title: Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic.
abstract: OBJECTIVE
  Many patients with panic disorder (PD) experience nocturnal panic attacks. We investigated the differences in demographic variables and symptom characteristics as well as response to treatment among patients with primary day panic (DP), primary nocturnal panic (NP), and the coexistence of DP and NP (DP/NP), and discuss whether NP is a distinct disease category.
  
  
  METHODS
  One hundred one consecutive untreated patients with PD were enrolled and subsequently divided into the NP, DP, and DP/NP groups. The presence of 13 panic attack symptom items as well as scores on the Panic Disorder Severity Scale (PDSS) and the Pittsburgh Sleep Quality Index (PSQI) were compared among the groups. After 3 months of regular treatment, PDSS scores were assessed again to evaluate treatment response.
  
  
  RESULTS
  Nocturnal panic attacks of the participants were mostly reported to occur in the first tertile of nocturnal sleep. The number of males, onset age, and presence of choking sensation were significantly higher, and the PDSS score was significantly lower in the NP group compared with the other groups. The DP/NP group showed the highest PDSS score, and participants in this group were prescribed the highest doses of medication among all groups. Only diagnostic sub-category was significantly associated with treatment response. The total score for PDSS and PSQI correlated significantly only in the NP group.
  
  
  CONCLUSIONS
  DP/NP could be a severe form of PD, while primary NP could be a relatively mild subcategory that may partially share common pathophysiology with adult type night terror.
authors.affiliation: Japan Somnology Center, Neuropsychiatric Research Institute, Shibuya-ku, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Sugiura
authors.forename: Shingo
authors.initials: S
authors.lastname: Nishida
authors.forename: Yoko
authors.initials: Y
authors.lastname: Komada
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Inoue
mesh_terms: D000328:Adult; D017668:Age of Onset; D000402:Airway Obstruction / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D020184:Night Terrors / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D016584:Panic Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D000929:Antidepressive Agents, Tricyclic; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Panic disorder; nocturnal panic; the Panic Disorder Severity Scale (PDSS); the Pittsburgh Sleep Quality Index (PSQI)