not alter PLCPl expression significantly. Determined mRNA levels for the expression of PLCPl were consistent in these findings, except for the inhibition of the mRNA for the expression of PLCPl also after lithium treatment. The reduced PLCpl mRNA levels after lithium pre-treatment may suggest the involvement of posttranscriptional modification (or delayed translational effects) of PLCpl after lithium treatment. The data from the current study suggest that antidepressant action may include downregulation of PLCPl expression and that modulators of the nitric oxidecGMP pathway (e.g. sildenafil as a PDE5 inhibitor) may exhibit similar properties. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Os mecanismos de defesa representam uma dimensão importante da estrutura da personalidade e do funcionamento psicodinâmico, sendo uma das formas de medir como o indivíduo habitualmente responde aos estressores. O estudo dos mecanismos de defesa utilizados por pacientes com Transtorno do Pânico (TP) pode ter utilidade no entendimento e no tratamento desse transtorno. O objetivo deste trabalho é o de avaliar os mecanismos de defesa do ego, nos pacientes com TP, e sua associação com gravidade, resposta ao tratamento e alteração pós tratamento. Sessenta pacientes com TP e 31 controles participaram da primeira fase do trabalho. O Mini International Neuropsychiatric Interview foi usado para confirmar o diagnóstico de TP e estabelecer o diagnóstico de co-morbidades. A Impressão Clínica Global (CGI) foi usada para avaliar a gravidade do TP e o Defense Style Questionnaire (DSQ-40) foi usado para avaliar os mecanismos de defesa. Em uma segunda etapa, 33 pacientes com TP sintomáticos e 33 voluntários normais foram avaliados com os mesmos instrumentos, aplicados no início do estudo e após 16 semanas. Os pacientes receberam durante esse período tratamento farmacológico com sertralina. Ambos os estudos demonstraram que pacientes com TP utilizam mais defesas neuróticas e imaturas comparados ao grupo controle. Os pacientes com pânico grave (CGI>4) apresentaram maior co-morbidade com depressão atual e usaram mais defesas imaturas do que os pacientes com CGI< 4 (média=4.2 vs. 3.5; p<0.001). Após 4 meses de tratamento, houve diminuição no uso de defesas neuróticas (4.6 vs. 4.2; p=0.049) e imaturas (3.6 vs. 3.4 p=0.035) no grupo de pacientes. Pacientes que usavam mais defesas neuróticas e imaturas apresentaram pior resposta ao tratamento. Pacientes com TP usaram mais defesas mal-adaptativas quando comparados ao grupo controle, no basal e após 4 meses. O uso de defesas neuróticas e imaturas está associado à gravidade do TP e à pior resposta ao tratamento. Os mecanismos de defesa são, então, parte de uma maneira estável do indivíduo lidar com conflitos, mas também são influenciados pelo estado agudo da doença. / This study aims at evaluating the defense mechanisms most frequently used by Brazilian patients with panic disorder when compared to a control group as well as at examining the association between severity of disease and co morbidity and the use of specific defense mechanisms. Sixty panic disordered patients and thirty-one controls participated in the study. The Mini International Neuropsychiatric Interview was used to confirm the panic disorder diagnosis and to establish the co morbid diagnosis. The Clinical Global Impression (CGI) was used to assess severity and the Defensive Style Questionnaire (DSQ-40) was used to evaluate the defense mechanisms. Panic patients used more neurotic (mean=4.9 vs. 3.6; p<0,001) and immature (mean=3.9 vs. 2.8; p< 0,001) defenses as compared to controls. Panic patients with severe disease (n=37; CGI>4) had more depression co morbidity and used more immature defenses than patients with CGI<4 (n=23; mean=4.2 vs. 3.5; p<0.001). It was concluded that the Panic severity and depression co morbidity found in Brazilian panic disordered patients are associated with the use of maladaptive mechanisms, namely immature defenses.

A presença de doença crônica pode ser determinante de sobrecarga familiar e interferir no ambiente. Por outro lado, os aspectos familiares podem contribuir como um fator protetor ou de risco na evolução da doença. Estudos têm avaliado a sobrecarga familiar em transtornos mentais maiores, como a esquizofrenia, mas ainda não há estudos que avaliem a sobrecarga e o ambiente familiar em relação ao transtorno de pânico (TP). O objetivo deste estudo foi comparar a sobrecarga e o ambiente de familiares de pacientes com TP e de familiares de pacientes com doenças clínicas. Também pretendeu verificar a relação da sobrecarga e do ambiente familiar com as características sociodemográficas dos familiares e com a gravidade do TP. Trata-se de um estudo transversal com familiares e pacientes com TP e familiares de pacientes com doenças clínicas, como hipertensão arterial sistêmica (HAS), diabete melito tipo 2 (DM 2) e cardiopatias. A sobrecarga foi mensurada através do Family Burden Interview Schedule (FBIS-BR) e, para avaliar o ambiente familiar, foi utilizada a Family Environment Scale (FES). Para verificar a gravidade dos sintomas do TP, foi utilizada a Panic Disorder Severity Scale (PDSS). A pesquisa foi desenvolvida em ambulatório de hospital geral e aprovada pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (nº 110109). Foram incluídos no grupo do TP 67 familiares com seus respectivos pacientes e 66 familiares de pacientes com doenças clínicas. Observou-se que existem diferenças significativas entre as características sociodemográficas dos grupos. Entre os familiares de pacientes com TP, predominam indivíduos do sexo masculino e com maior escolaridade do que no outro grupo. Em relação ao grau de parentesco, há um maior número de pais como familiares cuidadores de pacientes com TP e mais filhos(as) como cuidadores de pacientes com doença clínica. A sobrecarga objetiva “assistência à vida cotidiana”, “impacto nas rotinas diárias” e “geral” foi significativamente maior para familiares de pacientes com doenças clínicas (p=0,017; p=0,032 e p=0,024, respectivamente), enquanto a sobrecarga subjetiva “assistência na vida cotidiana” foi maior para familiares de pacientes com TP (p=0,025). O ambiente familiar foi diferente entre os grupos na dimensão “conflito”, sendo significativamente maior no grupo de familiares do TP. Após a análise multivariável com o Generalized Linear Models, permaneceu como variável independente de maior sobrecarga subjetiva quando o familiar é um dos pais em ambos os grupos (p=0,001). A sobrecarga objetiva manteve-se no grupo controle (p<0,05), sendo que a subescala “impacto nas rotinas diárias” e o escore geral permaneceram associados caso o familiar fosse um dos pais (p=0,017 e p=0,021, respectivamente). O ambiente na dimensão “conflito” foi maior quando o familiar era um dos pais (p=0,045) e a “organização” foi menor no grupo de familiares de pacientes com TP (p=0,034). Também foi analisado se pertencer a um dos grupos (controle ou do TP) e se o grau de parentesco determinava a sobrecarga familiar, porém não foi encontrada interação significativa. Observou-se correlação positiva significativa entre a gravidade do TP e sobrecarga familiar objetiva e subjetiva, que se manteve como variável independente após a análise multivariável. Os resultados indicaram que existem diferenças entre os grupos quanto à sobrecarga objetiva e subjetiva e que são determinadas pelo grau de parentesco, sendo maior principalmente quando o familiar é um dos pais. Os resultados também demonstraram queque a sobrecarga familiar está relacionada à gravidade dos sintomas do TP. Portanto, a avaliação de sobrecarga familiar pode ser útil no desenvolvimento de estratégias terapêuticas focadas na própria família e, assim, contribuir para melhorar os resultados dos pacientes. / The presence of chronic disease can be a determinant of family burden and impinge upon the family environment. On the other hand, family aspects can serve as a protective or risk factor in disease evolution. Studies have assessed the family burden associated with major mental disorders, such as schizophrenia, but there are no studies that assess the family burden and environment in relation to Panic Disorder (PD). The purpose of this study was to compare the burden and environment of family members of PD patients with family members of patients with clinical diseases. It also sought to examine the relationship between family burden and environment with the sociodemographic characteristics of family members and PD severity. This was a cross sectional study involving family members and PD patients and a control group of family members of patients with clinical diseases, such as systemic arterial hypertension (SAH), diabetes mellitus type 2 (DM2) or heart diseases. Burden was measured through the Family Burden Interview Schedule (FBIS-BR) and the family environment was assessed using the Family Environment Scale (FES). To check PD symptom severity, the Panic Disorder Severity Scale (PDSS) was used. The research was conducted in the general hospital outpatient clinic and approved by the Research Ethics Committee of Hospital de Clinicas de Porto Alegre (No. 110109). The groups were comprised of 67 family members with their respective PD patients and 66 family members of control group. It was noted that there are significant differences between the sociodemographic characteristics of the groups. The family members of PD patients are predominantly males with a higher level of education than the control group. As far as the parentage degree, there are a greater number of parents acting as family caregivers for PD patients and more sons or daughters as caregivers for patients with clinical diseases. The objective burden with respect to "assistance in everyday life", "impact on caregiver’s life " and "general" was significantly higher for family members of control group (p = .017; p = .032 and p = .024, respectively), whereas the subjective burden in terms of "assistance in everyday life" was higher for family members of patients with PD (p = .025). The family environment was different between the groups in regard to the "conflict" dimension, being significantly higher in the group of family members of PD patients. After the multivariate analysis using Generalized Linear Models, the independent variable with the highest subjective burden occurred when the family member is one of the parents regardless of the group (p = .001). The objective burden remained the same in the control group (p <.05), and the subscale of "impact on caregiver’s life" and overall score continued to be linked if the family member was one of the parents (p = .017 and p = .021, respectively). The "conflict" dimension of the environment was higher when the family member was one of the parents (p = .045) and "organization" was lower in the group of family members of PD patients (p = .034). It was also examined whether belonging to one of the groups (control or PD) and the parentage degree has a bearing on family burden, but no significant association was found. A significant positive correlation was noted between PD severity and objective and subjective family burden, which remained as an independent variable after the multivariate analysis. The results also demonstrated that family burden is related to PD symptom severity. Therefore, assessment of family burden may be useful in developing therapeutic strategies focused on family itself and thus contribute to improve patients outcomes.

Os mecanismos de defesa representam uma dimensão importante da estrutura da personalidade e do funcionamento psicodinâmico, sendo uma das formas de medir como o indivíduo habitualmente responde aos estressores. O estudo dos mecanismos de defesa utilizados por pacientes com Transtorno do Pânico (TP) pode ter utilidade no entendimento e no tratamento desse transtorno. O objetivo deste trabalho é o de avaliar os mecanismos de defesa do ego, nos pacientes com TP, e sua associação com gravidade, resposta ao tratamento e alteração pós tratamento. Sessenta pacientes com TP e 31 controles participaram da primeira fase do trabalho. O Mini International Neuropsychiatric Interview foi usado para confirmar o diagnóstico de TP e estabelecer o diagnóstico de co-morbidades. A Impressão Clínica Global (CGI) foi usada para avaliar a gravidade do TP e o Defense Style Questionnaire (DSQ-40) foi usado para avaliar os mecanismos de defesa. Em uma segunda etapa, 33 pacientes com TP sintomáticos e 33 voluntários normais foram avaliados com os mesmos instrumentos, aplicados no início do estudo e após 16 semanas. Os pacientes receberam durante esse período tratamento farmacológico com sertralina. Ambos os estudos demonstraram que pacientes com TP utilizam mais defesas neuróticas e imaturas comparados ao grupo controle. Os pacientes com pânico grave (CGI>4) apresentaram maior co-morbidade com depressão atual e usaram mais defesas imaturas do que os pacientes com CGI< 4 (média=4.2 vs. 3.5; p<0.001). Após 4 meses de tratamento, houve diminuição no uso de defesas neuróticas (4.6 vs. 4.2; p=0.049) e imaturas (3.6 vs. 3.4 p=0.035) no grupo de pacientes. Pacientes que usavam mais defesas neuróticas e imaturas apresentaram pior resposta ao tratamento. Pacientes com TP usaram mais defesas mal-adaptativas quando comparados ao grupo controle, no basal e após 4 meses. O uso de defesas neuróticas e imaturas está associado à gravidade do TP e à pior resposta ao tratamento. Os mecanismos de defesa são, então, parte de uma maneira estável do indivíduo lidar com conflitos, mas também são influenciados pelo estado agudo da doença. / This study aims at evaluating the defense mechanisms most frequently used by Brazilian patients with panic disorder when compared to a control group as well as at examining the association between severity of disease and co morbidity and the use of specific defense mechanisms. Sixty panic disordered patients and thirty-one controls participated in the study. The Mini International Neuropsychiatric Interview was used to confirm the panic disorder diagnosis and to establish the co morbid diagnosis. The Clinical Global Impression (CGI) was used to assess severity and the Defensive Style Questionnaire (DSQ-40) was used to evaluate the defense mechanisms. Panic patients used more neurotic (mean=4.9 vs. 3.6; p<0,001) and immature (mean=3.9 vs. 2.8; p< 0,001) defenses as compared to controls. Panic patients with severe disease (n=37; CGI>4) had more depression co morbidity and used more immature defenses than patients with CGI<4 (n=23; mean=4.2 vs. 3.5; p<0.001). It was concluded that the Panic severity and depression co morbidity found in Brazilian panic disordered patients are associated with the use of maladaptive mechanisms, namely immature defenses.

