title: Treating medication-resistant panic disorder: predictors and outcome of cognitive-behavior therapy in a Brazilian public hospital.
abstract: BACKGROUND
  In Brazil, treatment of panic disorder is most frequently initiated with pharmacotherapy, but only half of the patients can be expected to be panic free after medication. Studies have suggested that individual or group cognitive-behavior therapy (CBT) is an effective treatment strategy for panic patients who have failed to respond to pharmacotherapy.
  
  
  METHODS
  Thirty-two patients diagnosed with panic disorder with agoraphobia having residual symptoms despite being on an adequate dose of medication were treated with 12 weeks of group CBT. The outcome was evaluated for panic frequency and severity, generalized anxiety, and global severity. Comorbid conditions, a childhood history of anxiety, and defense mechanism styles were assessed as potential predictors of treatment response.
  
  
  RESULTS
  Twenty-nine patients completed the 12-week protocol. Treatment was associated with significant reductions in symptom severity on all outcome measures (p < 0.001). Patients with depression had a poorer outcome of the treatment (p = 0.01) as did patients using more neurotic (p = 0.002) and immature defenses (p = 0.05).
  
  
  CONCLUSIONS
  Consistent with previous reports, we found that CBT was effective for our sample of treatment-resistant patients. Among these patients, depression as well as neurotic defense style was associated with a poorer outcome. The use of CBT in Brazil for treatment-resistant and other panic patients is encouraged.
authors.affiliation: Anxiety Disorder Program, Hospital de Clínicas de Porto Alegre, RS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Elizeth
authors.initials: E
authors.lastname: Heldt
authors.forename: Gisele Gus
authors.initials: GG
authors.lastname: Manfro
authors.forename: Leticia
authors.initials: L
authors.lastname: Kipper
authors.forename: Carolina
authors.initials: C
authors.lastname: Blaya
authors.forename: Sandra
authors.initials: S
authors.lastname: Maltz
authors.forename: Luciano
authors.initials: L
authors.lastname: Isolan
authors.forename: Vânia Naomi
authors.initials: VN
authors.lastname: Hirakata
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D014151:Anti-Anxiety Agents / Q000494:pharmacology; D001938:Brazil; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology; D004351:Drug Resistance; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents