title: The development of agoraphobia is associated with the symptoms and location of a patient's first panic attack.
abstract: BACKGROUND
  The place where a patient experiences his/her first panic attack (FPA) may be related to their agoraphobia later in life. However, no investigations have been done into the clinical features according to the place where the FPA was experienced. In particular, there is an absence of detailed research examining patients who experienced their FPA at home. In this study, patients were classified by the location of their FPA and the differences in their clinical features were explored (e.g., symptoms of FPA, frequency of agoraphobia, and severity of FPA).
  
  
  METHODS
  The subjects comprised 830 panic disorder patients who were classified into 5 groups based on the place of their FPA (home, school/office, driving a car, in a public transportation vehicle, outside of home), The clinical features of these patients were investigated. Additionally, for panic disorder patients with agoraphobia at their initial clinic visit, the clinical features of patients who experienced their FPA at home were compared to those who experienced their attack elsewhere.
  
  
  RESULTS
  In comparison of the FPAs of the 5 groups, significant differences were seen among the 7 descriptors (sex ratio, drinking status, smoking status, severity of the panic attack, depression score, ratio of agoraphobia, and degree of avoidance behavior) and 4 symptoms (sweating, chest pain, feeling dizzy, and fear of dying). The driving and public transportation group patients showed a higher incidence of co-morbid agoraphobia than did the other groups. Additionally, for panic disorder patients with co-morbid agoraphobia, the at-home group had a higher frequency of fear of dying compared to the patients in the outside-of-home group and felt more severe distress elicited by their FPA.
  
  
  CONCLUSIONS
  The results of this study suggest that the clinical features of panic disorder patients vary according to the place of their FPA. The at-home group patients experienced "fear of dying" more frequently and felt more distress during their FPA than did the subjects in the other groups. These results indicate that patients experiencing their FPA at home should be treated with a focus on the fear and distress elicited by the attack.
authors.affiliation: Department of Psychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Mie, Japan. haranaomi13@hotmail.com.
authors.forename: Naomi
authors.initials: N
authors.lastname: Hara
authors.forename: Yukika
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Chika
authors.initials: C
authors.lastname: Yokoyama
authors.forename: Ken
authors.initials: K
authors.lastname: Inoue
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tanii
authors.forename: Motohiro
authors.initials: M
authors.lastname: Okada
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Kaiya
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okazaki