Tem sido proposto que vias serotonérgicas distintas originárias do núcleo dorsal da rafe (NDR) modulariam diferentes tipos de reações de defesa a estímulos aversivos. Deakin e Graeff (1991) propuseram que a ativação da via ascendente do NDR, que inerva a amígdala e o córtex frontal, facilitaria comportamentos defensivos aprendidos em resposta a perigo potencial ou distal, enquanto que a ativação da via periventricular, também originária no NDR e que inerva a matéria cinzenta periaquedutal dorsal (MCPD) inibiria reações de fuga e luta inatas em resposta a perigo proximal. No presente trabalho pretendeu-se explorar esta hipótese investigando o efeito da inibição do NDR, da MCPD e do núcleo amigdalóide basolateral, em ratos submetidos a dois modelos animais de ansiedade: o labirinto em T elevado (LTE) e o modelo de transição claro-escuro (MTCE). Os testes com o LTE incluíram uma variação metodológica: um dia antes do experimento, os animais foram pré-expostos por 30 minutos a um dos braços abertos do modelo. Tem sido demonstrado que a pré-exposição leva a uma diminuição do tempo gasto em atividade exploratória no braço aberto, assegurando que durante as medidas de fuga, os animais estão realmente fugindo do estímulo aversivo. No presente trabalho, a administração intra-NDR do agonista gabaérgico muscimol diminuiu as latências da esquiva inibitória (EI), efeito ansiolítico, e da fuga dos braços abertos do LTE, efeito ansiogênico. Além disso, o muscimol intra-NDR aumentou o tempo gasto no compartimento claro (TGCC) do MTCE, efeito ansiolítico. Por outro lado, a droga não apresentou efeito no modelo do labirinto em T fechado. Já a microinjeção de muscimol intra-MCPD aumentou a latência de fuga do braço aberto do LTE, efeito ansiolítico, não apresentando qualquer efeito na EI do labirinto em T elevado ou no MTCE. Finalmente, a administração de muscimol intra-amígdala basolateral prejudicou a esquiva inibitória do LTE e aumentou o TGCC do MTCE, efeitos ansiolíticos, sem alterar a fuga dos braços abertos. Em conjunto, os dados do presente trabalho corroboram alguns dos pressupostos da teoria do papel dual da 5-HT na ansiedade proposta por Deakin e Graeff (1991). É interessante salientar, ainda, a importância da pré-exposição sobre as medidas de fuga do braço aberto do LTE. / It has been proposed that distinct 5-HT pathways modulate different types of anxiety reaction to aversive stimuli. Deakin and Graeff (1991) proposed that the activation of the ascending dorsal raphe (DR)-5-HT pathways innervating the amygdala and frontal cortex would facilitate learned defensive behaviors in response to distal or potential threat, while activation of the DR-periventricular 5-HT pathways, which innervates the dorsal periaqueductal gray matter (DPAG) would inhibit innate flight or fight reactions in response to proximal threat. In an attempt to explore this hypothesis, we investigated the effects of reversible inhibition of the DRN, the DPAG and of the basolateral amygdala nucleus in rats exposed to 2 animal models of anxiety: the elevated T maze (ETM) and the light-dark model (LDM). An important methodological difference was included to the ETM tests. The animals were exposed for 30 minutes to one of the ETM open arms, 24 h before the tests. Pre-exposure seems to improve escape measurements in the ETM, assuring that during escape, animals are really escaping from the aversive threat and not simply ambling. In the present study, muscimol administered intra-DRN impaired both the avoidance, anxyolitic effect, and the escape task, anxyogenic effect, of the ETM and increased the time spent in the light compartment (TSLC) in the LDM, an anxyolitic effect. On the other hand, muscimol microinjected intra-DPAG enhanced escape latencies in the ETM, an anxyolitic effect, without altering inhibitory avoidance or LDM measurements. Finally, muscimol administered intra-basolateral amygdala impaired avoidance in the ETM and increased the TSLC in the LDM, revealing an anxyolitic effect in both tests, without altering the escape task. Taken together the obtained data seem to corroborate the dual role of 5-HT in anxiety, proposed by Deakin and Graeff (1991). At last, the importance of pre-exposure to the open arms of the LTE should be emphasized as a procedure capable of improving escape measurement.

