New Spectrum Condition Linked to Panic Disorder Proposed

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A high rate of association between panic disorder and physical illnesses has led researchers to propose the creation of a spectrum syndrome called ALPIM, according to a study published in the Journal of Neuropsychiatry and Clinical Neurosciences.

In their study, the researchers looked at the prevalence of certain physical conditions in people with panic disorder compared with the general population. They saw joint laxity in 59.3% of study patients compared with approximately 10% to 15% of the general population. This disparity existed for rates of fibromyalgia (80.3% in study patients versus 2.1% to 5.7% in the general population) and allergic rhinitis (71.1% in study patients versus 20% in the general population).

The researchers believe that panic disorder could be linked to these and other conditions that had previously considered unrelated. They propose the adoption of a spectrum disorder called ALPIM in order to help better understand how these conditions are linked. The proposal of a spectrum disorder is not new, but ALPIM provides new elements and groups to better represent overlap.

The letters of ALPIM stand for:

  • A: Anxiety disorder (mostly panic disorder)
  • L: Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising)
  • P: Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis)
  • I: Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome)
  • M: Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis)

"Our argument is that delineations in medicine can be arbitrary and that some disorders that are viewed as multiple disparate and independent conditions may best be viewed as a single spectrum disorder with a common genetic etiology," researcher Jeremy Coplan, MD, of SUNY Downstate Medical Center, said in a statement "Patients deserve a more informed scientific understanding of spectrum disorders. The disorders that are part of the ALPIM syndrome may be better understood if viewed as a common entity."

New Spectrum Condition Linked to Panic Disorder Proposed
A new spectrum disorder, known by the acronym ALPIM, associates panic disorder with several physical illnesses.

The relationship between mental and physical health is well established. But when mental and physical illnesses co-occur, patients' accounts of physical illness are sometimes arbitrarily discredited or dismissed by physicians.

Research by Jeremy Coplan, MD, professor of psychiatry at SUNY Downstate Medical Center, and colleagues has documented a high rate of association between panic disorder and four domains of physical illness. The research could alter how physicians and psychiatrists view the boundaries within and between psychiatric and medical disorders.

"Patients who appear to have certain somatic disorders — illnesses for which there is no detectable medical cause and which physicians may consider to be imagined by the patient — may instead have a genetic propensity to develop a series of real, related illnesses," says Dr. Coplan, an expert in neuropsychopharmacology.

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