A presença de doença crônica pode ser determinante de sobrecarga familiar e interferir no ambiente. Por outro lado, os aspectos familiares podem contribuir como um fator protetor ou de risco na evolução da doença. Estudos têm avaliado a sobrecarga familiar em transtornos mentais maiores, como a esquizofrenia, mas ainda não há estudos que avaliem a sobrecarga e o ambiente familiar em relação ao transtorno de pânico (TP). O objetivo deste estudo foi comparar a sobrecarga e o ambiente de familiares de pacientes com TP e de familiares de pacientes com doenças clínicas. Também pretendeu verificar a relação da sobrecarga e do ambiente familiar com as características sociodemográficas dos familiares e com a gravidade do TP. Trata-se de um estudo transversal com familiares e pacientes com TP e familiares de pacientes com doenças clínicas, como hipertensão arterial sistêmica (HAS), diabete melito tipo 2 (DM 2) e cardiopatias. A sobrecarga foi mensurada através do Family Burden Interview Schedule (FBIS-BR) e, para avaliar o ambiente familiar, foi utilizada a Family Environment Scale (FES). Para verificar a gravidade dos sintomas do TP, foi utilizada a Panic Disorder Severity Scale (PDSS). A pesquisa foi desenvolvida em ambulatório de hospital geral e aprovada pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (nº 110109). Foram incluídos no grupo do TP 67 familiares com seus respectivos pacientes e 66 familiares de pacientes com doenças clínicas. Observou-se que existem diferenças significativas entre as características sociodemográficas dos grupos. Entre os familiares de pacientes com TP, predominam indivíduos do sexo masculino e com maior escolaridade do que no outro grupo. Em relação ao grau de parentesco, há um maior número de pais como familiares cuidadores de pacientes com TP e mais filhos(as) como cuidadores de pacientes com doença clínica. A sobrecarga objetiva “assistência à vida cotidiana”, “impacto nas rotinas diárias” e “geral” foi significativamente maior para familiares de pacientes com doenças clínicas (p=0,017; p=0,032 e p=0,024, respectivamente), enquanto a sobrecarga subjetiva “assistência na vida cotidiana” foi maior para familiares de pacientes com TP (p=0,025). O ambiente familiar foi diferente entre os grupos na dimensão “conflito”, sendo significativamente maior no grupo de familiares do TP. Após a análise multivariável com o Generalized Linear Models, permaneceu como variável independente de maior sobrecarga subjetiva quando o familiar é um dos pais em ambos os grupos (p=0,001). A sobrecarga objetiva manteve-se no grupo controle (p<0,05), sendo que a subescala “impacto nas rotinas diárias” e o escore geral permaneceram associados caso o familiar fosse um dos pais (p=0,017 e p=0,021, respectivamente). O ambiente na dimensão “conflito” foi maior quando o familiar era um dos pais (p=0,045) e a “organização” foi menor no grupo de familiares de pacientes com TP (p=0,034). Também foi analisado se pertencer a um dos grupos (controle ou do TP) e se o grau de parentesco determinava a sobrecarga familiar, porém não foi encontrada interação significativa. Observou-se correlação positiva significativa entre a gravidade do TP e sobrecarga familiar objetiva e subjetiva, que se manteve como variável independente após a análise multivariável. Os resultados indicaram que existem diferenças entre os grupos quanto à sobrecarga objetiva e subjetiva e que são determinadas pelo grau de parentesco, sendo maior principalmente quando o familiar é um dos pais. Os resultados também demonstraram queque a sobrecarga familiar está relacionada à gravidade dos sintomas do TP. Portanto, a avaliação de sobrecarga familiar pode ser útil no desenvolvimento de estratégias terapêuticas focadas na própria família e, assim, contribuir para melhorar os resultados dos pacientes. / The presence of chronic disease can be a determinant of family burden and impinge upon the family environment. On the other hand, family aspects can serve as a protective or risk factor in disease evolution. Studies have assessed the family burden associated with major mental disorders, such as schizophrenia, but there are no studies that assess the family burden and environment in relation to Panic Disorder (PD). The purpose of this study was to compare the burden and environment of family members of PD patients with family members of patients with clinical diseases. It also sought to examine the relationship between family burden and environment with the sociodemographic characteristics of family members and PD severity. This was a cross sectional study involving family members and PD patients and a control group of family members of patients with clinical diseases, such as systemic arterial hypertension (SAH), diabetes mellitus type 2 (DM2) or heart diseases. Burden was measured through the Family Burden Interview Schedule (FBIS-BR) and the family environment was assessed using the Family Environment Scale (FES). To check PD symptom severity, the Panic Disorder Severity Scale (PDSS) was used. The research was conducted in the general hospital outpatient clinic and approved by the Research Ethics Committee of Hospital de Clinicas de Porto Alegre (No. 110109). The groups were comprised of 67 family members with their respective PD patients and 66 family members of control group. It was noted that there are significant differences between the sociodemographic characteristics of the groups. The family members of PD patients are predominantly males with a higher level of education than the control group. As far as the parentage degree, there are a greater number of parents acting as family caregivers for PD patients and more sons or daughters as caregivers for patients with clinical diseases. The objective burden with respect to "assistance in everyday life", "impact on caregiver’s life " and "general" was significantly higher for family members of control group (p = .017; p = .032 and p = .024, respectively), whereas the subjective burden in terms of "assistance in everyday life" was higher for family members of patients with PD (p = .025). The family environment was different between the groups in regard to the "conflict" dimension, being significantly higher in the group of family members of PD patients. After the multivariate analysis using Generalized Linear Models, the independent variable with the highest subjective burden occurred when the family member is one of the parents regardless of the group (p = .001). The objective burden remained the same in the control group (p <.05), and the subscale of "impact on caregiver’s life" and overall score continued to be linked if the family member was one of the parents (p = .017 and p = .021, respectively). The "conflict" dimension of the environment was higher when the family member was one of the parents (p = .045) and "organization" was lower in the group of family members of PD patients (p = .034). It was also examined whether belonging to one of the groups (control or PD) and the parentage degree has a bearing on family burden, but no significant association was found. A significant positive correlation was noted between PD severity and objective and subjective family burden, which remained as an independent variable after the multivariate analysis. The results also demonstrated that family burden is related to PD symptom severity. Therefore, assessment of family burden may be useful in developing therapeutic strategies focused on family itself and thus contribute to improve patients outcomes.

A presença de doença crônica pode ser determinante de sobrecarga familiar e interferir no ambiente. Por outro lado, os aspectos familiares podem contribuir como um fator protetor ou de risco na evolução da doença. Estudos têm avaliado a sobrecarga familiar em transtornos mentais maiores, como a esquizofrenia, mas ainda não há estudos que avaliem a sobrecarga e o ambiente familiar em relação ao transtorno de pânico (TP). O objetivo deste estudo foi comparar a sobrecarga e o ambiente de familiares de pacientes com TP e de familiares de pacientes com doenças clínicas. Também pretendeu verificar a relação da sobrecarga e do ambiente familiar com as características sociodemográficas dos familiares e com a gravidade do TP. Trata-se de um estudo transversal com familiares e pacientes com TP e familiares de pacientes com doenças clínicas, como hipertensão arterial sistêmica (HAS), diabete melito tipo 2 (DM 2) e cardiopatias. A sobrecarga foi mensurada através do Family Burden Interview Schedule (FBIS-BR) e, para avaliar o ambiente familiar, foi utilizada a Family Environment Scale (FES). Para verificar a gravidade dos sintomas do TP, foi utilizada a Panic Disorder Severity Scale (PDSS). A pesquisa foi desenvolvida em ambulatório de hospital geral e aprovada pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (nº 110109). Foram incluídos no grupo do TP 67 familiares com seus respectivos pacientes e 66 familiares de pacientes com doenças clínicas. Observou-se que existem diferenças significativas entre as características sociodemográficas dos grupos. Entre os familiares de pacientes com TP, predominam indivíduos do sexo masculino e com maior escolaridade do que no outro grupo. Em relação ao grau de parentesco, há um maior número de pais como familiares cuidadores de pacientes com TP e mais filhos(as) como cuidadores de pacientes com doença clínica. A sobrecarga objetiva “assistência à vida cotidiana”, “impacto nas rotinas diárias” e “geral” foi significativamente maior para familiares de pacientes com doenças clínicas (p=0,017; p=0,032 e p=0,024, respectivamente), enquanto a sobrecarga subjetiva “assistência na vida cotidiana” foi maior para familiares de pacientes com TP (p=0,025). O ambiente familiar foi diferente entre os grupos na dimensão “conflito”, sendo significativamente maior no grupo de familiares do TP. Após a análise multivariável com o Generalized Linear Models, permaneceu como variável independente de maior sobrecarga subjetiva quando o familiar é um dos pais em ambos os grupos (p=0,001). A sobrecarga objetiva manteve-se no grupo controle (p<0,05), sendo que a subescala “impacto nas rotinas diárias” e o escore geral permaneceram associados caso o familiar fosse um dos pais (p=0,017 e p=0,021, respectivamente). O ambiente na dimensão “conflito” foi maior quando o familiar era um dos pais (p=0,045) e a “organização” foi menor no grupo de familiares de pacientes com TP (p=0,034). Também foi analisado se pertencer a um dos grupos (controle ou do TP) e se o grau de parentesco determinava a sobrecarga familiar, porém não foi encontrada interação significativa. Observou-se correlação positiva significativa entre a gravidade do TP e sobrecarga familiar objetiva e subjetiva, que se manteve como variável independente após a análise multivariável. Os resultados indicaram que existem diferenças entre os grupos quanto à sobrecarga objetiva e subjetiva e que são determinadas pelo grau de parentesco, sendo maior principalmente quando o familiar é um dos pais. Os resultados também demonstraram queque a sobrecarga familiar está relacionada à gravidade dos sintomas do TP. Portanto, a avaliação de sobrecarga familiar pode ser útil no desenvolvimento de estratégias terapêuticas focadas na própria família e, assim, contribuir para melhorar os resultados dos pacientes. / The presence of chronic disease can be a determinant of family burden and impinge upon the family environment. On the other hand, family aspects can serve as a protective or risk factor in disease evolution. Studies have assessed the family burden associated with major mental disorders, such as schizophrenia, but there are no studies that assess the family burden and environment in relation to Panic Disorder (PD). The purpose of this study was to compare the burden and environment of family members of PD patients with family members of patients with clinical diseases. It also sought to examine the relationship between family burden and environment with the sociodemographic characteristics of family members and PD severity. This was a cross sectional study involving family members and PD patients and a control group of family members of patients with clinical diseases, such as systemic arterial hypertension (SAH), diabetes mellitus type 2 (DM2) or heart diseases. Burden was measured through the Family Burden Interview Schedule (FBIS-BR) and the family environment was assessed using the Family Environment Scale (FES). To check PD symptom severity, the Panic Disorder Severity Scale (PDSS) was used. The research was conducted in the general hospital outpatient clinic and approved by the Research Ethics Committee of Hospital de Clinicas de Porto Alegre (No. 110109). The groups were comprised of 67 family members with their respective PD patients and 66 family members of control group. It was noted that there are significant differences between the sociodemographic characteristics of the groups. The family members of PD patients are predominantly males with a higher level of education than the control group. As far as the parentage degree, there are a greater number of parents acting as family caregivers for PD patients and more sons or daughters as caregivers for patients with clinical diseases. The objective burden with respect to "assistance in everyday life", "impact on caregiver’s life " and "general" was significantly higher for family members of control group (p = .017; p = .032 and p = .024, respectively), whereas the subjective burden in terms of "assistance in everyday life" was higher for family members of patients with PD (p = .025). The family environment was different between the groups in regard to the "conflict" dimension, being significantly higher in the group of family members of PD patients. After the multivariate analysis using Generalized Linear Models, the independent variable with the highest subjective burden occurred when the family member is one of the parents regardless of the group (p = .001). The objective burden remained the same in the control group (p <.05), and the subscale of "impact on caregiver’s life" and overall score continued to be linked if the family member was one of the parents (p = .017 and p = .021, respectively). The "conflict" dimension of the environment was higher when the family member was one of the parents (p = .045) and "organization" was lower in the group of family members of PD patients (p = .034). It was also examined whether belonging to one of the groups (control or PD) and the parentage degree has a bearing on family burden, but no significant association was found. A significant positive correlation was noted between PD severity and objective and subjective family burden, which remained as an independent variable after the multivariate analysis. The results also demonstrated that family burden is related to PD symptom severity. Therefore, assessment of family burden may be useful in developing therapeutic strategies focused on family itself and thus contribute to improve patients outcomes.